To the Brink and Back: Burnout to Balance with Dr. Tammie Chang

In this episode, author Tammie Chang, M.D. speaks with Cohost and Lead Coach Jill Farmer about her journey through severe burnout to recovery, and how a combination of therapy and coaching helped her.

Warning: This episode discusses the topic of physician suicide. If you or someone you know needs help, please call the suicide hotline: 1-800-273-8255

“That’s what we pledged to do when we started medical school, and that’s what I thought I was dedicating my life to. And yet…I was one step away from an awful end.”

– Dr. Tammie Chang, M.D., Board-certified Pediatric Hematology/Oncology Physician, Co-founder of Pink Coat MD

Author Tammie Chang, M.D. speaks with Cohost and Lead Coach Jill Farmer about her journey through severe burnout to recovery, and how she speaks openly about her story so that others can identify and feel less isolated. Along with cohost of the podcast Master Certified Coach Jill Farmer, Dr. Chang discusses the foreboding steps toward intense physician burnout, and how a combination of therapy and coaching turned that around for her. “ Dr. Chang reveals how coaching helped her to assess her own needs and set boundaries in order to now be in a better place than she has ever been.  Author of the book, Boundaries for Women Physicians: Love Your Life and Career in Medicine, Dr. Chang helps listeners understand the importance of understanding the toxic culture of medicine, setting the right boundaries, and self-compassion.

“I think I’m much more myself now than I have been in my whole life. I’m even that much more on fire to be an advocate for change than I have ever been in my whole life. I’m truly grateful for that rock bottom place because I would never be here had it not been for that.”

• Dr. Tammie Chang 

Tammie Chang, M.D., is a board-certified physician in pediatric hematology/oncology and co-founder of Pink Coat MD, an uplifting community to empower women physicians. Using her expertise in coaching, leadership and consulting work, background in wellness and work as a physician, Chang guides women physicians to become the best version of themselves and protect their well-being by helping them achieve greater balance, prevent burnout and live healthier lives.

Her new book, Boundaries for Women Physicians: Love Your Life and Career in Medicine (Feb. 3, 2022)https://www.tammiechangmd.com/book, focuses on the understanding that to heal and serve others, one must first focus on having a healthy body, spirit and mind. Tammie highlights the importance of good self-care habits and boundaries in a physician’s life to avoid burnout, stress and exhaustion. She shares her story and that of three other physicians, acknowledging her struggles and the ways she broke the barrier of shame many physicians have when it comes to mental health and self-care. The goal of Boundaries for Woman Physicians is to equip women physicians with tools and advice to create healthy boundaries so they can thrive and love their practice. Tammie also published a companion workbook to help women physicians with time management and setting boundaries. Download her free workbook here.https://view.flodesk.com/pages/614e97b6337f1c2aacf52b33

Tammie leads personal coaching sessions, group programs and career consultations with the goal of empowering others to create the lives they want and become better leaders. She supports women physicians early in their careers by holding group consultations where they can share their experiences and vulnerabilities, as well as career sessions to tackle specific areas such as setting boundaries and time management.

She is the co-founder and co-CEO of Pink Coat, MD, a safe community and digital platform that provides support and resources for women physicians to help reduce burnout and improve personal well-being so they can achieve professional success. https://pinkcoatmd.com/

Partnering with leading experts across a variety of fields, the goal is to build a platform of supportive, self-compassionate female leaders to revolutionize medical culture. Previously, Tammie co-authored the Amazon #1 bestseller How to Thrive as a Woman Physician https://www.amazon.com/How-Thrive-as-Woman-Physician-ebook/dp/B09L8NNZH9/ref=sr_1_1?crid=1Q5Y4LXKER3VI&keywords=tammie+chang&qid=1638286450&sprefix=tammie+chang%2Caps%2C242&sr=8-1with Pink Coat MD co-founder Luisa Duran, MD.

Tammie serves as the medical director of Provider Wellness for her healthcare system and the director of her hospital’s Pediatric Cancer Survivorship Program. She also co-founded the Cool Chicks in Medicine community and the Women of Influence Network (WIN) at her healthcare system. Tammie serves as the program director of the American Medical Women’s Association (AMWA) ELEVATE Leadership Development Program for Women Physician Attendings, and as the President of the AMWA Washington State Physician Branch.

