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Conversations in Pulmonary, Critical Care and Sleep Medicine by the American Thoracic Society
Speaker: [00:00:00] You are listening to the ATS Breathe Easy Newsworthy Podcast, brought to you by the American Thoracic Society.
Ugo: Welcome back to the A TS Breathe Easy podcast. I am your host, Ugo. We are diving back into our conversation about mid-career in. Medicine and healthcare before our break. Dr. Meyer made a strong point that conversations around financial literacy need to happen earlier in our careers, and so that got me thinking.
If we already know medicine delays certain life milestones and we already know, mid-career brings a wave of financial and personal pressure, then. Why aren't we teaching life literacy alongside the Kreb cycle? Why don't we intentionally build financial education, [00:01:00] negotiation skills, retirement planning, and leadership boundaries into the framework of medical training?
'cause by the time we're. Quote unquote, mid-career. We're no longer just physicians. We are partners, parents, caregivers, leaders, and community figures. So let's explore that. Should financial literacy and life literacy be formal parts of medical education and what would change if they were? Let's dive back in.
Ugo: I often wonder if. Again, going back to the delayed adulthood, uh, theory, if we should incorporate along the framework of medical education, pieces of financial literacy, life literacy that we otherwise would not be, you know, we otherwise would not be exposed to until, you know, we reach this stage. And I, I wonder if that would actually have tremendous benefits for the, um, for medical trainees and medical professionals upfront.[00:02:00]
Josh: That's a great question ugo. Um, it's actually interesting. We, uh, I was part of a, uh, grant application, like a through a TS actually from, uh, a early career faculty member, Justin Inger at Nebraska, who, uh, basically ran a, had developed a curriculum for financial literacy for fellow pulmonary critical care fellows and implemented it a bunch of sites.
You know, one of, some of our fellows, I don't have, I think any of your classmates had went through it, but a couple of them have gone through it. Anyway, it was a really great idea, again, trying to address this exact issue, but you could argue that fellowship's a little bit too late to be starting that really, we should be starting this.
Ugo: It's hard to think about the Kreb cycle and balancing your checkbook at the same time,
Josh: right,
Kristina: right. No. Could it, couldn't I agree more, Josh? What? What you said, and I think, um, in addition to. Kind of the fight, financial literacy, um, and kind of what the day to day and how you should be thinking about, you know, money flow and, and savings, et cetera.
I think something to also talk about a little bit earlier is. [00:03:00] Um, as you enter, uh, mid-career, you know, this is a time where people are being asked to step into to leadership roles. So professional expectations expect, um, escalate, but often leadership roles, um, I don't know about you Josh, but leadership roles don't always come with extra money.
Uh, right. It might come with recognition, um, you know, specifically like an education heavy or science oriented paths, but it's, you know, you're doing a lot more and not necessarily getting compensated from a financial standpoint. Um, which is okay, and like I, that's part of the nature, uh, of this. So, but I think hearing about that earlier on and, and guiding people with, right, you may be asked to do these roles.
You, you know, your, your income may not change, but here are some strategies that you could do to make this role sustainable for you, right? So for asking for, you know, extra protected time, um, or asking. Um, for, uh, for, for those that may need like leadership roles within the science, science, basic science realm.
Like, are they gonna be getting support and coordinators in lab space, um, et cetera, whereas [00:04:00] those in the education, um, our clinical realm, maybe maybe having different needs. Um, but I think having those conversations a little bit earlier as well, I think could be helpful when people start to think about things.
Josh: Yeah, that's absolutely,
Ugo: and, and it's, it's interesting I think, um. Especially in medicine, we, we, I, I would make the case that we have a higher, um, threshold for tolerating a lot of things, and one of them is doing work that you're not adequately compensated for. We've been doing this since residency and et cetera, et cetera.
Um, so I, I think a lot of our conditioning is very accepting of things that aren't normal outside of medicine.
