Ep #317: What Women Physicians Need to Thrive

Welcome to the Weight Loss for Busy Physicians podcast. I'm your host, master certified life and Weight Loss coach Katrina Ubell, M.D. This is the podcast where busy doctors like you come to learn how to lose weight for the last time by harnessing the power of your mind. If you're looking to overcome your stress, eating and exhaustion and move into freedom around food, you're in the right place. Well, hello there, my friend. I'm so glad you're here joining me today. I am excited to be recording this for you.

My voice is like a little husky, so we're just going to go with it. And I also have my nine year old daughter on the couch near me. She's home sick from school. And I told her, you know, I asked her to if she could just try to be quiet while I record and she's doing so. So anyway, we got a little fly on the wall right now. I'm not used to recording my podcast with anybody else in the room, so it's a little bit strange for me, but I'm so excited about this topic today that I think I'm going to easily be able to drop it. So last Friday, February 3rd, was National Women Physicians Day. And so I was thinking when I was planning this episode, I was like, Well, I mean, I could do it earlier or I could do it late because Fridays right in the middle of the Tuesdays. So I just decided to do it on this episode.

So it's already past as you're getting this episode. But I decided to take inspiration from this day that celebrates women physicians to talk about what really helps women physicians to thrive. This was a really fun episode for me to put together, really distilling down all the things that I've learned from coaching women physicians for so many years and putting it together in something that's going to be really actionable for you. So first, I was kind of wondering, you know, when I went to medical school, I started medical school, let's see, in 1998. Yeah, 1998. I remember them saying that we were one of the first classes they had had. I mean, we were the first class where it was half women, half men. And that was such a big deal. It was so exciting. And so many women are going into medicine. It's going to be so good.

So I checked in to see since that time because it's been, you know, 25 years now. That's crazy. Since I started medical school. Oh, my gosh, how many US physicians are women? And it turns out that the latest data I could find was 54.2% women. So now there's more women physicians in the US than there are men. I checked into Canada as well. The best data I could find is about 42% women. But in the family physician category, which is for those of you in the US or in other areas of the world and you know, I'm no expert in Canadian medicine, but I've picked up a thing or two along the way.

Family physicians are the primary care doctors. Like if you are going to go to the doctor, you're going to start with a family physician. So there's lots and lots of family physicians. And I saw, I think 60% or even higher of those doctors are women in Canada. And so, you know, it's interesting. I actually found this article out of the University of Toronto talking about why women physicians are really great for health care. And and so I just want to share some of that with you. They were saying that it's about they're better for health care, but they experience gender pay gaps as we know, discrimination and depression. I just want to share some of the things that they talked about because there is just all this evidence showing that women tend to practice medicine in a style that is better suited for patients.

So compared to male physicians, women spend more time with their patients, they are more likely to adhere to guidelines. They're more likely to offer more follow up care and are more careful in their prescribing practices. They're also more likely to address mental health concerns and to establish collaborative partnerships with their patients. I mean, this literally, I was reading this. I'm like, Yep, check. Uh huh. Yeah, I'd say that. Yes, I agree. I agree. I agree.

Even as a patient. I agree. And of course it's not. I mean, it's a generalization. It's not every single person I have been taken care of by male doctors and I continue to in some parts of my life and they're great, but they're the reason I see them is because they're great. Right? I've also had plenty of other experiences, as I'm sure you have, too. They say, in turn, patients of female doctors have fewer hospitalizations and emergency room visits than those of male doctors. And this is even more pronounced for patients who have complex medical issues. And patients of female physicians are more likely to be up to date on preventive screening, such as mammograms, and are more likely to be satisfied with their care. So I'm going to link this in the show notes. But if you're interested in reading it all, the kind of everything I said, there's links in there showing the data to support that in case you're interested. But what they're saying in this article is like, the problem is that like, that's all great.

The problem is that the health care system has not changed along with practice style of the female physician workforce and that there are consequences to that. And so like I said, I mean, the gender pay gap, I've done an episode on that before. This is mostly talking about the arrangement in Canada, but I think a lot of it actually really applies to those of us in the rest of North America and in other parts of the world as well.

