Write Medicine

Making the Match: Building Professional Identity after Residency

December 27, 2021 Alexandra Howson PhD Season 2 Episode 21
Write Medicine
Making the Match: Building Professional Identity after Residency
Show Notes Transcript Chapter Markers

Brenda Thompson is my guest on this episode of the podcast. Brenda has a background in counseling and education and is a longtime professional in the graduate medical education space. For the last year or so, Brenda has been working as a resident and fellow liaison, educating residents who are transitioning into practice about topics such as how to negotiate a physician's contract, how to prepare for the interview process, and how to form their professional identity for the community, their patients, and their colleagues. 

Join the conversation to learn from Brenda about:

  • The role of the physician liaison
  • How Brenda and her colleagues teach newly minted physicians to stand out from the crowd, establish networks, create relationships, and negotiate contracts
  • How continuing education can educate established physicians about the business side of medicine
  • The need for health and well-being education for residents and fellows

Accreditation Council for Graduate Medical Education
American Medical Association
NIH Valerian Root & Lemon Balm Tea Study
Graduate Medical Education re[Think] re[Claim] re[Design] re[Create]: Memoir and Call to Action

Brenda: Twitter, Secondary Twitter, LinkedIn, Secondary LinkedIn
Alex: Twitter, LinkedIn, website

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Host: Alexandra Howson PhD
Sound Engineer: Suzen Marie

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physician, residents, specialties, residency, book, community, experiencing, people, happening, negotiate, terms, called, fellows, acgme, work, referral, program, talk, contract, graduate medical education


Alexandra Howson, Brenda Thompson



Alexandra Howson  01:13

Hello, and welcome. This is Write Medicine. And I'm your host, Alex. And today we're here with Brenda Thompson, a longtime professional in the graduate medical education space. Welcome, Brenda. Let's talk a little bit about your background first. And, as always, just learn a little bit from you about how you find your way into graduate medical education.


Brenda Thompson  01:43

So, my background stems from counseling, and then it stems from education. I started to work in secondary education and I found that just wasn't my right audience. So, I was here in Chicago, and I've worked with an employment agency expressing my interest to work for a college and they had a position in the graduate medical education office. And I went for an interview. And that's how it got started. So, I started off working with accreditation, working on accrediting programs, making sure that they were hearing to ACGME requirements. And then with that, I spanned a long career of moonlighting in programs and working with their accommodation consultant and going throughout the country and working with different programs, just helping them to see any deficiencies that might be in their program, that they might not be, you know, privy to, because sometimes you can be an expert at running certain aspects of the program. Everybody has their own expertise. So that would be my main focus. And then for the last year, I've been working as what I'd like to call a resident and fellow liaison. And I'm working with educating the residents on transitioning into practice topics such as how to negotiate a physician's contract, because they're often not taught that and residency, also how to work with interviewing the whole process, going over interviewing questions, kind of like a mock interview session, and really just educating them on how to form their professional identity. Their professional identity for the community, for their patients, for their colleagues, how to build those referrals and market, the practice, etc. So, my background is diverse, but it really focuses on educating with the residents and the fellows to become more successful in residency but meet their goals, post residency.


Alexandra Howson  03:36

Is that focus on professional identity, something is a new focus for residents and fellows? Or is that something that they've really always had to be kind of conscious about, but there hasn't really been a formal for way of introducing them to those topics?


Brenda Thompson  04:01

Yes, I feel like there has always been an inkling that they needed to be aware of how the reputation was being preceded within their own program, and also how they were attracting patients. So, I can tell you from my experience, we hadn't had much didactics in teaching residents and fellows about how to form your own professional identity, what that means to you as a clinician, and how to market yourself and people aren't necessarily experts in selling their services. So, we have to teach them how to do that. And I really feel like maybe in the last three years, that has really been an initiative within the GMB community, and that's when I got started actually ramping it up. And that's when I talked about it in my book, really kind of introduce it. And I've done two didactics on that with residency programs, but I've actually been busier with CME for established physicians giving a CME lecture on that, that's what has been keeping me busy. So, I feel that we have maybe missed out on that opportunity for so many years. So, they become physicians, and they're a little bit lost. And so now they need to have that knowledge when they are a physician.


Alexandra Howson  05:20

What kind of activity do you see in professional societies that kind of try to fill that space around professional identity and reputation.


