Latest / Coffee Playdate Podcast with Dr. Olga Deengar / Why Career In Medicine Burns Out Women Ep 48: Dr. Shona Velamakanni's Mission On What Actually Helps
Transcript
- Dr. Olga Deengar: Welcome to the Coffee Playdate Podcast. I'm Dr. Olga Deengar your host, and we have a very special guest with us here today, Dr. Shona Velamakanni, Welcome. Shona Velamakanni MD: Thank you. Thanks for having me. Dr. Olga Deengar: It's great to have you here. I always like to ask my guests if they drink any coffee. So do you drink coffee? Shona Velamakanni MD: course. I don't know any other doctor that that doesn't. It's a fuel for energy for sure. Dr. Olga Deengar: Absolutely. And how do you like your coffee? Shona Velamakanni MD: So my favorite cup of coffee is a Dunkin' Donuts hazelnut coffee with the splash of skim milk and a sugar. Dr. Olga Deengar: I like that. Shona Velamakanni MD: I learned I learned how to drink that in medical school. So it's my go to. Dr. Olga Deengar: Amazing. Well, let's get started with our first game. It's a rapid fires questions game. So I'm gonna give you two answers. You choose between them, whichever one you like more. You don't have to explain yourself, just go with your gut instinct. Ready? First question, explaining heart disease with an analogy or drawing the heart on a piece of paper? Shona Velamakanni MD: Analogy. Dr. Olga Deengar: Cool. Which one is trickier, talking to patients about blood pressure management or cholesterol management? Shona Velamakanni MD: Cholesterol management. Dr. Olga Deengar: If you had to choose the mitral valve or the aortic valve. Shona Velamakanni MD: Ooh, that's a tough one. Mitral. Dr. Olga Deengar: Very cool. And the last question here a cardiac care breakthrough in technology or a simple lifestyle change that patients can actually stick? Shona Velamakanni MD: Simple lifestyle change. Dr. Olga Deengar: Awesome. Now for the next game, it's called Take a Sip. It's the same concept, but we both answer. And if our answer is one, Shona Velamakanni MD: Perfect. Dr. Olga Deengar: then we take a sip from our coffee cup. Shona Velamakanni MD: Okay, sounds good. Dr. Olga Deengar: First question a perfectly organized calendar or a completely free Saturday? Shona Velamakanni MD: Organized calendar. Dr. Olga Deengar: Yes, me too. Next question here, giving the advice or receiving the advice you didn't know you needed. Shona Velamakanni MD: Giving the advice Dr. Olga Deengar: I'm gonna say receiving the advice. Just depends what you'd sort of need right now in your life, you know. All Shona Velamakanni MD: Right. Dr. Olga Deengar: good. Next one is a community built around career advancement or one built around real life support outside of medicine? Shona Velamakanni MD: Real life support outside of medicine. Dr. Olga Deengar: Real life support, cheers to that. Shona Velamakanni MD: First. Dr. Olga Deengar: And the last question, would you rather travel to the Caribbean or to Alaska for your next vacation? Shona Velamakanni MD: Definitely the Caribbean. Dr. Olga Deengar: The Caribbean same here. Shona Velamakanni MD: Cheers. Dr. Olga Deengar: I like to throw little fun ones in there once in a while. Shona Velamakanni MD: Yeah, for sure. Dr. Olga Deengar: All right, so Shona, I'd love for you to tell our audience a little bit about yourself and what kind of community you've built. Shona Velamakanni MD: So I'm a non invasive cardiologist. I recently read a stat that almost 85 to 90% of women physicians are firstborn daughters. That includes me. I'm a firstborn daughter. my I grew up all over the country, and actually, where I live right now in Naples, Florida, is the longest I've ever lived in a place. And it's been really wonderful to be able to develop a community not only of women physicians that I rely on for support and professional networking, but also to be part of a community where we know so many of our children's teachers, our coaches, our our our kids' teammates, our or a lot of our colleagues in the hospital, and other businesses, you know, in town, after living here for so long, you really get to know people in all different facets and different ways. So that is a little bit about myself and why I believe so much in really investing in the community and that we live in and work in. Dr. Olga Deengar: that's wonderful. It sounds like you've been traveling a lot throughout your you know, you're growing up. what made you kind of what sparked this idea of creating the community? Is this something that you were missing in your life? Is having kind of a stable place? Shona Velamakanni MD: Yeah, I think that's part of it. I, my parents are immigrants. so my dad is a PhD in pharmacology before he went to medical school and became a nephrologist. My mom's a social worker. and we lived in different parts of the country. I was born in Texas, then California, lived in Louisiana, outside of New Orleans, and then northern New Jersey where I grew up. and so for me, I learned quickly how to adapt. I played sports. That really was another language for me to help me know my community. and I was very, very close and still am with my family. but I do think that longitudinal relationship with friends was a little bit harder to maintain because we moved so much. And here, after you know, having our kids and raising them here and really being able to establish roots in a place, it really added a lot of extra color to life, a lot of joy, a lot of reward. And I think the main thing I was always raised with was that you have