And, you know, a big part that they said here is female doctors are more likely to have a spouse who works full time than male physicians, and they take on a larger proportion of parenting and domestic tasks. And that's really, really true and says add an. Old boy's club work culture that is rife with gender-based discrimination, abuse and harassment, which has little hope of change without the representation of female voices in medical leadership, and then talking about how burnout, depression and suicide are a real issue as well. There's a study by the Canadian Medical Association in 2018 that showed that female doctors had a 23% higher odds of experiencing burnout, 32% higher odds of depression and 31% higher odds of suicidal thoughts than their male colleagues.

And then my alma mater, University of Michigan, published an article in JAMA Network Open that shows that within six years of completing residency training, almost 75% of women physicians reported either reducing their work hours or considering part time work. And so there's a big thing in Canada, again, like this is just because this is out of Toronto, but it says we do not have a shortage of physicians in Canada. I actually was just in Canada. I got home yesterday for a workshop that I went to and someone I spoke to, he said, Oh yeah, we have such a shortage of of doctors in Canada.

This author says we do not have a shortage of physicians in Canada. We have a shortage of support for our female doctors. Right. This was written by Rebecca Trinkaus, who's a family physician and global journalism fellow at University of Toronto. So anyway, I thought it was a great article and so much to think about, right? We do such a great job, yet we suffer the consequences of that. So if that is all true, then what do we need to do to thrive as women physicians, Right? What do women physicians need in order to thrive? And so I have four specific categories of things that I want you to consider to think about, to journal on, to mull over in your brain, to marinate in, because this is some really, really, really good and important stuff to consider.

So much of what I see is physicians of all genders really feeling like they're at the mercy of the health care systems that are in place. And those systems, of course, as we know, are very much broken in a lot of ways. And I think that so much of what we focus on are the things that we can't immediately change or impact. Not to say that those things shouldn't be changed or impacted, not to say that we shouldn't put some effort toward changing them or making an impact on them. But what about today? What about feeling better today, now this week? Right. What do we do for ourselves to actually be able to keep afloat while this is all getting worked out? And that's what I want to talk about here.

So these are going to be things you're going to be working on more on a personal level for yourself. So the first thing is getting clear on your values. And if I'm 100% honest with you, when I hear people talk about values, half my brain just sort of shuts off. I've done plenty of different activities over the years where you're supposed to pick the things that are most important to you from a whole long list of values. And and I don't think there's anything wrong with that. It's not bad at all. I just often had a hard time figuring out how that applied to my actual day to day life. And so if you've had that experience as well, I'm going to make it clear for you on how it does actually impact your day to day life.

So what you're doing when you're getting clear on your values is you're finding out what's really important to you. So you as an individual, this is not what other people find valuable. This isn't what your parents think should be important to you. It's not what you think the quote unquote should be or or like a good person would think this or a good mom would think this or a good doctor would think this. What's actually genuinely, truly important to you? And then understanding why it's important to you.

And when you know this, when you have figured this out, this is how you apply it. You make decisions then for your life based on these values? Okay. So when you're feeling out of alignment in your life, right. When you're feeling out of balance, although, you know, balance is one of those words, right? Work life balance. It's like, is that even a thing? But alignment is a really real thing. Do you feel like your life is in alignment right now or not? We generally have an idea on the answer to that. Like, does it feel like we're aligned or does it feel like we're out of alignment? If you feel like you're out of alignment, then you are very likely out of alignment with your values.

So let me give you an example here. So years ago, I did a values exercise and found out that one of my top personal values is flexibility. So this means that having flexibility in my life is something that's very, very important to me. So let me give you an example of where this felt, where I was definitely out of alignment with this. When I was in my pediatric practice, the way we worked our practice was that we would get, you know, like have our regular bookings for, well, checks and follow ups and things like that. But then we had lots of space available for same day appointments.

And I know other some other practices and specialties have a setup like this. It's kind of uniquely, I think, very heavy in pediatrics, just because kids get sick, you know, and they just need to be seen much more short notice. And there is definitely more of a reliance on urgent care for adults and maybe even in some communities for pediatrics. But we really preferred to see our own patients, if at all we could. And we found that that gave better care to our patients. So we wanted to be able to see them when they were sick. And so that meant that some days I would walk into the office after just going to round on babies at maybe one or two or sometimes even three different hospitals.