Brenda Thompson  05:31

So, we find they're doing is they're bringing on what's called a physician liaison. There might be other terms such as a marketing director, but this person will usually go to the physician and say, you know what, we need to work on networking, to you know, provide our physician referrals. And so, we need to help them build up their space in terms of social media, in terms of building a list. So, what I see that we're doing in the community is attracting what's called the physician liaison partnership. And that is an expert who is going to help market a physician, to other physicians, in terms of physician referrals. So, that's how we're kind of forming our professional identity to our colleagues in medicine. And we're also going to help them market their practice and market their service. So, we're going to help teach them all about social media, and about search engine optimization, because we want to make sure that that physician is attracting the correct authentic patients, so they can build a referral. It's all about attracting authentic referrals, and not just casting a wide net with referrals. So, we will literally go and take them to different places, whether it is going to be a professional association, whether it is going to be meetings with other physicians and say, “Hi, this is who I am, these are my services. Can I start a partnership with you?” And that's the biggest thing that I think is happening right now in terms of what associations and what the community is doing to help those physicians or those residents build or start building a professional identity. And I can't stress it enough about networking, that professional identity within healthcare, especially if you're primary, and especially if you're one of those specialties that are going to have a heavy referral, maybe some specialties are more so that don't need it, such as dermatology. But if you're going to be a graduating resident, and you don't have necessarily a strong patient base that you had built already within residency, you don't want to be a fish in a big sea. So, they're going to get you with a physician liaison and help to market you.


Alexandra Howson  08:16

That's fascinating. I, you know, some of the work that I do, I talked to a lot of physicians. And you know, one of the things of course, and often in the programs that I talked to physicians about, you know, specialists, feral is part of what we're kind of interested in exploring. And I hear again and again, about the challenges that primary care providers and specialists have in establishing that referral process and the amount of work it takes to actually create a network and also the kind of defeatism that I sometimes hear from physicians about what you know, it just takes such a lot of work. And so, they're kind of crossing their fingers, hoping for that referral. That's interesting. So, yeah, go ahead.


Brenda Thompson  09:13

Just think in terms of investment to really invest in your profession, you're never necessarily taught how to sell your services and how to sell yourself as a physician. So, I would recommend any resident or fellow to invest in your practice. By investing in a professional who can do 90% of the work for you, you will have to be an active participant. Again, you'll might have to go to those associations, or you know, have some meet and greets, maybe pay for, you know, a primary care physicians' lunch, you know, have a lunch date and say, Hi, this is who I am. These are the services I provide; can I take you out to lunch to introduce myself to see if we have a good relationship, but that's an investment and I highly recommend doing that. Because if you have the time to do that, great, but you probably don't. So why not get an expert to do that for you. And to help you understand what all that entails.


Alexandra Howson  10:12

Establishing relationships is absolutely key, of course, as it is for anybody who's essentially running their own business; establishing those relationships, creating those networks. Right, it seems like that's one of the things that has really shifted in medicine. Right? Right. It is, do you think? Yeah, do you see that it's something that's kind of changing in terms of the tone set for medical graduates?


Brenda Thompson  10:46

So, what I see is changing is we're kind of moving away from the sole proprietor, at a time when physicians did not have to be linked up with another conglomerate. And so they were their own business and they had to market their own selves. However, now we're seeing the shift where you're going to be working within a large conglomerate. And what's happening is that physicians are relying on that employer. So, let's just say for example, Kaiser is huge nationwide. So, if you're going to rely on Kaiser to do the marketing, they're going to market for all of their physicians, and they might include you with the physician within all of their physicians. So, they might say, “Hey, we have so and so as a primary care physician” and you're going to be listed with all the other primary care physicians. So, what you need is your own website, you cannot rely on just your employer's website, you have to do independent marketing. So, get your own website so you can start building that email list. So you can start making daily or maybe daily, but so you can start having consistent communication through maybe an email campaign for Western patients. So, you can have an authentic relationship with them. Because Kaiser, for example, is not going to build your specific referral base, they're not going to help you with that email campaign, you really need to do that on your own. And then you need to have a website for you, your practice, your services. And there's much more to it, don't just have a website and list the page. On the internet, you need a page for every specialty you do. So, if you are plastic surgeon, you would want for every service that you do - if you provide rhinoplasty, if you provide facelifts, if you provide breast augmentation, each of those services needs its own dedicated page with its own dedicated search engine optimization, which is basically tag codes for the website. So, when a person says, or when they type on Google, breast surgeon in Chicago, or breast surgeon near me, you're going to have hundreds of pages. So, you have to make sure that SEO, the search engine optimization, is tagged to you somehow. But you're not - as a physician, you're not an expert in marketing, you're not an expert in all of this SEO optimization. So, why waste your time to try and study and learn that? Hire a professional to do that for you. And to also help educate you on that process. So now, I find it's all about not getting lost within your employer. It's about standing out from your other colleagues, because you are in competition with those colleagues. So even though you all might work for the same department within Kaiser, you know that physicians are in competition to one another. So, you've got to earn a living, and the only way you're going to do so is if you get noticed by the community. And so you have to have that entrepreneurial spirit, and really go and market for yourself and not just leave it to your employer. So, that's the big thing that I'm seeing that has recently changed. And I will say it's been changed probably in the last five years or so then social media got really popular, you know, Instagram, everyone's making videos, everyone's going on to YouTube and providing their videos. And that's what patients want to see they want to see - before and after. They really want to see a physician who was active, so they are looking for someone that is standing out on their own. And if you don't do that, you're gonna get lost, you're gonna be inefficient.