Tammie earned her bachelor’s and medical degree from Brown University in Providence, R.I. She completed her residency training in internal medicine and pediatrics at the University of Massachusetts and completed her fellowship in pediatric hematology/oncology at the St. Jude Children’s Research Hospital in Memphis.

Tammie lives in the Pacific Northwest with her husband and their two golden retrievers, and she spends her free time playing piano and being active in the beautiful outdoors with her family. She practices pediatric hematology/oncology in Tacoma, Washington. For more information, please visit: www.tammiechangmd.com.https://www.tammiechangmd.com

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Tammie: That’s what we pledge to do when we started medical school and that’s what I thought I was dedicating my life to. And yet, I was one step away from an awful end.

[DocWorking theme]

Jill: Hi, everyone and welcome to DocWorking: The Whole Physician Podcast. I’m Jill Farmer, one of your cohosts of the podcast and lead coach at DocWorking. And as always, this podcast is brought to you by DocWorking Thrive, where we provide coaching, brain-based stress management tools, and peer support for physicians and other healthcare professionals. Check it out at docworking.com.

I am super excited about our conversation today. We are very lucky to have Tammie Chang, MD. She’s a board-certified physician in pediatric hematology and oncology and co-founder of Pink Coat, MD, an uplifting community to empower women physicians, and her new book, Boundaries for Women Physicians: Love Your Life and Career in Medicine, focuses on understanding that to heal and serve others, you have to first focus on having a healthy body, spirit, and mind and she really highlights the importance of boundaries in a physician’s life to avoid burnout, stress, and exhaustion.

Tammie, as I told you, we were talking earlier, I read the book, loved it, it’s so clear, and I just really liked how you took your own lived experience, as well as highlighting a couple of other women physicians who you knew their story intimately, to be able to really give clear examples of what happens when women physicians don’t have boundaries or self-care, what the consequences of that are. So, thank you so much for being here.

Tammie: Thank you so much for having me. It’s a joy.

Jill: So, let’s talk first of all about your origin story. Talk about what led you to medicine and then where that point was where you were like, “Wait a second, something here needs to change. This can’t be how it’s supposed to be.”

Tammie: Absolutely. I would never in a million years imagined I’d be doing what I’m doing now, and I don’t think most of us in this space anticipate that either. So, not unlike a lot of your listeners, I’m sure and other docs out there, I’ve wanted to be a doc since I was a teenager. Very early on experiences, taking care of Alzheimer’s patients, just being involved in their care, like and honestly, I was just a teenager right, so I was going and spending time and it was so meaningful, and so I knew from that time that I want to do something. I didn’t know what that was going to be, how I was going to serve others. Fast forward, go through all those years of training, I absolutely fell in love with oncology and pediatric oncology. I felt like I found my calling. That’s where I’m meant to be, to help be part of that difficult journey for families of patients.

And then you fast forward, after all those years of training, where we go through training and really, literally takes almost two decades to get there. And five years out of training, I was at St. Jude, finished my first job and was now in my new job in the Pacific Northwest, and I hit rock bottom. Not unlike a lot of us in this space who are so passionate about helping other physicians and other clinicians, not only prevent burnout, but to thrive, just like the work you’re doing, I hit rock bottom myself. I was so severely depressed that I was actually suicidal, and I shared that very openly because it’s actually the silent story of so many other physicians, especially physicians who are women, and we know we’re going to talk about women too, as well today. And everything has come out of that time for me.

Jill: If you don’t mind telling us, obviously, it is a rock bottom moment, suicidal ideations, and just the challenges of thinking, the distorted thinking of thinking you’d rather be gone than to face what was in front of you, was it overworking, the number of hours, was it the type of work, was it the combination of those things? What would you say were the contributing factors?

Tammie: All of those, I think. [laughs] It was a combination of everything. So I think already pediatric oncology lends itself, it’s such a high empathy field and it’s very difficult to not take on the pain of your patients and your families, who you just care for so deeply. That’s why we do this work. So there’s already that piece. We take on so much, probably, even more empathy than some other fields lend themselves to be. Then there was a period of understaffing, overwork, a lot of personal and collective trauma, so my colleague’s daughter passed away from metastatic breast cancer in her 20s, very traumatic to just watch a colleague go through that. Another colleague got melanoma himself, and then we had multiple members of our own team going through cancer treatment. Then we had record numbers of new oncology diagnoses paeds, relapses and deaths for us that year. Leading up into that time, we probably had maybe about 50 to 60 per year and then that one year, we jumped up to 107, so, it gives you a sense of the huge number jump, and then also my own lack of boundaries as a young person. I was five years out of training, so in my late 30s and had never done anything but take everything on and take everything on as my responsibility. So I think it was a combination of all those things.