to give back, for from those things that you've always received. So I think the more you invest in your community, the more you enjoy and it it's a perpetual cycle that really feeds itself. Dr. Olga Deengar: Yeah. And do you feel like there is a need for a community for women physicians in in the Naples area? Was there anything that kind of existed beforehand or Shona Velamakanni MD: No, so my story was that, I trained in cardiology in the Georgetown Washington Hospital Center for both residency and fellowship. I was very lucky. We had one of those unicorn programs where at least 50% of the fellows that I trained with were women in cardiology. That was very different compared to most programs around the country. and honestly, most of my track and trajectory through the cardiology training was always guided by sort of a big sister. I had the cur I had female attendings, I had, female senior fellows ahead of me even as a resident. And watching them go through their journey gave me more courage, to go through mine. specifically in fellowship, my direct the fellow right ahead of me, she had been with me through residency. She was married for a while, they had triplets during fellowship. And I thought, wow, if if she could do three kids, I could try for maybe one. So Before I graduated fellowship, I had my first child and we quickly learned that we needed family backup. And they my parents at this point lived in Southwest Florida. So after fellowship, we really looked to relocate to Florida. We didn't know a soul here, but we knew that we had some family backup and then we relocated here. And when I landed in Naples, I was the only female specialist at that time hired by the hospital and really had been. going through the journey of being a mom and a female cardiologist on my own. obviously I had the support of my husband, he's a cardiologist too, but the I think the mom experience is pretty unique, especially with the demanding career in medicine. And going through some of those challenges and then having additional kids as an attending, I really kind of missed that sisterhood that I had had in training and realized it's a lot easier if we could create a network for each other. and that's really what inspired me to Work on making the women's physician society a reality. Dr. Olga Deengar: That's amazing. Yes, we all need that support from our community, our friends, our colleagues, because it's important. Even, you know, someone who would just listen for a couple of minutes and just help you, you know, throw some ideas around as to what you can do to kind of improve on a specific aspect of your family life, for instance. Shona Velamakanni MD: Absolutely. Dr. Olga Deengar: So I'm wondering what was that first step? What what did you do next to create this group? Shona Velamakanni MD: So initially when I started, you know, I had these thoughts when I was a young attending, and honestly, between having children and just establishing your career, you're that's all you can handle in life. I think after I had our our third child, by then we also had had like a slight change in administration. And we actually, when you look around, we didn't have many women in the C suite. We had no women in any of the medical leadership positions in terms of department chairs. and a lot of the the the feeling was that it wasn't very welcoming to women, particularly since the structure of medicine inherently wasn't really geared for women, right? I mean, we all have 7 a.m. meetings, ridiculously early rounds, late meetings after clinic, during dinner time, you know, it's it's almost like the whole school drop-off and spending time with your kids and family is an afterthought. And even now for both men and women, it's a priority, right? So a lot of those things still need some structural change, which is nice because it affects both men and women in today's you know, world of working docs. but I basically went to the administration and said, you know, we're graduating at that point, 50% of women in medical school are graduating into the medical field and we're not making the field of medicine very friendly for women. And in my local community, I think we should need to do what we can. I went to them and said we need to see what we can do to change the culture. And so we started the Women's Physician Society with the support of our hospital administration and really allowed women to we have events where we they can network. We have a mentorship program, we have a residency program so we have young attendings and mid-career attendings and senior attendings that help mentor our residents and we do that for each other. we have early career doctors who pair with almost about to retire career doctors so they can share their pearls of how they get navigated life. I think one thing most of us don't really fully grasp when we're in training is that medicine really can absorb your whole life if you let it. And if you don't put up boundaries it can really eat you up and burn you out really quick. And so you you can't learn that unless you talk to people who have walked that road ahead of you. And that's what I try to do is, linked up with mentors that are ahead of me, but I do my best to also linked up with those following me to make that path easier for them as well. Dr. Olga Deengar: Yeah. that's a great mission. And you mentioned mentorship. Now, do you feel like having a mentor and mentee, it sounds like you have both. do you feel like the burnout rates have gone down overall? Shona