So I already feel like I worked half a day and I'm walking in at 850, you know, to start the day. And maybe one of the medical assistance or nurses is kind of looping by and we'll say something like, We're already booking past 5:00 or hope you have your roller skates on today. You know, meaning you're going to be just running the whole day. I remember feeling so defeated, like I barely even started the day. And you're basically already telling me how to think about it, which is today is going to suck, right? Like, that's basically what they're saying. You're going to be exhausted and today is going to suck. So, you know, for better or for worse, this is just how it was set up.

So, you know, the phones would start ringing at seven. They would just start filling in those sick appointments. And sometimes by 9:00 in the morning, we were already booking past 5:00. And so it kind of changed actually over the years that I work there, but especially when I first started working there, we really the idea was you stay until the last patient who's called has been seen. So if someone calls at 530, even though the phones are supposed to be actually turned over to the answering service, if we're still there and working, we'll ask them how long it would take them to get there. And can you come right now? The argument over whether that's a good way of running a practice or not is not within the scope of this podcast. But anyway, that's how it was, right?

So we would just never really know when we were going to be done. And that made it really, really challenging. If we had any kind of activities that we wanted to get to after work. And so we would book out so far in advance. Sometimes, you know, things come up like with school and things like that. So I remember it was when my oldest son, who was now 17, he was in first grade. So how old was he? Probably six or seven. And his class did a class play. And so I didn't know in enough advance to make sure I had that day off.

But it was in the evening because most parents worked. And so I thought it should be no problem while the school was on, you know, with good traffic about a 22 minute drive from my house. And I should also say that my office still that old office where I used to work is a half a block from where I live. So it was basically the same thing, work or home, 22 minute drive on a good day, like with no traffic. So I come to find out that the class plays at 6 p.m. on this day and I'm working on that day. And so I think to myself, okay, you know what? I'll just make sure I'll just tell the front desk like I have to leave. I just can't see other people. Like I just, you know, whoever else calls in one of the other doctors is just going to have to see them because that's just how it has to be. And so I told them I made sure they knew. Also recognizing that there's going to be rush hour traffic, too. So it's going to take longer to get there. And I think I even had to have my nanny bring my son because he had to be there early for like, you know, getting himself ready and stuff. So she was going to get him there. I was going to meet my husband there and, you know, do a trade off with a nanny.

Okay, great. So that was the plan. Even the day of I tell the front desk staff like I have to leave, like there was literally there's no discussion. I have to leave at 5:00. So guess what ends up happening? They add people on, right? They add people on. And so then I'm thinking, okay, well, if I can get out by like five, ten, five, 15, maybe that'll work. This thing starts at six. I'd love to connect with my son before he gets up there and does it. But, you know, I'm rather than just being like I'm walking out the door because, like I said, you know, I'm thinking to myself, No, no, no. I have to, you know, help out. If they gave them this spot, then that's what I have to do. And so I cannot even describe to you the stress I felt of being pulled in two directions. Here is a patient I remember even specifically, one of the patients had, you know, a facial laceration. And so I'm like, okay, all right, I can draw them up on this. That'll be fine. I can do it fast. But just feeling so much pressure to not let the patient know that I'm trying to hurry yet Trying to hurry, like getting myself out of there. Just the racing around, wondering if I'm going to miss, you know, this important day in my child's life was also a very important person in my life.

Right. And and just racing out of there feeling so stressed in traffic, getting there right at the last minute, you know, finding a seat way in the back because all the other parents got there way earlier and just feeling so stuck. You know, like here is something that is important to me and there is no guarantee that I can make it there, at least in the way that I want to make it there. And really the issue there was that flexibility is very important to me. Being able to have some say in how my day is spent is just something that's very important to me. It may not be for you, right?

This is why our values are also different. So that was one way that this particular arrangement at this practice was out of alignment. For me personally, it doesn't mean it's a bad job, doesn't mean that someone else won't totally love it. It just means that it was out of alignment for me. So when we're making decisions, whether it's going into a new practice, leaving a practice, going to a different practice, or any other decisions that we make in our lives, personal or professional, we want to make sure that they align with our values, at least to the best of our knowledge. Of course, sometimes we get into a job having asked all the right questions, and then we still find out, Oh, once I'm here, it's actually a little different than I expected.

