Torie Sepah, MD, completed her internship in family medicine at Kaiser Permanente Los Angeles Medical Center, then went on to complete a psychiatry residency at LA County + USC Medical Center. She has studied physician burnout syndrome extensively. It is a topic that is very personal to her and we discuss why. She defines the syndrome, what the major causes are, what the consequences are and what has actually been proven to help. Among them is connection.
Her Facebook group – Physician to Physician: Healing the Practice of Medicine, has become a signal in the noise surrounding burnout, providing us with a community of physicians who understand the hardships of our field and can help.
She has worked extensively in correctional medicine, having served as the chief psychiatrist at the California Institution for Women, being the first female chief psychiatrist at that prison.
Since 2018, Dr. Sepah is a community psychiatrist once again, seeing patients with HIV in an integrated clinic and running her own interventional psychiatry clinic, which focuses on deep Transcranial Magnetic Stimulation (dTMS) as well as reproductive psychiatry, neuropsychiatric disorders, and early diagnoses or schizophrenia.
Dr. Sepah is an assistant clinical professor, department of psychiatry, Keck School of Medicine of USC. Prior to becoming a physician, she was a journalist and assistant editor of Ms. Magazine, writing the health column which prompted her interest in medicine. Dr. Sepah can be reached at her self-titled site, Torie Sepah, MD, and on Twitter @toriesepahmd.
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Disclaimer: This is the transcript to the episode. This transcript was created by a talk to text application and the function of having this here is to improve the page search engine optimization. This transcript has not been proofread, so please listen to the episode and don’t read this. The information contained herein will inevitably contain inaccuracies that affect that quality of the information conveyed and the creator of this content will not be held liable for consequences of the use of the information herein.Teresa completed her internship in family medicine at Kaiser Permanente Los Angeles, then went on to complete a psychiatry residency at LA County USC. She has studied physician burnout syndrome extensively, and it’s a topic that is very personal to her. And she discusses why we then define the syndrome. What the major causes are, what the consequences are, and what has actually been proven to help among them, his connection. Her Facebook group physician to physician healing, the practice of medicine has become a signal in the noise surrounding burnout, providing us with a community of physicians who understand the hardships of our field and can help. She’s worked extensively in correctional medicine, having served as the chief psychiatrist at the California institution for women, being the first female chief psychiatrist at that prison since 2018. Dr. SEPA is back to being a community psychiatrist. seeing patients with HIV in an integrated clinic and running her own interventional studies. Ettrick clinic, which focuses on deep transcranial magnetic stimulation, as well as reproductive psychiatry, neuro psychiatric disorders, and early diagnosis of schizophrenia. Dr. SEPA is an assistant clinical professor at the Department of Psychiatry at the Keck School of Medicine at USC. Prior to becoming a physician, she was a journalist and assistant editor of MS magazine, writing the health column, which prompted her interest in medicine. Dr. SEPA can be reached at herself titled site Tory SEPA MD and on Twitter at Torrey SEPA MDWelcome to the physicians guide to doctoring A Practical Guide for practicing physicians. Dr. Bradley Block interviews experts in and out of medicine to find out everything we should have been learning while we were memorizing Krebs cycle. The ideas expressed on this podcast are those of the interviewer and interviewee and do not represent those of their respective employers.Now, here’s Dr. Bradley Block.This episode is brought to you by Orange County, bookkeepers, healthcare, accounting, and all in one accounting firm for small healthcare businesses and private medical practices. One thing that I personally love about OCB accountants is that they are QuickBooks professionals with over 20 years experience focusing specifically on healthcare. They utilize a tailored approach individualized to your needs. There are full service bookkeeping firm specializing in accounting, payroll taxes, and financial planning. And for our listeners for limited time, they’re offering 25% off their services for the first three months. You can visit them at OCB med calm that’s OCB m Ed or call at 833-671-3873 or 949215 60 to 100. And check out the show notes for more information.Tech tutorial purpose. Thanks so much for being on the show today.Thank you so much for having me.So there are a lot of misconceptions out there about physician burnout and physician burnout syndrome. And I actually never heard of it referred to as a syndrome until I read one of your blog posts. So I think if you just call it physician burnout, I might qualify for that. Because in the most general sense, I’m feeling pretty burned out right now I have a three and a half