Alexandra Howson  14:34

And there's some specialties where this is more important than in others. Or I guess another way of asking that question is are you seeing this entrepreneurial drive in some specialties compared with others? 


Brenda Thompson  14:49

Of course, you can go on to social media for Instagram, even for Twitter, and you've got posts even on LinkedIn, you've got people posting their before and afters especially in dermatology and stuff. But what is difficult, and I think who needs to do it a lot better are other departments such as, you know, radiology. Nobody wants to be bombarded with a bunch of anything that has to relate to, you know, cancer or any more of a serious illness. It's more about the vanity. But you know, how are you going to become a successful physician if you're not marketing, so you have to be more tasteful in the way that you advertise. But you can still provide some before and afters. You can still provide other type of educational informational videos, or just pictures or post, even newsletters or any type of educational content. So it doesn't have to be all about any type of apology, or any type of you know, things that people may not want to see because it's graphic, or just pleasing to the eye. But it's not all about vanity. So, it really needs to, to stand out and to reach the audience. So, you have to really tag it to the specific location. But yes, it's really important for all of the specialties to do so. Especially the newest doctors that are graduating, because they really have to work hard to build up that social media presence in it. That's what everyone's doing these patients today, they are going on to the internet. So, it's not like what we've seen in the past, where they're waiting for a referral based on a family member, or a friend who might have worked with you with a physician. It's all now on social media.


Alexandra Howson  16:43

So, entrepreneurship, establishing networks, creating relationships, these are all things that residents and fellows face when they're transitioning into practice. What are some of the other challenges that you see residents and fellows facing in that transition period.


Brenda Thompson  17:02

So when you go into residency, you get a contract, but you don't negotiate it, the contract is absolute, and there is no room for negotiation. And unfortunately, the biggest mistake that graduating residents and fellows are making is that they assume you can't negotiate a physician's contract. That is not true, you can absolutely negotiate and you can negotiate anything that's in that contract, but they don't know what to negotiate. So they might take that contract as is, and sign away on it. They don't know what their non-compete statuses, they don't know how many miles that they can't work for a competitor. They don't know how many years they can't even work afterwards, you know, if they need the job, they don't know, the notice period, they don't know terms and conditions that could possibly get them fired. There's so much that they are unaware of that, unfortunately, hurts them. You can negotiate compensation, you can negotiate terms, you can negotiate anything that's going to help make you successful. So, for example, you know, parking in certain cities is expensive, here in Chicago, right $100 a month at a parking lot. So, you know, especially if you're on call if you're one of the specialties that will take nighttime you don't want to drive in Chicago at night and park somewhere in a garage in Chicago, you really don't. And of course, I don't think I need to explain how dangerous Chicago is. So, you have to make sure that you're going to have safety at your work. And can you get a parking spot? Can you get it close to where your specific office is all of that can be negotiated. For example, in San Francisco, it is extremely hard to find parking and it is extremely expensive. A lot of hospitals don't even have her again. You can negotiate something, you know, stipend for you Uber, for example, that might only be for on call experiences. But you can negotiate many, many things that you're not privy to when you go into residency. So, I just feel that the best educated consumer is going to be armed with the knowledge and transparency to make the best decision for their career. I think it's a mistake in the GME community to not be teaching residents, hey, this is the physician contract. This is what it all means. And this is what is typically negotiated. And this is what is typically negotiated for this specific area. And of course, if you move out of the location where you did a residency or fellowship, you'd have to find what is market rate trends for that local area that you're going to be working in. So, I always recommend to any resident or physician work with a contract physician, wherever you're looking to work at because they are going to be armed with the hiring trends. And they know what is typically negotiated and they can negotiate who correctly to get you the best and fair and most just contract for you. 


Alexandra Howson  20:10

So other noises? So where do your residents or fellows find contract physicians?


Brenda Thompson  20:16

Yeah. So, it is actually a very popular discipline in in law. So, what they would have to do is Google physician contract in Dallas or physician contract in Chicago or wherever they may be interested in looking at. If they have referrals from other mentors, for example, I always recommend like if you know, you want to stay in a place and you've got a mentor, ask them who they've worked with, because obviously, it was successful for them because they took the position. So as your mentors, hey, do you have a name of a lawyer who works with physician contracts that I can contact? If not, then Google, they do have set rates, of course, their lawyer, but they also have bulk packages. So, they know that you're going to be negotiating possibly at a couple of hospitals. So, you can either do per hospital, which is usually about $300. Or usually, they have a package of three negotiations. And that's usually about 900 to $1,000. So that it isn't a cost. But again, it is an investment for you and your future.