Ugo: Yeah.
Ugo: Um, so. That also adds to, you know, a, a big, a big topic in, in, in medicine now is about physician burnout and how, what does burnout look like, especially when you're now [00:05:00] juggling perhaps more.
Or higher stakes, uh, things, you know, being assistant program director, um, heading all these committees, et cetera, et cetera. Even being program director or anything else. How, what does burnout look like at this stage? I think burnout at a early career is more feeling overwhelmed with work, um, or not feeling necessarily valued at work.
Does the same apply with mid-career?
Kristina: Such an important topic, and thank you for bringing up this, this question, Hugo. Um, I, I agree with you, right? Early career burnout, I think has a little, it's a more drastic, right? You're either like high, very high, either have highs or you have lows, right? You get the paper accepted or you don't, right?
You get the grant or you don't. Um, and I feel like mid-career. I would say, um, burnout's a little quieter. Um, you know, that less dramatic exhaustion. Um, almost, almost like emotional flattening, I would say. I've been talking to some [00:06:00] colleagues and just kind of reflecting on, on, you know, how I felt at times throughout the last year and, um, it's almost too, I feel like at this stage you can feel competent, be successful on paper if someone was looking at your cv, but you may have like this internal disconnection or misalignment like.
You know, sin, some people may say like, cynicism may come at this stage, you know, loss of creativity, maybe a sign of burnout or almost like just feeling trapped. Um, it's hard to say this or kind of think about it, but like trapped by your own success. Um, so I think it's, I think burnout could look a lot quieter, um, in this stage and all can often go overlooked though.
Um, so I think it's important to think about 'cause, right? I think at mid-career you're. You don't feel senior enough sometimes to feel like empowered, but you're not junior to where you need someone to, you know, always be checking on you or have that kind of feeling of things. So it's a, it's a hard space to be like, kinda like the middle child.
You still need to be [00:07:00] seen and, and you still want people to check on you, but how that looks could be different. Um, but I don't know, Josh, if any of that, um.
Absolutely
Kristina: rings true to you, or you have different thoughts.
Josh: Absolutely. Smoldering is the word I was thinking as you, as you said, that, you know, things just kind of smolder and it's not a dramatic, uh, can't do this anymore quit, or whatever it is.
It's more of a, you know, I I or another term I've thrown around is a death by a thousand cuts. Right. Or, or, you know, it's just, it feels like that, you know? So yeah, definitely and I and you, we've all seen it or experienced it, right? I mean, you guys can think immediately of. Several people that you know are going through it or yourself or um, or yourself at times, et cetera.
Um, you know, there are, it's an area that I've thought a lot about and I've done, uh, a bit of research in and, um, it's, it's a tough area to study. It's a tough area to determine the etiology of. Um, I'm, I'm definitely a believer [00:08:00] in that it's not the amount of work that. Necessarily leads to burnout? I think it really is a mindset.
I think it is the workplace environment, and that is why it's so hard to fix it is we've created these environments that are really not conducive to, you know, uplifting, um, the people working in it. Um, you know, the a TS has a session actually, uh, focused on mid-career and one of the, one of the topics is, uh, specifically focusing around.
Strategies to mitigate burnout and enhance career satisfaction. That's on, I believe it's Tuesday afternoon. Uh, and it should be good. It's a scientific symposium through the, the Professional Development Committee. Um, so I would encourage everyone to check that out. 'cause I think I, well there's some speakers there that I think will be, uh, really hitting on all the topics that we're talking about today.
Um, but you know, it's a culmination of, um. Everything coming together, the, all of what we've already talked about today from life pressures, work pressures, financial pressures at a time where you're not necessarily being [00:09:00] compensated as much for, um, and you can have that smoldering feeling of, you know, I already did this, I already did my early career, hardworking years.