Velamakanni MD: So if you look at our data and we do the AMA survey data now for the last four years, our burnout rates are almost the same as they are nationally. We did make a little bit more of a dent locally here. We definitely see more women retained in medicine than we did, you know, five years ago. We definitely see more women assume leadership positions now in the hospital. So those are gains that we definitely can tangibly see. and I've actually talked to a lot of residents who we've recruited to be able to stay on as attendees in the community. And they say a large part of that is because of their experience with the that kind of a mentorship program that there are different resources in the community that have been identified for them for them to want to stay. So that that's a really nice thing. I think we're still early on. this battle for women and burnout in medicine is is a national issue. That I don't think any system has quite perfected yet. I think that there's still a lot of structural things inherent in medicine that was inherited by a lot of us that still need to be reframed. To be honest, I actually think COVID did a lot for those of us who are not in major academic centers in the Northeast to allow us to be able to attend meetings by WebEx. before it was considered you know, you weren't as engaged in your career if you if you asked for that. You had to be there present, you know, in person. And now I do think that the the the framework has changed a bit to at least allow you to participate. just because I can't attend a meeting in person doesn't mean I'm less engaged. It just means, I have I'm trying to manage multiple things that logistically requires me not to be, you know, on campus for every single meeting, especially when they're at 7 a.m. and 7 PM, you know, on a daily basis. So I think those kinds of things, you know, have worked in our favor, but there's lots of other things where medicine doesn't have, normal beginning and end times. that's something that I think we're all still trying to figure out. Dr. Olga Deengar: Yeah, it's it's a never ending struggle. Shona Velamakanni MD: It is. Dr. Olga Deengar: And you're absolutely right. There is a big misrepresentation of women in medicine. And when they do get to leadership roles, there's just a lot more work that they end up having to do, whether that's more administrative work or taking on extra responsibilities. So it is really important to have that support. Shona Velamakanni MD: And I think that's one of the most under identified drivers of burnout in women women are doing a lot of the unsung hero work in these in these institutions that are not RVU based, right? I mean our system looks at RVUs. So you only are the value if you're bringing in revenue for a patient. But in terms of you know, a lot of a lot of women are teaching and teaching is not necessarily very well paid. Women are doing administrative work, which you don't necessarily get paid for, right? When you can answer an inbox question for a patient and make them feel really good, that doesn't get you any more any more revenue according to the you know, to the hospital than someone who just answers a c a question in a cursory way, So there are a lot of things that are more in the gray zone that women aren't getting necessarily paid for, recognized for that I do think is leading to burnout because if you're just looking at the performance of physicians on a metric spreadsheet, you're you're missing the whole picture. Right. I do think medicine is art, and some of that art can't be depicted in a Excel spreadsheet and I think that's where it's missing. And if everyone got recognized for that too, that would also help decrease burnout because that's really what drives most of us to be doctors, right? We want to make people feel good. We want to make people healthy, we want to help them live longer, and that that's what rewards us personally. But it would be nice if we got professional credit for that too, instead of just looking at how productive all of us are, on a on a spreadsheet. Dr. Olga Deengar: That's a great point. have you thought about any type of kind of ways to implement those as metrics for burnout or measuring burnout? Shona Velamakanni MD: Yeah, we've talked about in the past there's a lot of trials now or or sorry not trials, I should say research, but that's been published about, outcomes, quality outcomes. there are this patient satisfaction scores, which I just think sometimes we choose things that are easy to measure because we don't know how to measure things, right? I mean, I think that's the root cause of a lot of these issues is that you're you're trusting people who don't necessarily fully understand the clinician to patient relationship. trying to find these random markers to measure and we miss the point. and we do that in disease and science as well, right? I mean, we sometimes we still don't know the root causes of things. We're just looking at markers and trying to track things to see how we can affect clinical endpoints. Translating that to burnout, sometimes I just think we're not measuring the right things. Obviously we still need, money to to keep the lights on and the, and the engine running. and we obviously want to have great outcomes for our patients. But I think that as a physician, we all know that in order to have really happy, well cared for patients, you need to have a really healthy workforce. And I think that is something that all of us need to get better at advocating for