year old, a two year old and a four month old and they’re all sick and nobody’s sleeping. And we’re all miserable. And I’m feeling pretty burned out. But But that’s not what burnout is. Right? That’s not what we’re talking about when you’re when you specify as physician burnout syndrome. So how do you define the syndrome?I’m really thank you for having me. And I’m very grateful that you asked that question. The definition is not insignificant. Because we have a way of, if we have a way of defining something, then we have a much better way of perhaps utilizing interventions that might be effective. We know there is a definition of burnout syndrome. And we’ve had that definition actually, for some time. It’s based on the work of a psychologist who was in a seminal psychologist in organizational psychology, Dr. Maslak, who defined through lots and lots of research, the burnout syndrome as a three prong syndrome involving emotional exhaustion, which basically means what it is, you know, you have really nothing left to give. And then secondarily, something that I think is a little bit poorly worded depersonalization was essentially means having negative feelings towards patients. And then lastly, having a sense of low personal accomplishment. So these three indices together when they reach a certain level, define physician burnout syndrome. And we actually can measure that using historically it’s been the MBI or the mass lack burnout index in most. And it’s why it’s important is because I often see that is referred burnout, burnout, burnout is referred to so many different situations that are not necessarily physician burnout, are but our stress, for example, or physical fatigue, which everyone can have and everyone will. Those are are not the same as physician burnout syndrome. And the ramifications of those are not the same as physician burnout. And our interventions for those should not be the same.So with regard to interventionshave the following which do you think are the most useful for treating?burnout syndrome? physician burnout syndrome, is it? Is it meditation, yoga or vitamin injections? Which of those three do you think are the most useful? I’m just kidding. That that is that’s, that’s right. Because that’s, that’s a lot of what we’re being told now is like, I’m sorry that you’re, yes, you’re going through this, you know, you should do try meditating, or journaling, or do you know, right? Like, those are the solutions that were being given.So that’s exactly right in there and the elephant in the room if you realize the fundamental problem with Those three solutions, what’s the what what is the problem there? What do you think it’s not that there’s anything wrong with yoga or meditation, I always say those have shown to do actually meditate mindfulness and yoga do reduce stress or a three month period, you know, in studies, we see that they can sustain or sustainable at least for right now for a three month period and reducing stress. But what is the fundamental problem, when we look at physician burnout syndrome and using those is that where they are placing the burden of the problem is on the physician. So the message is, you are lacking something either you’re too tightly wound, you’re too you’re not, you’re not relaxed enough. You’re too stressed out. All of the reasons and all of the ways in which you were selected. To really perform and excel in this profession, which is how you got this far, we now want you to actually undo that. And go learn yoga, stop checking labs on patients at night, because apparently that’s stressing you out and burning you out. We want you to now go learn how to become mindful on your weekends, by the way, and sign this form saying get it on your own time.But we’re not going to find someone to check those labs for you. You’re still going to be responsible for checking those labs. Just make sure you do your yoga before and after you check those labs. Because if something happens, you’re still responsible for it.Okay, so what happened with that that has been the most troubling component is that we skipped a lot of steps in not addressing physician burnout. appropriately, we went from, oh, doctors have quote, burnout. Therefore, it must mean they can’t control their own workload. They don’t have lives. They don’t know how to control their stress, something is wrong with them. So let’s start sending them to mindfulness training. And yet, we don’t really know whether that works or not. And now nobody asked. We’re just giving more putting adding more to these physicians place now we’re now we’re telling doctors, not only are you have a stress case, you’ve got to now learn how to become a mindful stress case. So you’ve got to learn mindfulness. In addition to checking your inbox and getting through the 30 tasks, you’ve got to do it in a mindful way.My favorite is when you get the incomplete because you, you haven’t taken that hour and a half course yet on mindfulness, so we can check the box that says that we are As an organization are addressing physician burnout, that was definitely something that I had to do for one of the hospitals where I had privileges It was just something else to add onto my plate as if I didn’t have enough.Exactly problem. Any assumption, the underlying assumption is, the problem is with the