Mary Remón: Welcome to the Burnout by Specialty series. This is a pediatrics episode and thank you to Doctors on Social Media for hosting this today. My name is Mary Remón. I’m a licensed counselor and coach for physicians. And today I’m really excited to introduce to you Dr. Claudia N. Emami, Dr. Ben Reinking, and Dr. Krystal Revai Sodaitis. Let’s start with brief introductions. Dr. Emami, welcome.

Claudia N. Emami: Hey there, this is Claudia Emami. I’m a pediatric surgeon, been in practice for over a decade plus and currently I’m an administrator as a chief medical officer.

Mary Remón: Welcome. Thank you, Dr. Reinking.

Ben Reinking: Hi, I’m Ben Reinking. I’m a pediatric cardiologist in an academic practice setting and founder of The Developing Doctor, which is a coaching service for physicians and healthcare providers.

Mary Remón: Great to have you here. Welcome Dr. Revai Sodaitis.

Krystal Revai Sodaitis: I’m Krystal Revai Sodaitis. I was in academic general pediatrics. I now have a non-clinical career and I also coach neurodiverse physicians.

Mary Remón: Wonderful. Well, thank you so much for being here today. I’m going to call on each of you with questions and starting with you, Dr. Emami. This is really about burnout specific to pediatrics. So could you describe what burnout looks like in pediatrics?

Claudia N. Emami: Well, I think in my case, because pediatric surgeon is technically a subspecialty, right? It’s a procedural subspecialty of pediatrics. I mean, the way I would describe it, the way it meant to me, and I think it started when I realized I’m not looking forward to my consults or my operations anymore. And I was dreading the call.

It was almost, you know, it took me back to my residency years when I was like a junior resident and I just dreaded to be on call. I dreaded going to work and it kind of, I started getting a similar feeling. And, you know, especially when you’re a pediatric surgeon, you’re dealing with people’s children. You always want to want to be your best self when you’re on and when you’re taking care of other people’s kids.

So I think from a conscious perspective, I felt like it’s not right if I’m not 100 percent committed, 100 percent there. And that’s when I started to look into why I felt the way I felt. And to me, I mean, that was the beginning of the burnout.

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Mary Remón: Thank you so much for being open and sharing that. I know many people can relate. Dr. Reinking, what is it about pediatrics specifically that makes burnout different from other specialties?

Ben Reinking: Gosh, you know, I think all physicians are service oriented, but I think there’s definitely a servant heart in pediatrics where we enter this recognizing that we’re caring for a vulnerable population. And at the end of the day, all pediatric specialties are about potential and wanting this little person who’s in front of us to realize whatever their God-given potential is.

I think I resonate with what Dr. Emami said, sort of the disconnect from why we went into this specialty or this field and then all of a sudden not wanting to do that and losing kind of that joy that we had in providing this service. I think it is a little bit unique to pediatrics, although I suspect it spans all the specialties.

Mary Remón: Thank you. It is a theme that I’m hearing across specialties, but definitely pediatrics has its unique challenges. Dr. Revai Sodaitis, when you were practicing, what part of the job would you say was most draining?

Krystal Revai Sodaitis: The part of the job that was most draining was something that I didn’t even realize existed until it was gone. And that is the weight of patient care.

The weight of the responsibility. You feel responsible for your patient’s outcome, even if it really isn’t that responsibility. Is that child going to drink? Is the antibiotic going to work? Will they respond to the treatment or not?

And if their lab results don’t come back reassuring, can you get in touch with that family so they can come back, go to the emergency room, whatever. Those worries stayed with me all the time.

Until I was no longer in clinical practice, I didn’t realize how heavily those worries weighed on me.

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Mary Remón: That’s a lot to carry. I can only imagine. Thank you. Dr. Emami, as a pediatric surgeon, what do you think people outside of pediatrics don’t see?

Claudia N. Emami: I think Dr. Reinking kind of referred to it. It’s not that the adult world or the adult procedural world is not apprehensive about the outcomes or especially for surgeons about the complications of what can go wrong.

I think pediatrics is just another extra layer of burden.

Kind of to point out what Dr. Revai was mentioning, you’re never really disconnected. It’s somebody’s child and you need to know what the outcomes were.

For me, even when I wasn’t on call, I was in a two partner practice. You are never free of the outcomes of the last operations you did. You’re always responsible.

And I think in my case I was extremely lucky that while I was heavily practicing I didn’t have to deal with a really serious complication or a really bad outcome other than just the usual and customary.

But I’ve had friends and I’ve seen friends who’ve been devastated by a result of something that went wrong during an operation, which happens. If you’re a busy surgeon that’s something you can’t really run away from.

But I don’t think you really feel that burden as much as you do until you get into practice.

In my case once I became a mother that became even more of an issue because every kid could be my kid.

So it’s almost just to put it in layman’s terms like I never wanted to break somebody’s kid.

And I knew that I can’t control it.

You constantly have to keep that beast at bay so that you remain the confident surgeon that you are, but you know it’s around the corner and it can happen to the best of us.

So that’s compiled with years and years of just doing it over and over again. It adds up.

For me in retrospect I think I never really realized how much burden I carried until I stepped away and decreased it.

And then I was able to take a breath and just relax, genuinely relax because I was a few months away from my last operation knowing that okay nothing really bad happened.