Jill: I totally understand that and, as I think it’s J. K. Rowling who said famously, “Rock bottom is the most solid foundation to begin to build a new future.” And so, for you, it was that point because the rock bottom was a catalyst for you to get help and you write about the fact that when you first sought that outside perspective, not having boundaries was one of the first things that was reflected back to you that you recognized and, gosh, I see it so often in my physician clients, in other conversations on the podcast. So often the highly, highly achieving physicians just believe that the harder they work, the more somebody else is going to recognize that they’ll take care of their needs and make sure they don’t have to keep overworking because darn it, you’re doing such a good A+ job. And so, there just comes this realization at some point, hopefully, sooner than later, that nobody else is going to create those boundaries for you, you have to do it yourself. Can you talk a little bit about your awakening to that discovery of the need for boundaries?

Tammie: [chuckles] Absolutely. I actually think my discovery came, it took some time, and actually, I love so much that you’re a coach as well because along the way, what I’ve done therapy for over 20 years, but it was when I first discovered coaching that everything changed and it was the first time I began to understand or see these things from the outside, and so it was actually probably about six months of coaching later that that started to sink in, so it took like, six months. And of course, by then I was like totally on the coaching train. I’m like, “I gotta become, what is this coaching stuff? I got to learn this magic” right, and then of course, I had no intention, but I became a coach along the way myself.

I think I recognized I had no boundaries pretty much. [laughs] and I also began to reflect back on the culture of medicine, and how we’re trained. I’m at this one specific phase of my career and I hope I’m still on the early part of my career. Hopefully, it’s a long time. But I think it’s even stronger in those who are older than me and generations before me, where it’s all about the giving, giving, giving, putting the patient first, putting your own needs on the backburner, and that’s what we pledged to do when we started medical school, and that’s what I thought I was dedicating my life to. And yet, I was one step away from an awful end to that life and career. And sadly, that is the case for so many others. So, that’s why.

Jill: I really love how you define this. This was new to me, this particular language in your book. You describe boundaries as protecting your life energy and, I just, I really want everybody to take that in because almost to a person, every particularly woman physician I’ve coached, which is a lot now over the last 12 of years, there’s a sense that somehow creating boundaries or saying no, particularly is selfish. And so when you think about boundaries as protecting your life energy, that’s not selfish. That’s smart and the only thing we can do in order to be able to give and serve to others. So, I just really liked the way that you language that.

Tammie: Thank you. It resonates for me very deeply because at the end of the day, we’re talking about incredible human beings. I mean, I think every human being is incredible and precious in their own right. But in particular, we’re talking about physicians, I mean they have, we’re talking about a special unique segment of the population who is driven A+ like you said before to do good for others. We’ve essentially put our own personal needs on the backburner for years, and so, in order to continue to do that incredible work and to serve others in a way that we know we’re capable of helping others, we gotta be okay, we gotta to preserve that life energy, and that’s what’s missing, I think from our culture.

Jill: Yeah and I think thinking about preserving your life energy, creating boundaries to preserve your life energy, really ties into some of the other research you cited in your book that I’m familiar with as well from Kristin Neff, talking about this idea that self-compassion, because when you can recognize, “I gotta have some boundaries to protect my life energy and that’s a way that I can be compassionate with myself and my needs, so that I can support the needs of others” and it turns out self-compassion is linked to lower levels of anxiety and depression. Yet, ironically, many physicians feel like it’s their job to beat themselves up and to use sometimes, the least amount of self-compassion than I see with any other sector of human that I work with. And so, understanding that the research says, self-compassion is generative and supports meaningful work, yet, there’s a lot of culture of self-criticism that I think needs to be examined as well. What are your thoughts on that?

Tammie: Oh, yeah. Our culture in medicine, it’s not that it’s necessarily unique from other industries, but we got a very specific culture in medicine and it’s a couple centuries old. It is so much about– I can’t even remember when I started to beat myself up inside, but it definitely got really strong during medical school and training, and beyond. It’s a very much a shame and blame culture externally, and then it’s amplified on the inside right, and so I think it’s so ingrained in us to be hard on ourselves and it’s actually so interesting, self-compassion, I was just at this conference and heard Dr. Tait Shanafelt expert who’s the preeminent expert in physician burnout today and he was talking about our self-compassion is like, down there [laughs] as physicians, and it’s a huge driver of burnout for us.”