physician. The problem is you’re either too wound up or conversely, by the way, you’re not resilient enough somehow. And if you weren’t, you lost your resilience. I always say this, how, how is that possible? So somebody was resilient enough to get to medical school, residency, you know, all of that and all of a sudden, they’re not resilient enough. They need resiliency. They need to go and learn resiliency all over again. How does that happen? How do you lose your resiliency? Why don’t we step back and look at what the actual contributors to physician burnout syndrome is, I found down at a table with people who are at the executive table of companies, healthcare institutions and said, you know, their intentions are very well, they really want to help physicians. But there is this place that they start is completely wrong, which is their starting at all the way out in z where they don’t start a which is, first let’s start with what is this? What is physician burnout syndrome? What isn’t it? Then from there? Let’s go to what are ways and what are the evidence based interventions if there are any By the way, and then from there, what are the why does this matter? Why would we want to address this? What are the ramifications of this? How, why are we all invested in this not just as physicians, but As a community, why does this matter to patients, to nurses to administrators, etc, lawyers, etc through that discussion, I rarely hear in that way. Most of the time, what I hear is a company will have physician coaching mindfulness training, they’ll have a retreat for doctors, they’ll have somebody come in, give a speech, about how to increase their resiliency, and improve their balance their workload.So it seems to me that this is similar to what the the general public thinks is wrong with doctors in that, in that when a patient comes in, we’re trying to treat their symptoms. We’re not trying to treat the underlying problem which is completely untrue. Because it’s not like when someone comes in, we don’t do we do our best to try to get them to move more and increase their physical activity. And, and eat better and is we’re not just trying to get them to quit smoking, we’re not just trying to push pills on them, we’re pushing pills in them, because we’ve tried all those other things. And, and they don’t work. So we’re just we’re just doing the best we can. So we’re trying to get at the underlying problem, not just treat the symptoms, but it sounds like in this situation, they’re just trying to treat the symptoms. They’re not trying to get at the underlying problem, although arguably, it is very hard to get like to make big system changes like this is much more costly. And it’s much harder than, you know, a yoga retreat or whatever it is. But so, so, so let’s talk about that. Right. So the symptoms of physician burnout syndrome, emotional exhaustion, depersonalization and a sense of low accomplishment. Yes, what are the causes?Good question. So the the causes have been pretty consistent, I must say consistently identified as being the same Since we’ve been measuring them in the last decade or so, the top contributors are loss of autonomy, electronic medical record system and having feeling I I just read the new the newest study that came out by medscape, which is feeling like a cog in a wheel, which I think is also related to loss of autonomy. Those are essentially the top two have been loss of autonomy, the impact of the electronic medical record system. And the shift to the shift in healthcare system from administrative large administrative burden has been the consistently identified over the last decade as the root contributors to physician burnout.I would say that with no expertise in this area, but I would say that You could probably lump EMR into increased administrative burden because what you’re doing the problem I don’t think is the EMR itself, right? Like I can now read someone’s chart and figure out what’s going on without having to translate, you know, someone’s horrible handwriting. So and then I can use dictation software, you can use a scribe, we can have templates. So there are a lot of ways in which the EMR is actually a good thing. It makes us more efficient. But the all of the garbage that we have to enter is, is unnecessary. And but but it’s it’s been put upon us by the powers that be. So I think that you could really lump into the administrative burdens, because it’s not the EMR itself. It’s it’s the administrative burdens that are cooked into the EMR so that the data can be collected and used by someone far away and not actually help the physician and help the patient at the time.Yeah, overall, you know, it’s true. There’s a lot of overlap in the way the one can look at this one can interpret the studies and the way the, the wording on it is described in terms of causes. There’s quite a bit of overlap. For example, the top radiology most recently recognized is excessive charting paperwork, okay? But then there’s, again increasing computerization and practice. Well, those two are very, you know, intimately related. And then there’s loss of control and autonomy 24% say, contribute that say that is the main contributor but then 22% feeling like a cog, a cog in a wheel. Well, those two are very similar, correct. So, there seems to be