In this episode we talk to Dr. Simon Maltais about his story of physician burnout and recovery.
“Your life becomes fused to what we do and it’s very hard, especially for physicians or healthcare workers, to say, ‘Well, you know, I’ve done this all my life and maybe that’s not what I need to do now.’” -Simon Maltais M.D Ph.D.
In today’s episode, Dr. Jen Barna has a very honest conversation about burnout and recovery with Cardiac Surgeon and author of the upcoming book, Healthcare Anonymous: Put Yourself First to Avoid Anxiety, Addiction, and Burnout, Dr. Simon Maltais. You would be hard pressed to find someone more driven or accomplished in his field than Dr. Maltais. At the top of his game and publishing a new article nearly every two weeks, Dr. Maltais realized that he was experiencing burnout. Dr. Maltais shares his story of taking a step back, considering leaving medicine, changing his definition of success, and ultimately creating a hybrid way to continue the work that he loves while making more time for himself and his family. Tune in to hear an honest and candid story of burnout and recovery and hear what Dr. Maltais believes is the future of medicine.
For more information about Healthcare Anonymous: Put Yourself First to Avoid Anxiety, Addiction, and Burnout and offerings, please go to healthcareanonymous.com
Dr. Simon Maltais is an active cardiac surgeon in the United States. He is French Canadian and board-certified in Canada in cardiac surgery. He is an internationally recognized leader in the field of heart transplantation, mechanical heart devices, and alternative cardiac interventions. Before 40, Maltais had led two world-renowned programs in his specialty and has pioneered numerous novel approaches for advanced cardiac surgery interventions. At the age of 35, he was among the youngest promoted associate professors at a nationally recognized institution. He is a frequent keynote speaker, has published more than 160 articles and has contributed to numerous books. As he worked in two different countries and health systems, Maltais has a unique perspective on the delivery of care and its inherent challenges for healthcare workers.
Dr. Simon Maltais earned his Medical Degree from Sherbrooke University, his Master’s Degree in Physiology from Sherbrooke University, completed his Adult Cardiac Surgery Residency at Montreal Heart Institute, Montreal University. He completed two fellowships, one at Buffalo University and the second, a fellowship in Heart Transplant and Mechanical Support at Mayo Clinic School of Medicine. He obtained his Doctoral Degree in Biomedical Sciences (Ph.D.) at Montreal Heart Institute, Montreal University. He currently works at HCA Healthcare in California.
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Please enjoy the full transcript below
Dr. Simon: Your life becomes fused to what we do and it’s very hard, especially for physicians or healthcare workers to say, “Well, you know, I’ve done this all my life and maybe that’s not what I need to do now.”
Welcome to DocWorking: The Whole Physician Podcast. I’m Dr. Jen Barna and I’m here today with Dr. Simon Maltais. I’m very excited to have you as a guest today on the podcast, Dr. Maltais, because as a world-renowned cardiac surgeon originally from Canada, but also you’ve worked at the Mayo Clinic as the Vice Chair, and you’ve published over 160 articles. So, extremely well known and well published in your field, you have made a transition into advocating for healthcare workers for their mental and physical health, and to advocate for prevention of healthcare worker depression, burnout, and anxiety. Welcome to DocWorking: The Whole Physician Podcast.
Dr. Simon: Thank you so much. I appreciate the invitation.
Jen: I’m so excited to have this conversation with you because of the important work that you’re doing now and to hear about what caused you to make this pivot?
Dr. Simon: Absolutely. Well, it’s certainly been an interesting two years, so to speak, for the reasons that we know about. I was at a point in my career where I went through professional and personal challenges myself, and it started to be a journal for me. I started to get up in the morning or write at night, what was wrong, what went well? As I started to get better or I started to make things better, I started to speak up about it. That means connecting with my colleagues, friends, and I was realizing that a lot of people were going through the same things. So, it became sort of a slow calling where it became pretty clear to me that I need to write and write about mental illness in healthcare workers. Then, I went on and it was completely what I usually do, but did a health and life coaching training and then through all this, I started to write the book every morning, and it came together over the last, I’d say, 18 months.