Whereas the, you know, in other professions, you're like, all right, you get like a big promotion in the career area. You become. Executive, uh, board, et cetera, et cetera. But in medicine, we just, the good thing about medicine is it's stable, but it's also, it's stable in that you don't have the, the big highs all the time.
At least not from a, necessarily, from a, sometimes as a career aspect you do, but you know, in general, you're there, you're working, you're helping people, you're teaching people, you're mentoring people, um, whatever your job entails. And, um. That, that smoldering burnout in midcareer is definitely prevalent in terms of how do we fix it?
You know, I haven't, everything we've studied so far has not really helped all, all I I know is that adding things doesn't seem to really be a solution. People have tried, you know, adding different types of [00:10:00] therapy. We did a, a, a common behavioral therapy study. We've, I've seen, as you guys all know, your hospitals have added.
Small gifts or par pizza or whatever have you. And, you know, to the point that it becomes something that, uh, people on social media end up just making fun of. Um, I think it's all well-intentioned. It is just, it's hard to fix the underlying problem. And I, I, you know, we haven't figured that out. Um, it's an area we gotta talk about more and think about more
Ugo: from, from what I've, I've read and, um, the.
Uh, to be honest, I, I read about this because I was trying to do a piece about it, uh, a little piece about it on social media with regards to burnout, because there's a misconception that it is about hard work or the avoidance of hard work, right? Um, but my pitch is that it's, it burnout is what happens when it's not just the hard work, it's that the hard work is already being done.
But it goes unrecognized, [00:11:00] unrewarded and or morally compromising. So I, I've, I've, I've been preaching that we need to stop telling people that they just need to connect their efforts to their goals. Because the problem, at least based on the research that I've done with regards to especially physician burnout, it's not.
Because the solutions that are being pitched are personal solutions, yoga, meditation, you know, things like that. But it, the, the solutions that actually work are more systematic or systemic solutions. The biggest cause of burnout amongst physicians is, um. Essentially administrative burden or clerical burden.
So for every hour you spend with a patient, you spend another hour documenting and, um, you know, trying to make sure the note is adequate for billing, but also make sure it's adequate for a defensive side in case something goes wrong. So there's a lot of clerical and administrative burden that leads to burnout that no one is addressing.
Instead, we're being, you know, we're having, you know. [00:12:00] Um, meditation and all that stuff. Uh, taking more personal accountability as opposed to systematic accountability. Yeah. Um, Dr. You had mentioned feeling stuck or trapped by your success and I, that that is, that really stood out to me. Um, how common is it to feel stuck or trapped by your success and what contributes to that kind of stagnation?
Because I imagine what it is, is, um. You become the kind of a, a specialized person based on your success. I think about it like a basketball player who becomes a three point shooter, but they can do everything else. But because the first 5, 7, 8 years they've made all these threes, people just put them out to the corner and say, Hey, just catch the ball and shoot.
So is that, is that similar? Is that a, is that a, a good analogy for what you're describing?
Kristina: I think so I played basketball, um, in, in high school too, so I love [00:13:00] that analogy, right? It's like sometimes we just, we just wanna lay up. We don't wanna be,
Ugo: yeah.
We
Kristina: don't wanna always be the three point shooter.
Sometimes we want, we want a different, a, a different shot. Um, but I, I think that's a great analogy, right? And, and thinking of things too. And I think, um, talking with a colleague who recently, you know, just got. Um, an RO one, um, which was fantastic for her work. Um, and I would say she's mid-career. Uh, but with that just, it's a lot, a lot more responsibility came, um, with just that one grant that she got.
Um, so it's hard. As I was talking with her, I was just, it's a different perspective. I'm like, oh, like things are great. Like you're getting asked to. You know, speak and like you're getting international recognition now, like this is fantastic. Um, but, you know, taking a step back and being like, wow, this is probably a lot for this person to challenge.