Jill: It’s such a different way of thinking, it’s kind of retraining almost what was trained into you in the grueling [laughs] medical training is. Don’t think about yourself and if you do, only think about yourself with harsh criticism and so, to be able to recognize this as a way to reverse and begin to heal from burnout, I think is a very powerful thing to bring to awareness.

So you talk also in the book about just how it’s rewarded through medical school residency for working before and after shifts, and nights, and weekends, and how that gets trained in and you talk about that alone, being clear with the boundaries around your time and what you’re willing to do outside of your work hours is being a really important place to begin to strengthen boundaries, so that you can create a sustainable longer-term career. Talk a little bit more about that and what kind of impact it’s had on you to get your boundaries shored up around working.

Tammie: I think it took me personally hitting rock bottom and almost quitting medicine completely and honestly, wanting to just not be around anymore, because I didn’t want to have to work anymore, to wake up to that. My hope, right, through all this work that you and I are both doing, and all your podcasts and all this– there’s so much great work going on in our community across the country, is to change that now so no one has to get to that point to wake up and go, “Oh, maybe I need to change my life in some way.” I truly believe like you talked about those early training years. It has to start at the beginning. I mean I really think this stuff has to start in college premed. It’s already stressful, and competitive enough, and then you throw kids into medical school, and they’re young, and formative, and they’re indoctrinated. We are indoctrinated in this culture and even if it’s unspoken it’s model. And so I think we today have such a responsibility. Those of us who are working and physicians and want to see a future of medicine to change now, so that we can model the kind of behavior and honestly self-awareness and self-leadership that we want for our next generation, which is for students and our trainees.

Jill: Powerful. So if you are coaching a very, very busy physician who’s in that moderate moving towards severe burnout phase, what would you say is a great place to start when it comes to thinking about reversing the burnout, the overwhelm trajectory, and creating some boundaries to protect that life energy, so it’s more sustainable as a career in the long run. Where would be a starting place for you working with somebody in that position?

Tammie: I want to hear your starting place, too. [laughs] That’s where I’m– No, I can learn from you. I take it to the very beginning. I start with what is our “Why”, what are your core values as a human being separate from your identity as a physician, like, who are you as a human being, what’s non-negotiable for you and what’s most important to you? Start there. We spend a lot of time there until that’s super clear and then we move out from there. Because until we know that it’s really hard to figure out the muck of all this other stuff, and that’s not stuff that’s part of our training still in medicine.

Jill: Yeah, very true. I would agree: values, or just the simpler way of saying that is what matters to you. Martin Seligman’s work and others in positive psychology would say that, this is character strengths or values in action, is a much more sustainable power source to plug into long-term. And so, I think it is great to start with thinking about re-plugging in if you’ve gotten disconnected from your values. Also, I find that when somebody is really in that more moderate towards severe burnout situation, it’s helpful to start “with what are your needs”, because I find often physicians are so good at being other focused and the needs of others that when I asked them that sometimes, they just give me a blank stare like, “What do you mean?” I’m like, “What are your needs?” They are like, “I don’t know.”

Tammie: I don’t know what that is. [laughs] No one’s ever asked– [crosstalk] [laughs].

Jill: Things like nutritious food, sleep, and exercise, and they’re like, “Oh, my gosh, yes.” Then they’ll make a list from there and then I ask him to circle how many of their needs are being met and it’s shocking to me how many physicians are not circling even that their most basic needs are being met, and so to me, that’s a place to start. Then we get into what are your needs to thrive and how do we creatively work together to help you make space for the things that make you thrive, not just survive, and how do we meet those needs, and why does it matter to you, as you said from a values perspective. So, yeah, that’s where we end up starting a lot of times as you said, for people that are in that rock bottom place, just really losing connection to their needs. Is that an experience you’ve seen as well?

 

Tammie: Oh, yeah, and that was me too. I mean, that was the very first thing. I think when I finally realized I needed to ask for help, I was like, “Everyone help me,” thankfully, so I at least felt that I was like, “I’m going to do everything I can to be better” and the very first things were like, “How are you sleeping, are you eating, how are you exercising?” The basics, right?

Jill: Sure.

Tammie: Which are the first things to go.