Alexandra Howson  21:18

And so, I'm kind of surprised that GME programs are not providing, or maybe I'm not, maybe I'm misunderstanding you. Are you saying that graduate medical education doesn't really provide the kind of information that graduates need in order to make these sorts of decisions, they're kind of leaving a little bit ill equipped.


Brenda Thompson  21:46

Absolutely, it's not a requirement. So, you've got to also understand that ACGME does require certain things, certain scholarly activity, for example, they require some wellness education. But this isn't anything that they require. So, programs are going to fill their didactics with the necessaries that they need for clinicians. However, it is somewhat gaining momentum. And there might be some programs that are even using their own in-house recruiters to come in to an adaptive chat session and teach them these things such as contract negotiation, or, you know, securing employment, and how that works. The whole recruitment process when you're going for your full physician position. But other than that, like I worked for a hospital, and I've worked in the physician recruiting department, but it was a hybrid position between that department in the GME office. And the whole goal was for me to contact programs, go to them and teach them all about contracts, and teach them all about the interview process. Because it did two things it showed these residents and fellows all about the company, and the name. So, it's like name branding. So, they can say, oh, you know what this person, obviously, these, this hospital, obviously cares about us getting a fair and just writing situation. So maybe we should be looking at opportunities with them. But then it also does another thing too, where you know, a lot of contracts, they do have a notice period, which basically means that any party to determine if it's not a right fit, that they can leave, they just have to give the notice in the notice period, which is usually 90 days. So, they're going and signing a contract determining that you know what I don't like this, or I don't feel like I got a fair contract, they get angry about the contract that they received, because they hear about their friends getting better contracts, because their friends knew to negotiate. And so, then they break the contract, they give the notice period that's required, they break the contract, and they go somewhere else, that hurts the hospital that hurts the community. It's not financially smart for any employer, to not have a well-educated physician going in to their practice. It hurts the community when they leave, you know, hospitals, clinics, they make an investment to that physician that's coming on board that money in that time that they had spent for that physician only to leave 90 days later. So, there are some hospitals and clinics that are trying to get more education out there. Because we kind of have to do things differently to make sure we're not being left. The community's not being left without a physician.


Alexandra Howson 24:29

Right. So interesting. So, you did mention wellness and our requirement to have wellness education, what kind of education around health and well-being our residents and fellows exposed to in their in their training.


Brenda Thompson  24:47

So ACGME requires fatigue mitigation and strategic napping. That's it. And for me to have a counseling background, I'm just floored that that's it. The problem really stems from, they're coming in from medical school already being traumatized, they're already being a victim of some form of harassment. And now they're coming in already traumatized. And then they go through residency and to keep getting beat down, so to speak. And now we've got a real serious problem on our hand, because we've got some physicians that aren't doing so well, but they're faking it until they make it so to speak. So, I don't think necessarily fatigue and strategic napping, are the only types of education in terms of loan wellness and well-being that should be taught during didactics. Or taught at any time during residency, I think we need more robust curriculum with that, in my book, I have a chapter all about it. Because I really believe that we need to start teaching skills, giving residents and hopefully even medical students really the tools on how to release all of the burdens that they are experiencing. And in the book, I do have a lot of statistics about the abuse, that that's happening in the learning environment such as drug abuse, alcohol abuse, but even harassment, physical abuse, sexual harassment, abuse, and the numbers are really high, the number is scary high 50% of females in medical school, have experienced a form of sexual harassment during their time in medical school. And so now they're coming in to residency, nobody's taught them, this is what you do if you've been sexually harassed. Nobody's taught them those skills. And then nobody's taught them how to go through mitigation, conflict resolution. So, they sit there and they're quiet, and I take it all in. Because there's number one, they're probably scared, they don't feel that they have any sort of power or safety, to make aware that they have been mistreated. And then that does something to you internally, emotionally, spiritually, and then, of course, physically. So, we have to help them gain better strength in terms of that whole aspect. What do you do when you've been harassed? What do you do when injustice has been done to you, we don't want them to internalize it, because that's just going to be a pattern for them. And then they're going to burn out even faster, and then we're going to lose positions in the workforce, because we're going to leave. So, in the end, there is a, there is a drain, right? For sure. So, the book, I have a lot of information about different techniques and different restorations that they can utilize, everyone's going to have their own best practice that works for them. But my goal in that book in the chapter is for residents and fellows to understand that they need some form of relief and emotional release, a spiritual release, a mental release to unreleased all of the burdens that are happening with their residency, and you know, at home as well, because you're going to have burdens with personal responsibilities. So, what works best for you, maybe you don't know yet, because you've never been given the opportunity to explore different means. So, I have a couple of different examples. I talked about body somatic therapy, which I think has worked really well with physicians. It's a type of therapy in terms of physical touch. There are some that don't involve physical touch, but are still a physical form of therapy. There's eye movement therapy. So, they're EMDR. Yeah, so therefore, you're not being touched with the facilitator is going to form therapeutic services based on your eye movements. And I know, that's a question I get a lot from physicians are like, oh, you know, like, if it's not a massage, I don't want to be taught and I'm like, no, no, it's okay. There's some that where you really don't have to be touched. But then there's also some other forms like, okay, if that's not something that you're comfortable with, there's a creative outlet. And I really stress highly, that individuals look into that because if you're not comfortable with a typical, alright, again, therapy like right, typical psychoanalysis, that's okay, maybe you don't feel comfortable expressing what you have been through, but you can still get it out. There are other forms such as we know, art therapy has become really popular. There's dance movement, movement therapy that has become really popular. I have an example of what's called sandbox therapy. These are our therapies in which you don't even have to discuss but your symbolic images and just the ball of movements have a meaning. And the facilitator who is working with you will know what those meanings are and so you'll be able to work through the process. And then they'll come up with a so-called treatment plan for you. And what I always recommend is get started with knowing how would you best handle a crisis. And when I talked to residents about that, they said, I have no idea how and I don't even know how to.