overall a very consistent message. That there is a disconnect in terms of physicians feeling that they have a voice in their work in the design of their work. And also feeling a disconnect in terms of when it seems work ends and begins, which appears to have appears to be related to both the inefficiency of the electronic medical record system but also the problem with electronic medical record system continuing to be on correct. So I have an app right on my phone. It gives me messages constantly. That you know, there’s an inbox in there Hey, patient message with a refill this this inbox, lobstering you know and that is really actually disruptive. You know, I’m at myyou need to get that off your Phone. Yeah, exactly. That sounds horrible. I don’t I don’t have that on my phone, I have to log in on my laptop on my system. So when I, you know that way, you know, at least the way that my practice work, we have a doctor on call if there’s an emergency, they’ll call the code, right? There’s the they’re these things away that that they’re these barriers, which, you know, there are barriers for the patient, but ultimately, they insulate us from having to have that feeling of being on all the time.And that it’s important that that is, you know, I talked to so many doctors and they’ll say, What do I do? I’ve been told to download this app. You know, am I supposed to check it all weekend? These are gray areas, though. So these are new gray areas. These are not we don’t what I always tell doctors and I learned this later in life. Where is it in your contract? Where is that app? Your contract?You you’ve got to you’ve got I guess a solution to that would be sort that out. Talk to whoever’s right so you’re not you’re you’re whoever that is, whoever is getting those messages is not the owner of their practice. They’re your lawyer, because if they were the owner, it wouldn’t be such a gray area. Well find out, address it, address it, don’t be afraid find out where your responsibilities starting and and do your best to get get protected time.That’s where we also have a problem as physicians and that’s not. And when I say problem, it’s this is probably something that I spend the most time talking to physicians, both in our group and individually is this isn’t about resiliency, but this the culture that we learn. Madison is one of stoicism. So we don’t ask whether we’re supposed to see that patient on that time, we will usually do what we’re told right at training. That’s how we are praying. I mean, I’m not proposing that that’s the healthiest way of learning medicine but that’s the culture in which we learned how to become physicians was not by placing limits or boundaries.Yeah, if you don’t wake up at midnight to check that lab, you clearly don’t care about your patients. Right? That’s what the messages,you’re not going to make it, you’re not going to finish residency. And so we have been, it’s hard wired in positions to grin and bear it. And we are a group that has a very difficult time, setting boundaries for ourselves and saying, Hey, you know, do I have to check this app all weekend long, or, you know, I mean, does it make you feel well, maybe I’m a bad doctor, if I take this app off my phone? Geez, you know, maybe I’m supposed to I mean, I you know, that’s what I signed up for. I mean, I’m a doctor, I, we just don’t do that because we’ve never, never done that. One of the things that I am trying to work on collectively. Lee is identifying the difference between becoming stronger as a group of physicians does mean, identifying what we are capable of doing long term and maintaining that is actually gonna have impact on our patients. So we will be better doctors, if we can say, Okay, how about how long can I sustain this? How long can I really check these, you know, this app every weekend, you know, and still love what I do and do it well and have a have a life that’s fulfilling. And in order to do that, it means having a conversation with other doctors saying hey, do you find that this is this is kind of intrusive, or what are your thoughts and as it’s much easier When you approach it as, as a group of physicians, then by yourself and having physician commodity, you know, we have a much stronger voice. When there are a few of us than just one of us.I think that is an excellent segue into talking about your, your Facebook group. Great, right? You’re the the power of the community, the power of connection. So tell us about the Facebook group. And then you know, starting with with its origins, why, why did you start it? Why is it so personal to you?Yes, yes. And I started it in a general sense, there is an evidence base, one of the truly, probably the most consistent and the highest level of evidence based intervention for physician burnout syndrome is peer to peer. That’s true peer to peer that means physician to physician support and Ideally, it would be one hour a week during the workweek, by the way, without any administrators or supervisors in the meeting that has been, you know, shown in randomized control trials even to reduce physician burnout and prevent it. I did a study in residency on physician burnout syndrome, when I was a third year resident in psychiatry comparing burnout between two specialties and also between residents and attendings, and we were