And then you have the opportunity to, you know, advocate for yourself so that what you're doing is in alignment with your values. And if they're not able to work with you on that, well, there is your answer on that decision. Should I stay or should I go? Right. That is how values can be really, really helpful. You know, for you to really understand. You don't need to know like the 17 top values for you, but maybe 3 to 5. What are the most important ones to you? You don't have to justify them to anybody. You don't need to explain them to anybody. They're important to you because they are. And then those are what's informing your decisions. So good. Okay, The next thing that you need in order to thrive as a woman physician, you need to understand yourself well, or at least better. Right? So sometimes, you know, perfection is the enemy of or, you know, what do they say? Great is the enemy of good or something like that, right? Sometimes we're like, Well, I need to understand myself really well. I would just say, let's just work on understanding ourselves better. And in the process of doing that, we will understand ourselves well, right? What I mean by this is understanding what helps you to feel your best, what actually is fulfilling to you, what makes you feel satisfied? Like understanding yourself. Right. What do you like? Understanding your experience of things.

When I interact in this way, particularly professionally, it's very fulfilling for me. I feel like I bring a lot of value. I feel like my energy is up. I feel really excited about what I accomplished. That's going to be different from person to person, right? Good thing, because this way we can all cover all the different things that need to be done. You know, if long term patient relationships are fulfilling for you, then maybe a busy, urgent care job is the right fit for you. Or maybe locums is something that you can do as a short term fix, but long term locums isn't going to be for you because you're hopping around so much. Right. And for other people, they don't care at all about long term patient relationships.

So good to know then that's not important to you. Then you can allow that to inform what you're doing, right. Just understanding who you are as a person. So whatever is true for you is valid and acceptable. Okay. There's so much judgment that we often bring to ourselves where we maybe even understand what's true for us. But then we think it shouldn't be true or it's bad that it's true. And when I want to offer to you is that whatever is true for you is valid and acceptable. You don't need to justify it. You don't need to apologize for it. It just is okay. So here's an example, a little bit of like a hot button topic for a lot of people where they get a little like, here's the thing.

Some people don't particularly want to spend a lot of time with their kids. But they think they should and that a good mom would. Right. And so they think that even though they understand themselves well and deep down, they don't really want to spend a ton of time with their kids. They think that that's wrong. And so even if they aren't spending a lot of time with their kids, which is what's actually best for them in that moment, they still feel guilty about it or they shame themselves, right? They make themselves think that there's something wrong with them because that's what's actually true for them. But what I want to offer to you is what is true is valid and acceptable.

I've said this before, but I must say it again sometimes this is like just with the kid example. Sometimes this is just true for a certain season or age group of their lives. The older my kids get, the more fun I have as a mom. I personally am just someone who enjoys that time more. Other people, oh my gosh, they could keep them babies and toddlers for the rest of their lives. They would do it right so they can't wait to be home. It's also okay to be like, You know what? This is not my favorite time in my child's life.

I'm definitely going to be a present parent. I will be around, I will be involved. But if there's an extra shift to take, someone else can watch the kid. I might take them up on their offer and not feel bad about it. Understanding yourself well, or at least better, helps you to thrive. You don't need to make any explanations. You don't have to justify any of it. If it's true for you, it's true. So you don't have to have traditional relationships. You don't have to do anything the way other people do it. Whatever is true for you is valid and acceptable. And when we guilt and shame ourselves and judge ourselves, it's very exhausting. And I think that really contributes to the burnout that so many doctors are experiencing, right?

That what's true for me is not okay and resisting that. And then that creates that exhaustion. Right and burn out. Okay. The next thing that you need is we talked about being clear on your values, understanding yourself well, or at least better. The next thing you need in order to thrive is to identify your needs and then meet them. So what does it really mean to meet your needs? Because this is something that a lot of people talk about. But what does it really mean? What it means is fulfilling your healthy desires, right? So meeting your needs is not eating a quart of ice cream in front of the TV at night.

Right. That's fulfilling a different need. And I'll get to that in just a minute. So we have desires. And by healthy desires, what that really means is desires that lead to outcomes that are desirable for us that we want. Right? So when we're eating a quart of ice cream in front of the TV, in the long run, that typically doesn't give us a result that we're happy about, right? So we wouldn't consider that more of a healthy desire. So what meeting or identifying our needs in the meeting them requires of us is for us to take responsibility for our own experience of our lives. Right? Instead of thinking that it's other people's job, blaming other people, giving other people that responsibility, we have to take responsibility that we're actually the ones creating our experience. And that's actually really good news.