Alexandra Howson  30:16

 I was just thinking that a lot of people won't know that.


Brenda Thompson  30:20

They won't know how that and I said, okay, so what did you do in high school when you were, you know, sad, what do you do when you were mad? And I'm surprised at how many people say I just listened to music. And then I was able to cry, I need to cry. And I say, okay, that's great, because there's something that's called binaural beats. So, if you're a type of person that has a cathartic release through music, perfect, there is a therapy out there for you. And it's called binaural beats music. And I'll discuss in my book as well. So, there is something for everyone, you just have to be aware of what it is. So, one of the other topics I talk about when I do education to residents, and physicians is these different examples of what is out there in terms of producing a cathartic release. So, you can unreleased, those buried pent up emotions. And so again, I talked about whether it's creative art therapies or somatic therapies, music therapy, they just have to be given the information, this is all new to them. It's more of holistic approach. I even have in there about you know, because I've had a lot of residents that have taken an Ambien, and then you know, they come to work, and they're all drowsy, but they really didn't have a choice, they wouldn't have been able to get to sleep. Well, the NIH has done a study saying that lemon balm tea, mix with valerian root tea, is stronger at producing sleep than an Ambien. And they're all interesting, a lot of people don't know that information. So, I have that also in the book, but I have more of non-traditional remedies, solutions. It's practices for physicians, I don't recommend medicine, I don't recommend any of that, because I can't I'm not a doctor. And my background is in counseling my background happens to be in a form of transpersonal psychology. So, I studied different religions and cultures. And it took on more of an East West approach. And now I go to different residences, and I educate them on those approaches. But I just think the emotions that are buried and pent up is what is causing these breakdowns. And I know in healthcare, we like to call it fatigue, I like to call it a breakdown because that is in fact, what it is when you get burnt out, it's because you broke. So, I don't like the whole resistance teaching because if you stretch something, it's going to break. So, we can't keep building their tolerance, we have to help them release have a cathartic release of what they need to be, you know, what needs to be expelled from their emotions or their memory, etc. and help them create healthy patterns. So, when they do get into a situation, such as you know, especially residency when they're hushed a lot, I talk about depersonalization. My definition of fatigue, is going through a depersonalization moment of depersonalization experience in residency, you are hushed a lot, you don't have a voice. And that is really, I think that's really just a disservice to our residents. And we don't want them recycling these bad habits. Because once they become on the floor, and they start working with medical students, and then they start working with residents. That's what they're gonna model. And then that's the whole recycling pattern happening, happening all over again.


Alexandra Howson  33:49

So, whenever I know I have so many questions right now, there's, there's so much good stuff there. And I do want to talk a little bit more about your book, but before we get there, so you've been talking about therapies that can be, you know, recommended for residents in terms of, you know, self-managing, and self-managing their own health and well-being are. Is there much research on outcomes for residents, fellows, junior doctors, using these therapies for health and well-being?


Brenda Thompson  34:33

Yes, and I have listed those studies, not all of them, of course, but I have listed studies. One thing that I always make note of whether it's in the book or when I do my education presentations, I know doctors are scientific, and I know the rest of the evidence. So, I have on there, the actual research studies. So, if they're interested in it further, they can go and look up the reference so I always list the reference always was the study, it's that further knowledge and if they're interested, hopefully they are and they look into it further, because I really want them to understand that I know for them, they need to have everything proven by sight. But you know, we can't see what's happening with our emotions. And so, it's hard for some people to believe that a Eastern West approach can be just as effective as a more traditional Western approach. So again, I'm not a doctor, I don't talk about prescriptions. In my book, I talk about nontraditional means, but I do give the evidence base there to prove that it does work just as well just like the whole Ambien I have the NIH study, in my book, they can reference it, if they're interested in it they can reference it if they just want to make sure that it is correct. But yes, I mean, there is higher, and better things to do in terms of getting the mental, and the physical, and the emotional, and the spiritual help that you need, then just medicine.