Jill: It’s not that any physician doesn’t know this. Obviously, they know that. At the molecular level, all of the data that most human beings don’t understand [crosstalk] why it’s needed. It’s just that knowing doing gap and it just feels like it’s so much more important to help other people have their needs met to the point where you forget, as you said your life energy just goes away at some point if you’re not meeting your needs.

Tammie: Our priorities or personal needs, our pyramid is inverted.

Jill: Yeah, very well said. I think that’s the message. I can’t say it often enough as many different ways as I can. We’re just leaving too many passionate, brilliant people stray from what their purpose is by having the institution of medicine pound the life out of too many people who really are meant to be fantastic healthcare providers. These conversations, I think, are more important than ever. Speaking of that, the Surgeon General recently came out with something that I think brings this conversation to the forefront. Can you talk a little about that?

Tammie: Oh, yeah, he named the burnout of healthcare workers, the number one national priority right now and he came out with an advisory. It’s a 75-page document. So well written and it’s distilled it down and it breaks it down for like, “If you are an organization, this is what you need to do. If you’re involved in state law, this is what you need to do. If you are a patient, this is–” It’s well written.

Jill: That’s good. That’s very good to know. It’s important and do you think it’s going to help more people take this seriously in the way that it needs to be taken seriously?

Tammie: It’s pushed it forefront yet, again. If we can – we’re all rallying around this, right, and the more we can put this in the forefront of not only the people in healthcare, but the general public, I think that’s where the power is. If it’s not written down in a law, things take a long time to happen, and even then they take a long time, so I think this is important for all of us because really, talking about the wellbeing of physicians you and I today, but it impacts everyone. All the other healthcare workers, but then our patients and our patients’ families, and then our communities, and it just keeps going. We, of course, care so much about the individual physicians and caretakers themselves, I mean, that goes without saying, but the ripple effects are huge when we can really take our people, that’s the whole point of this entire field of healthcare is to care for everyone.

Jill: Mm-hmm. Beautifully said. So, Tammie Chang today compared to Tammie Chang at rock bottom, as you got coached and really saw a very different perspective on the life that you wanted to live and create for yourself, then began coaching and now have a chance to put your own coaching into play in your own life. What does it look like for you that’s different than when you were at that rock bottom?

Tammie: Oh, I was a different person. But I think I’m also so much more myself than I have ever been in my entire life, and I’m still learning. My word this year, you’re going to laugh. Well, I laugh. My word this year, my goal is ease, E-A-S-E, because I’m the opposite. I am not chill person [laughs] and I know it right, so each year and each month that goes by is a new learning part of my journey, too. I am learning to become more of the person that I long for other people able to be. I think I’m much more myself now than I have been in my whole life. I’m even that much more on fire to be an advocate for change than I have ever been in my whole life, and I’m, I’m truly grateful for that rock bottom place, because I would never be here had it not been for that.

Jill: Yeah, I can totally relate, and I too in the past have chosen ‘ease’ as my word of the year.

Tammie: Okay. [laughs]

Jill: This year, it was ‘contentment’ because those are spaces where we think they just sort of come naturally to people, but it hasn’t for most of us. And so, it is a place of cultivating and looking for that space and that energy in our lives, so I love that that’s where it’s taken you and I love that the path of looking for ease actually makes you more fully embodied as who you were meant to be in the world. That’s really inspiring and what all of us want on our path to self-actualization. So, thank you so much for your candor. I really highly recommend to everybody that you check out Tammie Chang, MD’s book, Boundaries for Women Physicians: Love Your Life and Career in Medicine just released earlier in 2022 and available where all books are sold. And Tammie, if somebody else wants to learn more about what you do, how can they find you?

Tammie: Oh, yeah, I have two websites. www.tammiechangmd.com. So, it’s Tammie with an I-E, and I also have www.pinkcoatmd.com as well. That’s my other platform I do with my med school classmate from Brown.

Jill: Thank you, thank you, thank you for telling your story, for being willing to be an inspiration for other women physicians, and for helping to pave their way to make this a meaningful, and impactful, and life-giving career. We really enjoyed having you here today.

Tammie: Thank you so much for having me.

Jill: And thanks to all of you for joining us. Make sure you share this with your friends, and colleagues, and others who you know will also learn and be impacted, as well as go to docworking.com today to learn more about how DocWorking Thrive can help train your brain to deal with stress better, to get better coaching, and all the other resources that we have available to support you in your life in medicine. Until next time, I’m Jill Farmer on DocWorking: The Whole Physician Podcast.

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