Um, and, you know, do things day to day and keep ba and I think maintaining boundaries, um, is a little bit harder, um, sometimes as people become more successful. So how you are intentional with keeping boundaries. [00:14:00] Um, and I think to, to Josh's point earlier too, I, I still think about, you know. Yes, you may be successful, um, in other people's eyes, um, and your own eyes, but.
What, what is gonna happen in five years? What is gonna happen in 10 years and are, what are your goals and how is that gonna change? I, I think one thing I tried to start, um, asking myself too, because I feel like one of the, one of the questions that I ask applicants now on interview day, instead of the five to 10 year plan, I'll be like, okay, you're at a TS in 10 years and you're gonna be recognized, um, by the a TS organization as an early career faculty member.
Like, what area do you wanna be known in front of your peers about? Like, that could be anything. It could be teaching clinical research. Um, so I think I started asking myself that, you know, wow. Like when in 10, 15 years I'm gonna be at a TS being awarded, uh, you know, so award for. You know, senior faculty member, like, what do I wanna be known for amongst my peers, um, [00:15:00] in pulmonary critical care?
Um, I still don't exactly know quite yet, but, you know, it's, it's a different way to start thinking about things. Um, so sometimes I think we just have to start thinking and reframing things a little bit differently as we go through, um, our career paths.
Josh: No, I mean, it's all, a lot of people in medicine, especially doctors, you, you know, you're going to not only have you invested financially into your.
Career that you are now in and literally tied to by loans, but you know, you don't know how to do much else. You don't know how to, you know, say for retirement, you don't know how to play basketball, you, whatever it is, you know, there's plenty of examples like that, right? I mean, you've, you've done it at your own cost, you know, and, and, and you've gone through some training that, you know, puts gray hair on your head.
You know, um, and I will, and coming back to your point on burnout, you know, I, I, you know, I think a lot of people, if you ask a doctorate, when was your happiest kind of time in your career? A lot of people, I think, think back to residency and or fellowship, [00:16:00] which is probably the hardest time that you've ever worked in your life, you know?
And I, I always make that point when like, well, I want more time off, or I want more. Yeah. You know, et cetera. I want to have more protected time, whatever it is. Well. I don't, I don't think it's that time off. I think working harder is better for burnout when you're in the right environment, when you have a team mentality.
And I think sometimes that is lacking once you become a faculty member. Like, yeah, you have a team, but it's just not the same. Right? You guys know it's not. It's not your co-residents. It's not your co-fellows where you're really in the trenches and every, when you're faculty, you have a team, but you know, everyone's also got their own priorities.
They got life, they got kids, they got parents, they got all the things so. It's, um, I find there's a bit of a less that, that to me, that I think contributes to some of this. It's a, it's not really a solvable problem I don't think yet. Um, but that, to me, that's part of like, kind of what goes into nar. But, um, but yeah, we are kind of trapped in your own success, which most people would say, oh, oh, woe is, [00:17:00] woe is you, you know, but, um, you know, it, it's, everybody's got problems at different areas.
As I tell my son, there's always people, there's always people better, there's always people worse. You just gotta have that perspective and you always got to, um, find where you fit in and not try to deviate too far. Um, I don't know. I don't know that that helps answer the question, but it's, you know, when you're, when you're, how, how, how do people get out of this feeling of, of, uh, being stuck or how do they successfully navigate the challenges of big career?
Is there's always someone in a better and a worse situation. You're no different than anybody next, next to you. And trying to find your way through that pathway as linear or as non-linear as it may be is, is what life is about. You know?
Ugo: And, and that kind of leads me to, um, and we've spoken about this, uh, along the way, and I think that's kind of.
A, a good, interesting thread, uh, uh, um, about this conversation is what are some of the barriers and structural or [00:18:00] cultural or personal that often make career pivots in medicine, especially difficult in mid-career now, Dr. Meyer, you could speak to this, having made a mid-career pivot from being a nurse to, you know, going into, into, um, being a physician.