Alexandra Howson  36:14

Right. And, you know, part of the part of the evidence base for some of these modalities is also experiential. You know, but we discount that in the West, or in, in in western approaches to kind of knowledge creation and knowledge building. You talked about burnout. And of course, some of the words that we use in this space burnout, fatigue breakdown, you're really kind of emphasizing that how in sync our organizations like so I know, the American Medical Association, for instance, is doing a lot of work at the moment and has been doing a lot of work around burnout and resilience. In particular, over the last few years, they have a couple of initiatives. How in sync is the AMA with the ACGME, and other graduate medical education organizations.


Brenda Thompson  37:07

They're all in sync, because in my experience, from what I have seen that I'll actually work together, so when they move forward with such an initiative, they're all on the same page, because they've all worked together. So, when they moved forward with when ACGME move forward with this wellness initiative couple years ago. They communicate that with the other important association, right, there is no competition there, you know what I mean? AMA is not going to come out and say use our curriculum instead. They're all working cohesively together.


Alexandra Howson  37:41

Now, it's interesting. And the other thing I wanted to ask the question about was you talked about resilience training and focusing on resilience? Can you talk a little bit about that, because I'm not sure I know what that is, or where it fits in the graduate curriculum.


Brenda Thompson  37:56

And, you know, I don't necessarily agree with the resilience training, I know that it is necessary, because you do have to build up your tolerance for certain things. However, there's a point when you also have to learn how to expel what is going on in your mind, your body, your emotions, your spirit, etc. So yes, it does make sense in certain specialties. Of course, now, if you're working in ER, you're going to have to build up your tolerance to what you're seeing in ER, you're going to have to build up your tolerance to the fast-paced energy to the horrific scenes that you might be experiencing. And I understand that, but the thing is, is that we're teaching that relying on that, and I don't think we can just rely on building our tolerance up, because at some point, the body is going to not be able to handle it. And we know that because that is fatigue, when you start having fatigue, that means your body is telling you I can't go anymore, can't handle it. Your mind through mental capacity saying I've had enough. Now, you're fatigued because I'm trying to get you to slow down and stop. So, I don't like just the focus on resistance, resilience training. And I feel like that is the only type of education we're putting out there in terms of trying to better your well-being. Oh, so go ahead. So that's why I really focused a lot on this book, as I've had a lot of people read this book before it was published. And they said, well, this book is really it's like a background of psychology and education. I'm like, great, because that's what I wanted it to be. I wanted it to really be about working with their wellness in terms of helping them achieve wellness, through having a healthy mindset, spiritual set, emotional set. How do you do that? Well, that means you've got to do the work. Just building tolerance is not doing the work. You have to sell. And that's why I give several different muscle modalities. So whatever works best for you, whatever you may be interested in, maybe you're interested in in writing. And that is actually one of my other backgrounds. Because when I focused on transpersonal studies, I did a concentration in therapeutic creative writing. So maybe for some individuals who do need to get it out, they need to talk it out. But they don't feel comfortable, because you've got to remember in health care, physicians are terrified of going through a Ph. P, a physician health program, I talked about that in my book. And I actually, that is a precursor to chapter five, because we don't ever want a physician to have to go to a PHP program. And I talked about in the book, how they can lose their license, I talked about how in the book, a PHP program, if you don't agree, the physician either agree with the assessment, you don't have a say in it. And if you don't agree with it, and you refuse to follow through the treatment, you maybe want a second opinion, etc, they have the power to take away your license, essentially, they have the power, take away your license, because they will not release you back to work. So, we have to work really diligently to make sure that our physicians never have to go to a PHP program. And if they're too terrified to do that, do so because PHP programs have a negative connotation that we have to teach them different practices, to help them get active in releasing everything that has been burning them out. So


Alexandra Howson  41:40

Right, right, you so I think I misheard earlier when you were talking about resilience training you You mean, resilience training? Right? Is that correct? Yes, yes. I just wanted to clarify that because I think we talked about resistance a couple of times that we both meant resilience training. So, I just wanted to clarify that for listeners. But the word resistance is still in my head, because I'm wondering what resistance Do you see from residents and fellows to this work, because you know, one of the things that we know about physicians is that there is a reluctance to talk about mental health and well-being, there is a reluctance to talk about the impact of, of mental and physical fatigue on the body, there is a reluctance to talk about and to process in a very explicit way, what it is that you're seeing day in day out in the ER, and, you know, and I think we've that, you know, the general public has become much more aware of that in some of the personal testimonies that physicians have given and other clinicians during, you know, the pandemic, or pandemic history, where people are seeing incredibly traumatic, you know, scenes and experiences of death and dying, that go beyond what they are normally exposed to, in, in, in the ER, and we know that, you know, lots of people are, are from other parts of a hospital, are working with COVID patients and being exposed to things that they wouldn't necessarily expect to see. So very long winded context there. But how much resistance or reluctance Do you see in the people that you work with, to considering some of these modalities?