And the reason it's good news is because if you're the one who's responsible and guess what? If you don't like it, you don't like your experience, then you get to change it. What's so hard for us is when we think other people are responsible and then we think they need to change so that we can have what we want. And guess what? We can just cut that middle person right out of there. We get to decide, okay, so in order to do this, in order to identify your needs and meet them, you first have to value yourself and hold yourself with enough esteem.

To make yourself a priority. And this is another thing, right? We think everybody else needs to come first. And we're if we're even on the list, we're at the very bottom right. So we have to build that self-esteem. Another term that I use a lot is your relationship with yourself. You need a strong enough relationship with yourself to care enough about yourself that you will actually make yourself a priority. Right. Because if you identify your needs but don't prioritize yourself, you're still not going to thrive.

So you have to work on that if that's something that you struggle with. We work on this in our coaching program all the time, right? People coming in who have accomplished so much, but their opinion of themselves, their thoughts about themselves, maybe universally or in certain areas of their lives are not positive. We can just say, okay, so this is something that we can really work on together. If you're taking part in activities that don't support you. Right? Like the ice cream in front of the TV. What you want to do then is figure out what the need is behind that behavior and then find a better way to meet that need. Okay. So here I'm going to give you the example, Right. So you're eating on the couch. You've got the tub of ice cream. You know, just as an example, right. You're in front of the TV. You're just like zoning out, eating alone in front of the TV.

So, you know, the need being met is not like an ice cream deficiency. It's not a TV deficiency. Right. There's something else behind that. Some other need that's being met by that behavior. It's just not being met in a way that creates a long term outcome that's desirable. Right. So in this example, what might the need be? And it could be several needs, but it could be a need for connection, Right? Feeling included. Feeling some belonging. Right. If you're there alone, you might really be longing for that connection. I actually saw something. Or maybe it was even you know that friends, the show from the nineties, the reunion show that they did a little while ago. Like there are all these people who were saying how watching that show during a period of time when they were feeling super lonely or isolated really helped them to feel better and help them to feel more connected.

So that's great if it gives you some outcome that you're happy about. But at the same time, it's also good to understand like, Oh, I'm lonely, I'm desiring connection, What are some other things that I can do to solve for them? Right? So it could be a need for a connection, for belonging. Sometimes we just want to feel like we're being cared for, right? Or we really just want to feel safe. And food often can come in, can sort of pinch hit for us, can be that thing that comes in and helps us to create that in the moment.

But long term creates other problems. Another need that a lot of people have is respect to be respected, to be treated with kindness and with courtesy. Yet here's what's interesting We often don't treat ourselves with that respect and kindness and courtesy, right? Some of us, many of us have a lot of room to improve in how we treat ourselves. So if the need that we have is to be respected and we're trying to fill that in other ways that don't give us those desirable results, it's important to understand, you know, what it is. I want to feel respected. I want to feel, you know, that I'm treated with kindness and courtesy. Maybe I could start with offering that to myself first.

So what would that look like? Is kindness and respect eating a bunch of ice cream from the TV? I'm not going to say it's not, but I'm going to say that probably most of the time it's not. I don't always like to talk about like absolutes, like always and never. But probably the majority of the time. The vast majority of the time, that's not actually kind or respectful to us. Right? So if there are things that you're doing that you wish you would stop, understand, you're doing that for a reason. It's meeting a need. Let's figure out what that need is and practice, explore, experiment with meeting those needs in other ways that give you the need fulfillment that you're looking for and give you the long term result that you also are looking for.

Okay. The final thing that women physicians need in order to thrive is to review first get clear on your values. Second, understand yourself well, or at least better. Third, identify your needs and then meet them. And number four, last but not least by any stretch, is manage your mind and process your feelings. And you know, everything that I've just been talking about. This is all things that we work on in our weight loss for doctors only coaching program. We have so, so much on this. We work on this all the time, so very helpful, but in particular the managing the mind and processing the feelings part.