Jen: Your upcoming book, Healthcare Anonymous: Learn How to Put Yourself First while pursuing a calling, is coming out this spring, is that correct?
Dr. Simon: That’s right. So, it’s now available in pre-order on all the usual suspects and it will be available April 5th, is when it’s coming out.
Jen: Fantastic. So, would you mind telling us a little bit about your personal journey? You mentioned that you went through some difficult times and I know, as a physician, sometimes it’s difficult to talk about that.
Dr. Simon: Yeah, I’m absolutely willing to do that and it’s part of the process. The book is going through some of that as well. I was recently reading a book by Matthew McConaughey, but I had a lot of green lights in my life. I went through school pretty easy, med school was easy, went to the hardest possible specialty I could get in, was very successful at it, graduated very quickly to be an Associate Professor before 40, Vice Chair of departments in world leading institutions. But then slowly, things were chipped away, whether it was personal or professional, I had less and less time for myself, for my family, for my son. I thought I could keep it all together as we all think.
Then, gradually, it started to affect my professional career, my decisions, my ability to work, of course, being 50 to 60 pounds heavier makes it harder to go through your days every day, and I started to have a bit less of empathy for people I care for. These are sort of early signs of burnout. All of a sudden, I really had this moment where something needed to change and change quickly. I wouldn’t say overnight, because it’s a cliché, but I decided to make a transition and let go, and started saying, “No,” and then leaving a lot of my responsibilities and things I had to do. Not clinically, but professionally, I used to travel 50,000 air miles a year for meetings, for presentations, for publications. I would have something to do and then I was President of the International Society of Heart-Lung Transplant, just decided to stop, and it was hard to realize that the profession that brought you so much and that is bringing you so much still is slowly destroying you in some ways.
Then for others it will be different and we talk about this in the book. For me, it was realizing, and that’s what we go and describe in the book that I’ve developed healthcare disease. That’s a weird thing to say because the system that heals you is making in some ways, also people that work into it sick. For me, it was to realize that the mechanism I had developed, the models I’ve had over the years, my personality traits, the things I’ve acquired over the last 15 years were slowly impacting all aspects of my life. From one day to the other, I started to peel off. I took almost six months off in Thailand by myself, sold everything after changing professions and starting over.
The book is the story about the last three to five years. But mostly, what I went through personally putting it all together is what I see as a maybe a process that a lot of us, not just about physicians, but healthcare workers and healthcare workforce go through at some point in our career. I was also very tired to see other people going through things and not knowing where to go, whether it’s burnout, whether it’s even clinical manifestation of stress and anxiety. I’ve had colleagues that unfortunately passed away from that.
Jen: I think we all have.
Dr. Simon: Yeah. So, it became a necessity for me to just act upon it. In the book, it’s fairly easy, sort of described as a disease where I see the event, whether it’s burnout, or anxiety, or depression, or any other of those addiction development, alcoholism, or the end result of something more chronic. And that we acquire, it’s hard for us to rewire our brain to see things differently, and we feel like we need to continue. Then, in the middle of the book, we have almost 20 healthcare workers that have been nice enough to share their story. We separate them into four different classes. Then, towards the last part of the book, we give steps for potential recovery and what helped me throughout the process.
Jen: So, how long would you say the process was that you were feeling the symptoms of burnout, which you describe before you actually woke up and realized, “This is something I have to address.” How long would you say that process was in retrospect?
Dr. Simon: Right. Retrospectively, it was probably a longer process than I actually think it is. But it hadn’t been going quite right for, I’d say a couple of years. I was still, for lack of better term, at the top of my game, meaning, I was doing 400 surgeries a year, I was on every single committee, I was publishing a paper every two weeks, I had a lot of accolades. But then, there are other places in my life where sometimes, I made a wrong decision personally, sometimes, I would make decisions about my family that weren’t perfect and retrospectively wasn’t the right one. Then, sometimes with patients too, I wouldn’t have devastating consequences of surgery. Sometimes, you have complications and things, and it used to really be a moment for me to introspect, to write down what happened, to look at the steps and try to make it better, but it became a bit this job that always part of it, “Oh, patient was sick.”