Brenda Thompson  43:34

I would say it's 100%. And I do talk about that in the book as well, because again, as I, as we were just talking about the physician health program, it is such a fear for a physician to be referred to that. So, if you can imagine if you're experiencing some mental fatigue, and you're going to your administrator, your CMO, whoever you may be going to as a physician and saying, I need a break, I really do need, I need a break. That is enough evidence to put them through a PHP (partial hospitalization program) program. So that is terrifying. They don't want to talk about it because of if you look into PHP programs, and again, I have it in my book, it is not something I personally would ever recommend a physician to go through. And that's why they're scared to talk about their mental health. Because if you can get told you've got to go through a PHP and you can't practice anymore until you've been signed off by PHP program. Well, PHP programs are often never paid for by insurance companies or by the employer, and they can house up to $100,000. You can do a 90-day program and pay $100,000. Can you afford a $100,000? Bill? Probably not. So that's another added stress. Yeah, there may be some physicians that make really good money, but that's absurd. And then like I talked about before, they have the threat of their latency and taking away forever. So there goes their entire career. That is terrifying. So, I had this conversation, me having a counseling background, when I first learned about PHP that was actually working in surgery. And I was working for a really busy trauma hospital. And one of my chief residents came in and you know, they were burnt out, of course, they were just talking about, you know, experiencing some things in the 10 rooms. So, if you've ever had the experience of working in a hospital that's got a t 10. Room, oh, my goodness, you can only imagine what that patient is, has had happened to them, you've got every specialty in there trying to save this person, for example. So, I had heard about my residents saying, you know, one of the attendings had just really had it. I mean, he was like, experiencing burnout, and just having an emotional wreck, we had a physician already take his life very recently. And it really just affected a lot of the surgeons, of course, but one in particular, who was like, I'm breaking, I am breaking, and he was too afraid to say something to who the supervisor would have been for him that director because he didn't want to be put through a PHP program. And I'm like, what do you mean, I'm like, that's great, you've got a dedicated treatment plan for you with experts and counseling, you know, I have a counseling background, it's going to be helpful. And then I got educated on the PHP in why physicians are so afraid of it. And I haven't looked more into it, because I don't want to recommend my residents to go do something that could actually jeopardize them. So, what are you to do as a physician, you want to get the help, but you're so terrified about what can be done to you, you can be placed into, you know, a non-voluntarily go into a PHP program. So, I really do try on the other side, so to speak, whenever a physician comes and talks to me, I say, pay out of pocket and go to a counselor. That's what you should do, that's the safest thing for you to do. If you've really got a fear of having to go through a PHP program, then don't tell your supervisor that you are experiencing certain elements, go talk to a mental health professional, if it is something to where you don't feel that you can work through it. And you're going to have to have a conversation with your supervisor. But for the for the first part that you can do when healing is going directly to a counselor pay out of pocket, and therefore there's no trace that you went to go see a counselor. So that's the situation in healthcare today that we're working with. We've got lots of physicians that are so afraid that there is an evidence trail that they've seen help for their wealth, health and well-being. Or they're doing things in secret. And I'm part of that. I will tell any physician, any residents to go see a counselor and pay for it out of pocket. So there's no trail. Did it cut off?


Alexandra Howson  48:24

Hey, who you are, can you hear me? Yeah, you froze. And then you went out? So, you were Yeah, you were just wrapping up that thought about investing in your own mental health, paying for a counselor rather than going into PHP.


Brenda Thompson  48:40

Exactly. If you definitely have a fear of what the consequences are telling your supervisor or telling anyone, but please go to a counselor and pay for it out of pocket. Don't just sit quietly and deal with it, because there are going to be professionals that can help you.


Alexandra Howson  48:57

Right? So, you have talked about your book a few times. Can you just kind of give us a brief description of what the book is about and what it's called and where we can find it.