pretty surprised that our residents did not have a reduction in resident in their burnout syndrome. As they escalated through training, meaning as their call dropped, and our attendings had higher burnout syndrome, then attendings in another specialty, despite having, you know, essentially no call right? something was amiss. That was in 2011 when I did that study, and there was a wake up call when I did that study. In it was a big program it was at us LA County USC. So the N, if you will, was large enough where, you know, the results were, were significant. And we, as a result implemented, approved a peer to peer group for one of the resident classes, which was a third year resident class and I left the group as a pilot, I found from that that was the starting point. And I did that for another three years, expanded it to ob gyn residency, etc. Fast forward years have passed and physician burnout, you know, there at USC LA County. That model actually built on itself every class now and as a group apartment actually has a peer to peer group and is, you know, self sustaining. I returned it to this concept when one of my classmates from medical school took his own life, two years ago, it was quite a surprise to me. He was, you know, somebody who was, you know, I was shocked, I have to say I felt a degree of blame because I had been in contact with with him on Facebook and you know, he hadn’t come to our reunion and I had reached out and I’ve noticed some, some things, some signs on, you know, some pose, but I had really been dismissive of them even as a psychiatrist because he was a physician. I just thought, Well, yeah, I’m just I’m reading too too far into this. She’s fine, you know, and, and I’ve deeply regretted not reaching out and not doing more to find out how he was doing. I was very troubled by his loss because it wasn’t just a loss for for me in terms of a friend but it was a loss for his community, the loss for his patients because anytime a physician takes their life, we lose 3000 Patient contacts just a year. So physicians are there’s a multiplier effect. So we lose a million patient contacts a year just due to physician suicide. And Jason was a veteran. So very unique position in that sense and his connection with patients. I just felt it was a tremendous loss. And when I went back and looked at statistics of physicians who do complete suicide, I was rather shocked at how little we know about physicians who complete suicide, but what we do know is that 85% of them do not access any psychiatric care, including not being even diagnosed with depression or anxiety, and most of them are feel lonely and isolated. If that made sense that made a lot of sense to me. He had recently moved to a new state and it seemed that a community was something that had been protective. Not just for Jason, but his protected had been protected from me when I was in medical school and residency, something that I desperately missed even as I was progressing in my career in it would be ideal to set up in person groups for physicians, I felt, if at the minimum, I could set up a virtual doctors lounge, if you will, where there’s a safe space for doctors to just say how they feel, maybe maybe we can, maybe they can reach out to me Maybe I can help get them up, you know, somebody they need to talk to you or I can they can just feel like they’re not alone in how they’re feeling. Maybe that would prevent somebody like Jason from becoming increasingly isolated, and feeling getting to the point that he did. And that’s how it started. And we now have close to 3000 position members. It’s been incredibly gratifying to have a place where doctors can go to tosay how they feel if they’re having a bad day. does appear to be that physicians will open up to other physicians more readily. Which makes sense. It makes sense, right? Human beings are tribal. And, and physicians are a tribe. We get each other right. We have this, this experience in the same way that particular to, to Jason Yeah, veterans, right? They have this is unique lived experience that only veterans get that only veterans understand absolutions. You know, I’m not comparing the two experiences, we don’t go through what they go through. But we do have this unique lived experience that only other physicians get. So it makes sense that we’d open up to each other because you know what, I know the person reading this gets it. I know, they get it because they went through what I went through, they’re going through what I go through,and they and you important. One of the things that we worked very, very hard on into crew is for four of us now who are the administrators in the group and We work very, very hard having physicians learn how to mentor each other in the group because we treat each other sometimes worse than we treat anybody else. Interestingly, because that’s how we learned to be. It’s like how you treat family sometimes. So a lot of it is really learning and modeling. We are, you know, we go back to very interesting to see, to see physicians, and I’m certainly not perfect. And I’ve done this as well, which is we can regress back to our training days when we learn in a specific way. And when we are stressed, we’re not always the most tolerant with each other, by the way we are with patients, but we’re not with