So, looking back I think the symptoms of the problem were there before and it’s hard to explain how it came together, but I would say that, it’s like, I was looking at myself from the outside in and at some point, I realized that I was the one in the highway driving the wrong way. And then, for people like me, because in some ways, what I do is heart surgery. It takes a fair amount of confidence and ego. I mean, it’s not a secret. Heart surgeons have egos that are hard to deal with usually, but mine was pretty big. And the parts that have helped me get to where I am, the ego is sort of a catch-22 thing, where the parts that help you oftentimes will have an impact on other things in a not so positive way. You know, the competition, the self-criticism, so those things gradually took a lot of place.
Well, I said, “Well, if all these things are happening” and then, you call me, “oh, they’re happening to other people,” but the common denominator is me. [laughs] That was the realization at some point that I needed to refocus, I needed to look at the values, I needed to take a pause to reassess what I was doing and how I was doing it.
Jen: I want to take a moment. As you pointed out to thank our families, by the way, who do make huge sacrifices that often go unrecognized as we try to be everything we can be at work, you do often take a backburner. All this especially with someone who’s so incredibly driven and I can’t imagine how you’ve managed to accomplish as much as you have? But I’m wondering whether this process has had you redefine the meaning of success in any way.
Dr. Simon: Yeah, and that’s a very good comment and question. I think the success part is not only redefined through that because you were talking about family, and I think that’s critical. When you face those challenges, the system is pretty good about pointing it out. When you’re at the point of burnout, or there’s a problem with a patient, or you’re addicted to something, there’s a system in place in the system to help you. Now, it is just a moment in time where a lot of it is to check boxes from an HR perspective and make it better. If you really want to truly make a change, there’s got to be a question you need to ask yourself, whether you’re in the right field, and you’re in the right space, and whether this lifestyle is appropriate for you. And you’re right when you do all these things, your life becomes fused to what we do. It’s very hard, especially, for physicians or healthcare workers to say, “Well, I’ve done this all my life and maybe that’s not what I need to do now,” and that part is hard not only just conceptually to say, “I’m going to do something different,” but also personally, right? You studied all these years, your mom will be disappointed, your friends will look at you, you have this second-degree gratification from society about work, about things that, “He’s a doctor, why does he want to do something different?” So, for me redefining success was important, what it meant for me, and that changes over time. And realizing that, maybe, now the success is having a good day with my son going to Universal Studio with him, and then, tomorrow, it will be to maybe feel better about my health, and overall, maybe, treating a complicated patient. So, not always defining success with the amount of cases you do, the amount of papers you published, and then realizing that that’s okay.
Now, looking back, I loved what I do, and I still do, and I still publish not as much, but I still do. But I do it differently. I do it because I invest in it, I just don’t do it to put my name on something or having you know, PubMed my name, and have the most papers out of people that were in my medical school promotion. So, doing it from more of a better insight than before. Yeah, success is an important one and it’s a changing concept for a lot of us. I feel like realizing that is a first step to perhaps making it better. For some people, it will be to leave it completely.
Jen: So, that’s a good point as well. I think a lot of us tend to think in black and white. So, it’s like, you’re either all in and publishing in your case to the greatest extent that you possibly can personally, in your case, which is at a phenomenal level, and you’re doing an incredible number of surgeries. So, when you stepped back and made these changes and took some time off, when you came back, did you find a place in between completely leaving medicine and working all the time or did you leave medicine altogether? How did you find the right balance?
Dr. Simon: Right. When I took a step back, the day was filled with time. [laughs] You know, it’s amazing. It was in between jobs. So, I said I’m going to take a break operating and take an extended period of time before I started a new one. So, I had this possibility and I went, as I said, to a different country in Thailand for a period of time and let go all the emails and the responsibilities. So, suddenly, you’re really faced with yourself a lot.