What, what were some barriers to that decision in, in that case? And if you were to make a similar decision now, what, what would be essentially be hindering you? Dr. Denson kind of hinted at, you know, you're kind of in the, you're kind of in this kind of, um, uh, the inertia of medicine is so strong because once you get into medical school.
The inertia is residency. The next inertia is fellowship. The next inertia is like you kind of have to pay off your loans. Uh, so like there's a, there's always something that pushes you forward, um, that might prevent you from making any meaningful career pivots. What [00:19:00] are some of the structural, cultural or personal, um, barriers that you can identify in your own experience that, that can make these pivots, uh, particularly difficult?
Kristina: I think a lot to unpack, um, with that question. And I think, we'll, we'll face a lot of things. I think reflecting back on my pivot from nursing to medicine, um Right, thanks. At the time that were maybe some barriers where I had, I had a full-time career, um, so leaving a full-time career, um, where I was bringing in half of our income for my wife and I to basically being a student again for.
For some time was, uh, not an easy decision to make, but something I feel grateful that I had her support with. Um, I think other things to think about too. Um, right, you had to, I had to really think about, I mean, I think it pushed me to think about what is it that I want in life, right? I have this career, um, I'm happy at work.
Um, I was a assistant nurse manager at the time when I went from nursing to to medical school and I was like, look, if I stay on this, on this path that I'm [00:20:00] currently on, I think like. This is what I envisioned. My, the lay thing is looking like I was, it was a balance. I had direct patient care, which provided me joy.
I had a leadership position, which also provided me joy. So kind of giving that up and kind of going into an unknown, um, I think was hard. Like, am I gonna be success successful in medicine? Like, what does, what is that gonna look like for me? Um, but I, it really, that thought process really solidified the decision for me, um, to do it.
And. It really made the, made me who I am to be today. So if I had the opportunity to do it again, I would've 100% do it for me. 'cause it was, um, personally the right to. For me, um, and, and my family as, but as you said, barriers, I mean, there were a lot of sacrifices, um, along the way. Um, I had to work full time and go to, uh, I had to work nights and then go to school during the day to finish my prereqs to go to med school.
Um, that took a little bit longer. Um, you know, leaving kind of my, my family, um, in Texas and moving, um, away was also very hard to do. But, uh, definitely a [00:21:00] sacrifice that I thought would, would be helpful for my training. But how do I. Think of that situation and then apply it more to a situation now, you know, people po potentially wanting to pivot in in mid career.
Not that it's unheard of, but I think that this does happen. Um, you know, pretty frequently where people may have started out with a pri primarily research career and then wanna pivot to more, uh, clinical career or even more of an education type career. Um, and I think the other way around, I think we, we see that in different things as people get experiences in, um, different opportunities come about.
Um, I think it all comes down to you having to personally reflect. You know, what is gonna make you happy? What's gonna bring you joy? Um, I hope everyone has some type of joy when they go to work. Um, but that looks, that could look different for, for different people. Um, so thinking about that I think is really important.
Josh: I've always done myself, 'cause I tend to, I actually tend to set the bar pretty low. You know, whether it was been when I was taking the MCAT or my [00:22:00] boards or grades or residency or fellowship, you know, I, you know, I was always. I do this as an ICU doctor too, is I tend to prepare families for worst case scenario, I prepare myself for worst case scenario or, or my fellows or my son, whoever it is.
I tend to, you know what, like even if you fail this test miserably, or even if you don't match, or let's say you don't make this baseball team, which he's trying out for today, you know, things, whatever it is, like it's gonna be okay, you know? Uh, the lows are. Are never so low that it's the end of the world.
They also should never be so high that you're on top of the world and life. You know, I, I minded in philosophy in college, I don't know if I actually learned anything other than how to think a little bit. And everything in life is about moderation. Right? And finding where you fit in that is okay. Either way.