each other. And part of what we work on in the group is learning to not have an answer for each other. We’re not here to judge other physicians or I’m not here to tell physicians what to do. We’re not here to give people you know, their you know, a path to this is the thing to you should do to not do that you shouldn’t done that. Most of the time, what the group we’re we’re trying to teach physicians is building camaraderie, true camaraderie, which means listening and accepting the physicians because we need each other. In the end, not a lot of physicians anywhere actually, wherever you go, we’re always just a few of us. And that in itself is a significant goal is relearning how we relate to each other as well because we are very, we are more comfortable being not so great with each other at times. And that is something we also work through in the group. And we can’t afford to turn our backs on each other. There’s not enough physicians. So we work on that in the group as well. You know, We give people a lot of chances in the group, you know, a lot of feedback on how to combat you know, let’s let’s approach this this way let’s work together because we want we have young physicians, we have older physicians, we have male physicians, we have female physicians, we want a group that is truly diverse, and reflects the reality of the physician workforce. Right. And that takes a lot of work to sustain all of these people having conversations, right. But that’s important. That’s the other facet of it is being able to hear each other among the noise.So you took this this issue, right, that led to the loss of your friend and colleague, the isolation and you turned it on its head, right you gave you you created this forum for connection. So that was your response to that. I think that’s incredible. And I think the fact that we have so many positions that being said, there are a million physicians in the country, right? And only 3000 of them are on this Facebook group and I’m sure, tons more are would be would be helped by this. Right? more connections because it’s just exponential right? The more physicians you have, the more positions you can connect with each other. And the more we can we can help each other and create recreate this community. Right. And I think it’s just like you said, it’s from our training in our training, right? You have to go it alone, you got to do it alone, you got to achieve and you got to beat your competitors. You got to beat. Yeah, your classmates, your ranking class needs to be better than theirs if you’re going to get the competitive spot. And now, we have to look past that and work together. And yeah, there’s a lot that we’re up against. Right?We will not make it if we’re not going to be a solid group. So we won’t survive because we are out number in every This is the first year 2019 where there were more physicians employed and owners of practices. So And that means that in any administration, there’s never going to have a majority of physicians, right? And we’re onlyheaded more in that direction, right? The more complicated this gets, the more infrastructure you need for billing, the more infrastructure you need for your electronic medical records and charting, the less you’re going to be able to have a physician run practice, the more you’re going to need the infrastructure of a much larger organization. So it’s, it’s only going to get worse, it’s not going to get better.That’s exactly right. And if we have to learn and this is something we talked about, also when the group is I think, we have some divided and subdivided and more can our little tiny into our sub sub specialties. It’s like, read diet, you know what, like, you know, not just psychiatry, but it’s like,oh, yeah, I can. Yeah, and in, in my field, right, like, I’m not specialized enough as an ear, nose and throat doctor, we have right ologists and otologist syndrome. otologist facial plastics Yeah, yeah, yeah. Or ophthalmology. Wow, like,retina. There. Isthere a different we had an episode of that a little while ago, where apparently they’re eight, eight subspecialties in ophthalmology. It’s it was and I’ve always an ounce and you have eight different fellowshipsand everybody and here’s the thing is I can tell you right now because I’ve sat you know I had the the true privilege of having a seat at the Big Boy table and that hurts us extremely. When we are so subdivided and can’t see beyond our sets of subspecialty. We’ve got to be a fit, we’re physicians or we’re going to fit that’s how we get pay disparity. That’s how we get essentially moved into this position of not having very strong bargaining power. We are not very powerful in our you know, as a one forensic science coyotes just like in the hospital, you know, it’s just like, so what if I think, you know, I click 86 times to close, who cares? I mean, there’s like one person, right. Whereas, as a group, we actually have a voice. We, you know, we each physician creates 17 jobs 17 to spite existing. Okay, that’s quite, we also don’t know our worth. That’s the other thing we’re incredibly we’ve managed to not understand our our impact on the larger economic ball. That’s whywe direct so much of the money in healthcare, right, the healthcare is just, it’s a huge percent of the GDP and who’s deciding how that