This is an area where coaching really, really shines. What we have been trained to do is to stuff our emotions, right? We have to be professional, whatever that means to us, and maybe the people who taught us that we should be quote-unquote professional, whatever that means. We've learned to deny our emotional needs, to assume that if we don't feel our emotions in the moment, that they'll just go away, which they don't. Right. We just haven't learned very supportive or functional ways to deal with our emotional life. And all of us have emotions. I remember learning about this and being like, Yeah, but what if you just don't really have a lot of emotions? If you're asking that question, guess what? They're there.

You're just unaware of them like I was. You can become more in tune to your emotions. I am living proof. Okay, so we have to learn to stop stuffing our emotions and instead learn how to process them. We need to move them through us. This is a skill that you can learn. You also need to deeply understand and buy deeply. I mean, not just like a surface-level cognitive understanding, but like in your bones deeply understand that your thoughts and your beliefs are what have created everything you have in your life, both desirable and undesirable. So everything you think and believe creates a result for you and your life if you have a result that you're not happy with. Then what we need to do is look at thoughts and beliefs.

Okay, We have to work our way up to find what the root cause is, and that is the root cause. So it's not like eating keto. How many carbs are eating? Has nothing to do with that. Has nothing to do with that. Has everything to do with the way that you think and what your beliefs are. Another important part of this is recognizing that not all of your thoughts are true. In fact, probably most of them are not. Thoughts are not fact, thoughts are not truth, thoughts are just thoughts. And we get to decide how we want to think about things.

If you've ever changed your mind about something, you know this to be true. You get to decide how you think and what you believe. So this is great news, right? If our thoughts and beliefs create all of our results in our lives and we want to change some of those results and we know we can change our thoughts and beliefs. There we go. Right. That's what we help you with, with coaching. So really, ultimately, how you leverage your mind. That's how you create more desirable results. Right. Understanding that there's a lot of actions that can be taken and different things, but it always will come back to your mindset, the way you think and what you do with your emotions. This is an area where coaching really shines and I think a lot of people are still a lot of physicians, Women physicians are really struggling with this and don't really understand this in a deep way.

And that, of course, is exactly what we can help you with. In our weight loss for doctors only coaching program. So it will be opening up another cohort very soon. We'll be starting it actually in May. So if that's something that if this is resonating, then you might really want to start considering whether learning more about the program would be in your best interest, because these are really what it boils down to. Right. And you understand. Right. Just to review, what do you need in order to thrive, You need to get clear on your values.

You need to understand yourself well, or at least better. You need to identify your needs and meet them. And you need to manage your mind and process your feelings. So guess what was not included in that list? Like you need your administration to change. You need to hire a new office manager. You need them to give you a different medical assistant. Like none of that factors in. So I want to just point this out very clearly that you absolutely can thrive as a woman physician in the current health care system, even though that system is broken and very messed up is a nice way of putting it. All right. You really, really, really can thrive. And I think the first step is recognizing that you thriving is even a possibility, because so much of what's discussed right now is what's wrong and what's bad. And what I want to focus on is, yes, and that may be true. And what are we going to do about it for you today? We don't want to have to take weeks and months and years and decades to wait for somebody else to fix things. That's not a life well lived. A life well lived is going okay. And my immediate zone of influence, what can I do? And you always have influence over yourself. All right. I'm hearing somebody getting a little antsy over there. So a little bit of a longer episode anyway.

So she did great. All right. Well, thank you so much for your attention. I appreciate you being here. I appreciate you listening. For anybody who is a woman physician or knows one, please, please share this episode with the other physicians in your life. Or, you know, if you go see your doctor, share this episode. Everybody wants to feel good. They want to feel like they're living a life that is in alignment with what they want, and this is exactly how to get it. So please be sure to share this. You can share it on social media. Tell your friends and let people know. Send a text to somebody who needs it. And that way everybody can do better. And as we know, based on that article that I told you about, like when women are in charge, when women are taking care of patients, patients do better. We have so much to offer, so much to give. It's so valuable what you offer. We want to make sure that you're thriving at the same time. And that's exactly what I want to help you with. You're doing a great job. Keep it up and I'm here for you. Have a great rest of your week. Happy National Women Physicians Day and I'll talk to you next time. Ready to start making progress on your weight loss goals. For lots of free help. Go to https://katrinaubellmd.com/ and click on Free Resources.