Ugo: Thank you. I, no, that was, that was well said. Uh, both of you, I wanted to talk about a TS and how. ATS [00:23:00] is supporting mid careers. What toolkits, roadmaps, things like things of that nature that are available for physicians in their mid careers.
Josh: Glad you asked that, Hugo. 'cause I wanted to mention one or one other thing is we have a roadmap.
It's geared towards mid careers. We always have had an early career mode roadmap as part of the, the old mid committee that I was on before, I don't know what it, know, what it's called even anymore. And the, we used to create an early career roadmap, which kind of guided new people to a TS We're, we're the best talks that are relevant to your career.
Where are the best events to go to? So we're, we're gearing one up for the mid-career. We did one last year and it's kind of a newer area, but as, as we talked about today, it's hard to really define that. You'll see this year we have new things. We have the storytelling series, which are Sunday, Monday, Tuesday at 4:00 PM Uh, in the networking supercenter, it's open.
We often, uh, often have an open bar available. It's supposed to be casual. I encourage you to attend that. We have the, [00:24:00] uh, the PDC has the scientific symposium, uh, breathing new Life into your career, and thriving through transitions, which I mean has great speakers. Um, from all walks of ats. Um, so I'd encourage that.
And then the, uh, toolkit and the roadmap, which will be coming out and on the website soon at least, are the things that I know, uh, from a mid-career standpoint and a TS is trying to really support. So feel free to, you can email me or, uh, look on the website to give more information about that.
Ugo: So these are the things that will be available at a TS 2026.
Kristina: Yeah, those are fantastic things. And I think a TS as an organization is so, so wonderful. Right? 'cause it provides community. Um, and I feel like every member feel seen in whatever way, wherever they are along the career. Uh, I know we were all talk, Josh was saying too, like, he probably joined when he was a resident.
I remember joining as a resident too. And like they have, we've been retained, um, for, for the last few years because of, because of the, the opportunities that are there. Um, [00:25:00] so yeah, I'm looking forward to, uh, definitely those, um, mid-career opportunities that Josh mentioned. I think a couple other things that I particularly like every year, um, really being involved in your assemblies.
I think that there's a lot of opportunities, um, for faculty of all stages within your own assembly. Um, and I'm a big fan of the Women in Diversity Forum. Um, getting to hear people tell their story, um, as, as a lot of things that we talked about today, just hearing how others have, um. Struggled with things, how they've overcome things, how they've used the peer network and mentorship along the way I think are important.
So in addition to what Jos mentioned, those are a couple other things I wanted to make sure that we highlighted though, um, that it's going to a TS 2026 can make sure to attend.
Josh: And second that the diversity forums awesome. It's every year. It's great if you can make that.
Ugo: Fantastic. I'm looking forward to a TS 2026, and that brings us to the end of today's conversation.
Dr. Meyer and Dr. Denson, thank you both for being so open and [00:26:00] honest about the realities of mid-career life in medicine. We've covered a lot of ground today from recognizing when. Actually entering into this phase to managing the financial pressures that seem to compound right when you thought you'd finally gotten ahead.
We talked about burnout and what that looks like when you're no longer a trainee, but an established professional who's supposed to have it all figured out. We explored some moments of feeling stuck. The challenge of pivoting. Institutional structures while, um, where, where built that, that weren't built for career transitions and the very real juggling act of caring for children and aging parents while still showing up as a leader in your field.
But we spoke about hope, right? We spoke about the resources that a TS is building, the toolkits and the roadmaps. Designed specifically for where you are right now and what's coming out for those of you attending at a TS 2026. If today's conversation resonated with you, I encourage you to [00:27:00] explore those a TS resources and to attend a TS 2026.
And remember, being mid-career doesn't mean. Being stuck necessarily. It just means you have experience, perspective, and choices, even when it doesn't always feel that way. Uh, thank you for listening to ATS Breathe Easy podcast. I'm Dr. Ugo Zema and until next time, keep growing and keep moving forward.
Speaker: Thank you for joining us today.
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