money is spent? physicians. So our impact on the system is true is tremendous, is tremendous.And if we actually were able to see or solve as we did in medical school, as physicians, or as med students as one unit, you know, and even in residency, I can We will probably be more cohesive than we become as we kind of progress, you know, we start to fall more and more into our specialties and it does not benefit us. And we know that if we look at the bills that we’re seeing go through in terms of Medicare reimbursement, we know it’s not helping us to be seeing ourselves as such specialists and specialists know that we’re losing. We’re you know, we are not because there is no, I should say there’s the American Academy of nurse practitioners. There’s the American Academy, there’s the American Psychological Association. There’s not the AMA is then there’s a me but then there’s also then all these other subspecialties, right, there’s like the APA. There’s the AFP and we’re, you know, we’re all over the place and we have not really stood behind one strong lobby and it shows I’ll tell you that your number of residency positions that are increasing at 3% per year, as opposed to our medical student admission rate has gone up 10% which it should they adjusted their rate, but Senate has only approved a 3% increase in terms of residency position. So we have 7%, whereas this gap, so we have found more than 1000 physicians in the US we create each year. We’re standing there, unmatched. Okay. But just to end then we’re talking about a physician shortage and increasing provider status for everybody we can, and we have more than 1000 physicians standing there every year. And that partially is because we’re not quite united yet in the network. But we were still thinking about what what little subculture psychiatry to our block, right.Well, for all its flaws. Yeah, this is one place where Facebook I think, has been a great benefit because I’m a member of the physicians on social media. Ah, that Donna Cornell’s Started, right that’s, that’s just growing exponentially. So now I have this community of doctors on social media. I’m a member of passive income physicians and the white coat investor Facebook group, because here’s another, if you can gain financial independence, then if you’re suffering from burnout, you’re financially independent. So you can go tell your employer to screw off. And you can find a job that works for you and work and work on your own terms. So they’re all you know that with regards to social media, we’re able to amplify each other’s voices. And then with your group, we’re able to find a community to help us, right, it’s physician to physician healing the practice of medicine, so we’re able to help us heal each other, heal each other through difficult times. So for all Facebook’s flaws in this one regard, it’s really helped us to coalesce in these communities, which might be disparate, but right, like I would have never interacted with you for my entire life, had these things not existed and now you know, we’re able to amplify each other’s voices and can with eachother, I completely agree Facebook has changed the way physicians organize. We have grassroots organizing we’re doing we are campaigning for, you know, patient sprites on Facebook. I mean, we finally have a voice. I think we found each other. I mean, where it sounds really cheesy maybe but you know, where we finally, I think are we are utilizing it in a way that is beneficial both in creating a community that’s helpful for us, and ultimately is going to have a larger impact on improving healthcare, because if doctors are healthy and staying alive and happy, then we know that trickles down, we know that we know that from study.Oh, well, that’s Yeah, that’s a whole other issue is that physician burnout syndrome affects patients patient outcomes. And it makes sense, right, because one of the symptoms is depersonalization. So if you depersonalized your patients, right, that that will ultimately affect their outcomes. Well unfortune We can’t open that door right now because I know you have a patient to see and I’ve got to go pick up my kids from school. So we’ve, but it’s really been great talking to you. Where can people find you online?Yes, I can be well on twitter at Torres SEPA and di t o r i s EP h empty. And our Facebook group, I think the best way is to just look at the link it’s for we go through a it’s not a no, it’s a closed group. So we go through a vetting process for physicians and physicians and training. It’s called physician to physician killing the practice of medicine. And my website is based. It’s linked to my practice in large part but it does have a link to the my writings on Kevin MD. So it’s www dot. Tory’s efa. md calm.Well, Dr. Theresa, thank you so much for taking the time. It’s been great talking to you.Likewise. Thank you again.That was Dr. Bradley Block at the physicians guide to doctoring. He can be found at physicians guide to doctoring calm, or wherever you get your podcasts. If you have a question for previous guest or have an idea for a future episode, send a comment on the web page. Also, please be sure to leave a five star review on your preferred podcast platform. We’ll see you next time on the physicians guide to doctoring.Transcribed by https://otter.ai