Then, we talk about this in the book and there’s only really three ways to avoid having a disease in general. It’s to change your exposure to it. So, I’m leaving, and I’m not getting exposed to this bug or this bacteria, or this milieu. It’s to remove yourself from it to say, “I’m going to change myself or develop a certain way to immune system or some therapy to make it better or I’m going to change my interaction with it.” It’s the conditions that are in it. And so, for me, while initially, I went to these meetings in Chicago, I remember physicians that want to move away from medicine and fair enough, there were like 500 people looking to do something different. Someone opened a coffee shop, I’m going to travel around the world and make it like a humanitarian type situation. I think the best solution for me out of those three was to find a way to interact better with the system.
So, to answer your question, when I came back, I established a series of balances that for me were a way to, we talk about this in the last portion to book, virus scan myself. The book’s called Healthcare Anonymous. I know there’s a step within the Alcoholics Anonymous recovery that talks about how to check yourself and then make sure that when you feel tired, when you feel hungry, when you feel like you’re at a craving, you have a problem and you’re taking on too much. So, I try to be alert every day and I take moments during the day that are always the same ones. Usually, it’s after my first surgery, I’ll eat out and I’ll take a moment for me, myself. No meeting, no discussion about the next case.
And I’ll try to assess where I’m at in my day. Am I tired? Am I stressed? Am I thinking about something else? Usually, if I’m at peace and I’m happy with what I did, and I feel it’s a good day, usually it’s because I’m in check. Now, if I feel like I’m missing time, I’ve got to call this, I’ve got to do this, I’m running between cases. That’s because I failed the virus scan test. That means then letting go things. Maybe doing more meditation, maybe taking time off, maybe reducing my caseload. So, I’ve learned on a daily basis and it’s a learning process to try to do that.
I try to meditate a little bit. My wife’s trying to get me into that more, but I try to meditate and do breath work which has been helpful. If you also bring people to be around you as a community and that’s not being like a guru type person, but like, if you inspire this environment around you, it helps you keep yourself in check. So, I encourage some of the nurses to speak up, I try to be nice. Being a heart surgeon and being nice is sort of this antagonistic sentence, but I try to do that, and work hard to do that, and that’s helped me to keep myself in check. So, I went back, I practice now. I don’t practice as much. I still do high end surgeries, but I do it in the more of a Simon controlled way.
Jen: That’s an excellent solution and all really good advice. It actually reminds me, when you talk about going to that conference where physicians were all there, and someone had to open a coffee shop, and someone had to leave and travel the world, that reminds me, I don’t know if you ever saw this show years ago called Mad About You, but I remember when I was a medical student, I used to watch it. The main characters in the show had a friend who was a cardiologist, and he quit his job, and went to work in a coffee shop as a waiter or in a restaurant as a waiter. As a medical student, I remember watching that and thinking, “That is so ridiculous. No doctor would ever do that.” [laughs]
Dr. Simon: Listen– [crosstalk]
Jen: And now, of course, I can completely understand why someone would want to do that, and maybe step away, and remove that immense responsibility. [crosstalk]
Dr. Simon: Absolutely. When you get to this point where your identity is challenged, where all you’ve learned you’re afraid of talking about it because you feel being judged. You know, I had so many conversations with one of my friends who was going through a similar process to say, “Why don’t we just open a coffee shop and then just be our own bosses?” But reality is if you don’t treat the problem, you’re going to carry it to whatever you’re going to accomplish. It’s hard because we talk about character traits in the book, how we develop our character traits in basically between 15 and 30 years old, and after that everything’s pretty much fixed. Well, while we’re in medicine or training, that’s where we’re on call, we are at the hospital all the time, we learn how to react in a certain way without having the maturity to do it. So, I wonder sometimes and I wonder at the moment, whether some part of medicine would have been a better fit for my skills. It would have been recognized before, maybe heart surgery wasn’t the right choice for my personality. Maybe I would have done something different that would potentially be more fulfilling or avoid being in this process at 40 some years old. And that’s part of education, maybe some education we need to bring early on in training and in the hospital system.