Dr. Olga Deengar: Yeah, and it's societies like this that bring women physicians together that can really help shine the light on all of these different problems that women are facing. And not just women, men too, but here we're focusing on, the society that you've you've created. I'm really curious to know, was there maybe a conversation or a moment in time? event with with your peers where you just thought, this is why we do this. Shona Velamakanni MD: Yeah, I have I had a female physician really struggling with how she was trying to do, you know, raise her family and still get credit at work for kind of leaning in and being a leader. And she came to me and said, I'm just I don't know if I can do this anymore. I don't know if I can I can stay in medicine anymore. The demands are just too high and this is too hard. And so, and she didn't necessarily have the same, family support network that I had the advantage of having. And I said, Okay, well, what's gonna happen if you just take a break? If you need a break and you need a year to think about it, do it. And I said, You're in demand, you have a very specialized skill set, you can do it if you want to. And just reset yourself And then when you come back, negotiate the life you want. So if you don't want call, ask for it. you'll get paid less. But if that's what it takes to make you happy, that's it. We're always racing and racing But the truth of it is medicine is a marathon. And you can really pace yourself in order to finish the way you want to finish, And in Finishing first doesn't mean crossing that finish line. Finishing first might be making the most difference and help as many people as you can to the best of your ability. And so for her, she took a year off and she did. She reset the table and she was able to come back and, I helped talk her through, you know, how t how how to negotiate what her position was. And She came back happier and she's more engaged and she has more control over her life and her schedule. So to me, I was like, yes, this is why we, came together to do this. And it's not a one size size fits all approach. Every single person chooses different things. So actually this year I took a a big step and I changed my hour commitment. So I'm able to have a little bit more free time. I still do work. You know, I still read studies, which if even if I see less patients in clinic, because I feel like that's my way of contributing, but it gives me more time and it works at the pace that I want to work. And I kind of wonder why didn't I have the courage to do this before? It's just that no one else before me had done it. But as I saw some of my colleagues do this in other fields, I thought, why not? And sure enough, there's no reason why I couldn't have and I'm glad I did. So I have more time now and it that makes me a lot more balanced and a lot happier. Dr. Olga Deengar: That's amazing. It is really hard to take that step on your own because like you said, you just kind of adjust to the system and you say, Well, this is just how things are. Shona Velamakanni MD: You don't know that you can ask for more or ask for different and it and it's nice when you can bounce ideas off of other people who are perhaps asking that question, why not? Dr. Olga Deengar: Exactly. I'm really glad that you were following the path that you wanted to follow, something that felt more aligned with your values and being able to take a little bit of pressure off seeing more patients. It's it's good. Free up your time. Yeah. Shona Velamakanni MD: Right. That's right. Yeah. Dr. Olga Deengar: Good. now I do I do want to ask if there's someone who's listening right now who's a female physician, who's looking for more support. What would be a good way or what would be the next step for her to start creating that circle of colleagues around her? Shona Velamakanni MD: So, I was originally engaged through the women's cardiology chapters in my state, right? So we have the American College of Cardiology, it's incredibly organized and there are lots of different state chapters, there's a national meeting, and so I got a lot of my ideas actually from them to say, why couldn't I do something like this local? I mean, obviously we're more than just cardiologists in our society, there's not that many women cardiologists anyway, right? But we were able to I was able to use that kind of model of reaching out and having meetings and having network to see who would who would be invited. So ours is multidisciplinary. We have hospitalists, we have pediatricians, we have ER doctors, we have pain specialists, you you plastic surgeons. I mean, it runs a whole gamut of the the female physicians that we were able to get within our institution. But our medical staff office was a resource for me to be able to reach out and say, hey, can you identify who our female physicians are who have privileges at our hospital? Can I email them, let them know that, I'm interested in starting this? And if you guys anybody wants to be part of the steering committee. So we now have at least six or seven members who we've identified sub chairs where we have someone who looks at data because we do the AMA survey and we actually do categorize it also based on gender. We have a communications chair, so she's able to post all the events that we're doing and any, you know, topics that we're we're planning on covering. We have a engagement chair, so that's someone who is able to come up with ideas for what topics that the you know the medical staff want to talk