Brenda Thompson  49:09

So the book is called Graduate Medical Education. In short, it's about barriers to success in the GME community. So, through my 10 years, I found the same common themes, no matter where I was in the country, no matter if I was working in the GME office, or if I was working for a specialty. And it didn't matter which specialty it was working for. It seemed there were these common themes. And so, I wanted to break down these themes and talk about different strategies that I felt maybe we could start looking into and exploring and seeing if we can get better outcomes. And it really is all about strengthening the foundation of GME and strengthening the residency learning experience. And of course, the treatment and really working on our transparency so transparency with medical candidates, medical school students getting into residency because that's always a hot topic where they feel like they have no information, they feel that they have been misled. So, we don't ever want any candidates coming into residency off on a negative start. And then we talk throughout residency, and then of course, post residency all about negotiating for physicians' contract and the whole interviewing process and how to market and brand yourself and your services. So, it's kind of wide net in terms of how we can strengthen the community, because in reality, it has to be broken down. Because we have to strengthen our whole dynamic with bringing in our candidates, we have to strengthen the dynamics, first graders, I think it's going to be a shock to people when they read how very little training our own administrators have, even though they are responsible, they're working towards the accreditation. And then of course, we have to talk about just the GME community in general. And that includes ACGME. And that includes match, for example, so, it talks about ways that we can improve, and it also showcases what's been going wrong. So, in terms, for example, there are things that are going wrong in terms of the whole ranking and matching process and how that can be manipulated. There's manipulation within the evaluations for trainees. So, we've got some things that we can improve on. And I'm just using my opinion based on my experiences, on ways that maybe we can strengthen those. So, the book can be found on Amazon, and it's in Kindle version, and it's also the paperback version.


Alexandra Howson  51:46

Other lessons that they're continuing medical education continuing professional development community can draw from the landscape that you cover in your book,


Brenda Thompson  51:59

I think so, I do give a lot of personal stories, I make no mention of names, no mention of institutions, no mention of employers or anybody, because that's not what I'm highlighting. I'm highlighting on what is happening. And so yes, the lessons of what happens when we don't have transparency. And unfortunately, we match with candidates that probably aren't the best for what the community needs. That's a problem. There are lessons and what happens when we do try to manipulate. There are consequences to that. And I give stories about what I have seen happen. And there's consequences to how we treat our residents, and what is happening in terms of their health, but in terms of also what is happening in terms of the leaving the profession, and what's happening to the community because we have mistreated physicians, and now our communities are going to suffer, and they are suffering because we are in dire need of a few specialties right now. Right internal medicine, psychiatry, family medicine and in pediatrics. Were in dire need of those. So, oncology too, of course, yes. And I hope that those stories spurred inspiration for certain members of the communities to kind of go back to the drawing board and say, okay, well, maybe we do need to look at this, we all know that you can manipulate rankings, we all know that you can manipulate, you know who you bring into an interview. So, I talk about that, too, you know, we're really in in a sensitive time right now, because we don't want to discriminate, but yet, we want to attract a diverse population, right? I mean, the community needs diverse physicians. That's only what's fair. But in doing so, you might alienate other parties. And I do talk about those experiences. So, we got to kind of go back to the drawing board, you know, we see pictures during the Eris application, and they said, okay, you know, what we need a black person in our program. Great, I can see in the picture that he's black, or you know, what we need a female in our program outbreak, I know that they are female, I can see the photo. So that's what's happening. And is that the right thing to do? I mean, the community needs the best physician. So, we need diversity, but we also need the right physician for the community's needs. And I focus on that kind of heavily because you can't just meet a quota, you have to meet what your physician's need. And I do put the blame also on match. You know, I remember working with a program that the community needed a specific physician, and they were so afraid of not matching and therefore not getting that physician in the program directors like we need a damn physician in this community. I can't risk not having a physician because of the match rule. He did manipulate, data manipulate because the community needed this type of physician and I don't think there's anything wrong with that the whole thing is in good intentions, however your community needs have to come first. So, if you know, you know, you need to physician, you know, you need to match, you've got to do what you've got to do. Because if the community goes without a physician, especially in specialty physicians, so there are a lot where to recruit for, you can't punish your community, I'm sorry, match. But you can't expect a physician to do that.


Alexandra Howson  55:31

And people can read about that in your book, where can listeners find you?


Brenda Thompson  55:36

They can find me on LinkedIn. If they just had been Brenda Thompson, I'm sure there's a lot but for Natasha, Chicago, and then you'll see my tag, it's GME expert. And I'm also on Twitter, which is medical score education. So yeah, that's where they can find me,


Alexandra Howson  55:56

I will make sure to put that information in the show notes so that people can have access to that. Thank you so much for your time. Brenda, I really appreciate you taking time to talk to us on right medicine.


Brenda Thompson  56:10

Thank you. Thank you for having me. I hope your audience learns things from this conversation.

Brenda's background
What is a physician liaison?
Physicians and marketing
The role of graduate medication education in supporting physicians after residency
Supporting physician wellness
What is the evidence for therapies that support physician well-being?
The role of GME in addressing physician fatigue
Partial hospitalization programs
Making the match
Take aways