Jen: Well, another thing that comes to mind listening to your story that I have to commend you for is, the financial ability to step away at the time when you needed to and that’s something else that I feel really passionate about is just helping physicians to educate themselves about how they can put themselves in a position to be financially free or to be financially independent, so that they can get into a safety zone where if they ever need to walk away for any reason or to step back and work less, that they have that option, and I think for a lot of physicians, of course, we have the debt problem in the United States, especially, early in our careers, which can make us feel like indentured servants.
But I think, if people do take the steps to get themselves into a secure position, it’s not necessarily what you might ultimately be aiming for, but just to aim for a number that gets you into a place of security, where you could live frugally if you need to. That, I think, gives a lot of peace of mind. And so, even if you don’t walk away at all, but you then have the peace of mind to feel like you’re in control, gives you a little bit more, I think, power to come back around to maybe help fix some things in your own world or in the system that might be broken as opposed to feeling overwhelmed by those things or to be at the table, I guess, with some potential solutions.
Dr. Simon: Yeah. And I think to be at the table and to surround yourself with likeminded people, not that it’s a bad thing to be with people that just work, work, work. I have friends that are certainly stuck in this sort of mindset still. But what you’re describing is doing in more of a hybrid way where you start identifying values and things you’d like to do outside of work, and maybe how you can turn this into a business for me, now, it’s become being a book author, now, perhaps spreading a word out, and then we are also launching our coaching business. So, for high-performing people, healthcare clients being a part of that, we have professional athletes, musicians, and business people that are within the same– All the themes are common, right? It’s like the dedication to your work, it’s the family, it’s the values. So, we’re starting conventional and functional medicine helped program for this group of people.
It’s finding a way to make yourself or changing a bit of your identity from being just someone that goes to work from Monday to Friday and on call every four and that’s okay. I think, medicine in general, I was just reading this Harvard Business Review. With COVID, a lot of people have gone home and do this hybrid sort of work now. While telemedicine has been forced on healthcare, I think, a lot of places for right or wrong reasons are trying to move away from it now that COVID is getting a bit better. I think that’s the future. A lot of enterprises and Google tech companies have realized that, and I think it would also increase the satisfaction in family values if physicians or healthcare workers would have this ability to leverage and be more efficient at work and leverage some of the technology.
I don’t need to see patients at my office, an 83-year-old and use a percutaneous valve. They have to travel two or three hours with their family. Honestly, I could see all their tests and talk with them for 45 minutes and see them the day of, and they would probably solve a lot of this back and forth and inefficiencies. I can go from having a coffee with my wife and having a consultation, going back playing with my son, and have the same sort of work done. But healthcare is a bit slow to adopt some of that stuff. I hope that some places will be proactive to leverage some of that mindset to help people move away from just being at work with a white coat from Monday to Friday, and then every four call.
Jen: Thank you so much. Dr. Simon Maltais, wonderful points of wisdom. terrific advice, and I’m excited to read your book, Healthcare Anonymous, learn how to put yourself first while pursuing a calling.
Dr. Simon: Yeah.
Jen: Coming out in April, but you can preorder the book now, and we’ll put a link in the show notes.
Dr. Simon: We have a website where people can go and look at the book and some of the people that have read it before the release. Dr. [unintelligible [00:21:49], who is one of the leaders, he has read the book and is supportive. So, we’re pretty thankful to have that kind of support.
Jen: I can’t wait to check it out and look forward to talking with you, again.
Jen: Do you ever feel as a physician that you’ve lost the connection between why you went to medical school and what you’re doing now in your career? As a physician, you’re trying to make so many people happy all day long and you’re trying to accommodate whatever is heaped upon you as excessive as it often is. But what if you had an online community of like minded physicians facilitated by coaches who specialize in working with physicians to help you get back on track and figure out what matters most specifically to you?
Amanda: I’m Amanda Taran, producer of DocWorking: The Whole Physician Podcast. Thank you for being here. Please check us out at docworking.com and please don’t forget to like and subscribe. Thank you for listening.