about. And then we have a mentorship chair, someone who helps organize the attendings with residents as well as early career with you know late career docs to be able to meet up for coffee. So that's kind of how we organized our women in medicine chapter. We call it the Women's Physician Society at NCH. and I would say that's the best way to approach it And you'd be shocked how many people are really interested in doing this. And if you just take a little bit of time to invest in those kinds of networking, not only does it help your practice, it helps your overall well-being, it helps you share resources. we have people who've shared nannies, dry best dry cleaning spots, cleaning services, landscapers. you name it, every service out there. people say, Hey, what's your experience? It actually could help save you time in terms of searching for a lot of these things too. And in fact, September is coming up as Women in Medicine Month. We have a huge celebration that we do. every year. So all of our grand round speakers are women physicians. They have a platform either to talk about something that's important to their practice or an important topic for women in medicine. We have a panel actually coming up next week where we have early, mid, and late career docs of different employment models, who help talk about how you navigate the landscape of medicine with our residents. and then of course we have some, you know. nice networking, cocktail hours and events to be able to socialize. Dr. Olga Deengar: This is incredible. How did you even go about putting it all together? So let me let me focus my question here. Did you know that you were gonna create this team all at once, or did you assign, let's say, the mentorship coordinator first and then kind of built out the departments as they went along? Shona Velamakanni MD: So we identified interested members and then we actually I talked to at that time we had a female CMO, which is part of that that that sphere of influence the Women's Physician Society had on the original C suite when when the administration new administration came on board. You know, they were very good about making sure they had a a chief medical officer that was that was a female or at least some sort of female influence in the C suite, which was fantastic at the time. And she put us in touch with someone she had met through her network over in California. And they had an organizer that explained how they structured their women's physician society. And so we took a hint off of them and we sort of tailored it to our hospital and our system in our community as to what would work. And so everybody decided what they were most interested in in spearheading. And then everyone kind of came to our all of our meetings. We meet monthly and we kind of throw in what it is we'd like to do. There are certain times of our calendar, you know, here in Southwest Florida, we are very seasonal where our patient influx is just triple, you know, from January through April. So we try to minimize our events then, but we have support networks, we'll have an ice cream social so everyone can just have some sugar for their stress and talk it out, right? But then you know, in the off season we were able to have more, you know, team building events. So we've done things like cooking classes, pottery painting, paint and sip events, you know, we've gone on little sailboat cruises, you know. We also pair with our wellness committee overall too. So there are It's not all necessarily all for women. Sometimes we can do men and women events. It just gives us a unique way of networking with each other. And I think we've we've all found we've also you find a lot of female patients want to see other female specialists. or, primary care doctors. And so we end up referring to each other. And it's just it's it's easier when you can basically text someone on your phone rather than have to, look 'up on the internet and cold call someone and try to introduce yourself. So I think it works out great. It works out great for us and for our patients too. So Dr. Olga Deengar: That's amazing. And thinking back to medical school, did you envision yourself creating this amazing community? Shona Velamakanni MD: No, actually I think most of us in medical school are just trying to survive and figure out how we're gonna do this. You know, I you know, my my dad, as I mentioned, went to medical school later in life. So when I was in middle school and high school, I watched him go through residency. And that's pretty much where my view of medicine, came from. And I I said, if you can survive residency, you can be a doctor, right? I didn't see necessarily what life was like as an attending. My kids joke, Mom, when we go do homework, you do homework too. That's when you they they go do their homework and I go either finish charting or reading echoes or whatever, cardiac imaging I'm reading in my study. I don't I would have had a different perspective, had I been able to see that part of it too as as a kid. but when I was in medical school, it was just about really getting through all the curriculum, getting through those rotations, doing the best you can. Only when I started to do clinical rotations and, for early part of my training I thought I was going to be a surgeon. I really was sensitive to that issue too. I didn't re even realize cardiology that issue until later into my twenties, that there were less women in cardiology because it was an internal medicine subspecialty. You know, half the internal