But yeah, that’s the way I would say that went down.

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Mary Remón: I hear similar themes from other pediatricians who are parents. And I hear both you and Dr. Revai Sodaitis saying that you didn’t know how much you were carrying until you stopped carrying it. So that’s a theme. Thank you for sharing. Dr. Reinking, back to you. Think about system pressures. Where do system pressures hit hardest in pediatrics?

Ben Reinking: Gosh, I think this is a timely question. I’m a new division director and so I’m confronted with system pressures that I was less aware of until recently. And so I think one of the things that keeps popping up is just lack of autonomy and lack of control.

I happen to have a lot of new wonderful great young faculty who have young families and all of them are in two physician families actually. And so there’s this double pressure on both in the entire family to kind of meet the needs of the family as well as clinical obligations and just career dreams and aspirations.

And we have this ridiculous rule that all clinics need to run from eight to noon and one to five. And people can’t take a half hour off to pick up their child. And if they need to, then that’s a deficiency.

Allowing people to have just the ability to control their schedule. I don’t have anyone on my team that doesn’t want to work. They want to work and take care of their families. Allowing people to do that in a way that is safe and healthy and fulfilling for them is something that could be done easily and is a pressure that could be easily relieved if we were able to do that.

Mary Remón: That’s an important point. Dr. Revai Sodaitis, when you were practicing, what part of it felt most unsustainable to you?

Krystal Revai Sodaitis: I think that the continuing ramp up. It was twofold. Especially as it seemed like every year Bright Futures was recommending five new things that should be covered within a well child visit.

And because of system pressure and expectations there was less and less time being allotted to those visits.

So the shrinking of time that you could spend with your patients. There’s a lot more the expanding of what was expected to be covered during those times.

And I think also what has happened especially over the last five years. I haven’t been in practice in the last five years but I’m still active and board certified and I know what’s happening within the pediatric population especially around mental health.

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Mary Remón: I’m hearing that and so thank you. Dr. Emami, what is it that you think keeps people practicing?

Claudia N. Emami: I would like to really believe it is the love of the practice. It is the reason why we all became doctors and decided to take care of little ones.

Because it is so much more pleasurable to be close to this end of life than the other end of life.

But there are generational differences, there are training differences, and people want to have work life balance. I mean it is a good thing.

But the world of practice of medicine especially when it comes to pediatrics is changing because hospital management and health system management are changing.

There are a lot of mergers, systems are getting bigger and bigger, they are becoming closer to the way the corporate world runs.

The people that are managing healthcare and dictating these productivity numbers are increasingly non physicians.

One of the reasons I wanted to become an administrator was because I really do believe healthcare needs to be run by subject matter experts who are providers, physicians and nurses.

Not only administrators.

Because we all go into medicine to practice medicine, not to manage hospitals.

But I think that crossover is key.

And as Dr. Revai Sodaitis mentioned they keep adding to that plate because those people are trying to maximize productivity.

Healthcare is going in that direction and the people keeping the healthcare system alive, doctors and nurses, are losing more and more control.

So that is going to lead to more burnout.

COVID did not help, but I suspect it would have happened anyway.

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Mary Remón: Thank you for that. Along those lines, Dr. Reinking, in your new role what do you wish leadership understood, or what do pediatricians wish leadership understood?

Ben Reinking: I think administration should understand that physicians want to work. Healthcare providers want to work.

It is not that there is pushback against productivity metrics.

We all want the bottom line to succeed.

What I have learned in my new role is administrators want providers to be successful.

This relationship works best when we work as a team rather than against each other.

That is how the system works best.

Mary Remón: Thank you. Dr. Revai Sodaitis, if one thing changed what would reduce burnout the most in pediatrics?

Krystal Revai Sodaitis: Allowing physicians more autonomy and flexibility around their schedule.

Most of us who go into medicine are hard workers. We want to work.

But we also want to care for our own children.

Allowing flexibility so physicians can be caregivers for their own families would go a long way.

Mary Remón: Thank you. Dr. Emami, any advice for doctors going into pediatrics?

Claudia N. Emami: I would say get informed about how the world is changing.

Information is power.

It is great to have idealism, but if there is a big gap between the idealism and reality that disappointment will lead to burnout.

If you go in informed hopefully you will be pleasantly surprised rather than disappointed.

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Mary Remón: So I have one final question. It is the same question for each of you. How can we make pediatrics more sustainable?

Ben Reinking: Provide broad expectations but allow local control.

Allow physicians to control schedules and empower middle management to support their teams.

Krystal Revai Sodaitis: Separating routine well child care from complex pediatric care.

Using nurse practitioners or physician assistants more for routine care.

And having specialists focus on higher acuity cases.

Claudia N. Emami: Pediatrics likely needs better compensation.

Middle management also needs to better understand what pediatric physicians actually do.

There is a disconnect especially in hospitals that primarily treat adults.

More pediatric voices need to be involved in management and leadership.

Mary Remón: I’m so grateful for each of you for adding your unique voices and experience and expertise to this important conversation. Thank you so much, Dr. Emami, Dr. Reinking, and Dr. Revai Sodaitis.

This will conclude our pediatrics episode of Burnout by Specialty.

Thank you all.