medicine residents were female. So it it didn't even strike me as an as a real issue. until I started interviewing for jobs and seeing what the landscape was like there. And that's true today, too, even for our trainees. I always tell them, it's a very different world out there when you come out as an attending. so don't expect that same culture that you, you know, it had the joy of experiencing as a resident or as a as a student. You're pretty protected, you know, compared to what life is like out there as an attending. You kind of have to pave your own path. And after doing that, I realized that's that doesn't have to be that way. And that's really what prompted me to to to build this community. Dr. Olga Deengar: what a story. This is so cool. Thank you for sharing. I Shona Velamakanni MD: Of course. Dr. Olga Deengar: would like to end by asking two questions. The first is if there's someone who is planning to create a community for women physicians in their local town, what advice would you give them? Shona Velamakanni MD: So I would say, make sure that you get the support of your institution. It's a lot easier to do it that way if you're going to be reaching out to people within your institution. I will tell you we had a female physician who just moved to town. She was the spouse of one of my colleagues and she didn't know anyone and she just somehow reached maybe two physicians she had met and she said, Is there a local outside of a hospital women's physician group and they said no why don't you start one and so she sent out a text saying hey I would love to meet some women physicians I booked a date you know at a cafe let's meet up and then more women physicians kept adding and adding and adding to this WhatsApp chat. We have I think three hundred and forty four women physicians between I live in Collier County, Lee County as well that are now interested in meeting and now we have to find a space that's big enough. So you can start it I mean This this doc started it, you know, just with a WhatsApp chat with with a few, a few female physicians. I think it's just people are waiting actually, I think, for networking and community. And I and I think it wouldn't be really hard for you to start it. but I would say that making the time to see it through is also really important. if I had just started saying, hey, let's meet, but didn't necessarily try to have any sort of structure behind it, I think this kind of thing can fall apart. So I do think for me, having those subcommittees, having that steering committee, having that engagement from those women who wanted to be leaders really did help galvanize more interest. And in fact, now we're we're looking at we just elected a whole bunch of new chairs to take over, passing it off to the next generation because we've been doing this for about seven years. so I think it's starting, you know, it has roots now and now it just needs to grow further and further. But it becomes more relevant, especially addressing topics that are important to women. whether it's contract negotiation, work life balance, family, caregiving, taking care of parents, taking care of children, all of these things affect us in all different ways. And so I think the more open you are, and the the more strength that you invite, I think the more powerful your community can become. Dr. Olga Deengar: That's great advice. Thank you for that. And I always like to ask, is there a book recommendation that you have for our listeners today? Shona Velamakanni MD: So I've recently read a couple of you know, I'm I actually really get inspired by fiction, but I've taken a deviation and honestly, life has been so busy. I would love to tell you that I'm an avid book reader and I'm lucky to get in a maybe a book or two a year. I think the last two books that I read both had different women empowerment messages. One was Untamed and the other was Let Them some of these lessons I learned already before I even read these books, but it crystallized them in interesting ways and interesting stories. but the biggest advice I would also give people that you asked me before. that I strongly feel in terms of how to maybe approach our life in medicine is a lot of the tools that were in our toolbox to help survive our medical school and our residency and our training are not the same toolbox that we need as attendings. We need to find a different set of tools because it is a marathon and we want to enjoy life. And I I think rather than getting devoured by our careers, that we need to say, I need balance, I need I need my family, I need my fun, I need my hobbies, I need an off-ramp for when I decide not to be a doctor anymore, maybe in the future when you either retire or move on. but I think those things are really important and to realize some of the tools that we use to survive might actually harm us as as attendings. And we need to kind of rethink how we think about resiliency, how we think about our passions in life and make sure that they're balanced. Dr. Olga Deengar: Yes, there's nothing more important than balance in life. Absolutely. You gotta have your physical health, emotional health, relationships, like work, everything. Got Shona Velamakanni MD: That's right. That's right. Dr. Olga Deengar: a good spot. Well, thank you so much, Shona, for joining us today. We had an insightful conversation. I really enjoyed it. Thanks for sharing everything that you've shared with us today. And it's been a pleasure. Shona Velamakanni MD: Thank you so much for having me.