Yeah, I think we're ready. Welcome everybody. I thank you for coming to this lecture. I think it's always my goal on the Program Planning Committee to have a lecture that is not so dense and medical information and doesn't have 30 citations per slide and sometimes spend some time to talking about aspects of our own lives and aspects of how we can continue to be happy in our field of physical medicine rehab. So thank you for coming to our talk today about finding joy in physiatry, both at different career stages in life. My portion of the talk will be kind of talking about how I found the most joy in physiatry meeting patients where they are. We have Megan Stojola, who's a medical student and a fourth year medical student going into Peds Rehab. So we're very thankful for that as a pediatric rehab doctor myself, who is gonna talk about joy at a younger career stage. Nate Olison, who is Associate Residency Director at Washington University in St. Louis, who will be talking about aspects of finding joy in medical education. And then Dr. Haekyung Kim, who is Chair at University of Texas Southwestern, who believe it or not, will be talking about the joy she finds in administrative work. So I know many people may not believe that's something that can happen, but something that I think she has done a great job in doing and does it with a smile on her face. So my first portion of the talk is about essentially meeting patients where they are. And the reason why I thought this would be a great presentation is if you were to look at the most recent Medscape survey about the number of hours spent on paperwork or administrative tasks per specialty, and guess who won? We did, right? And so wildly, physical medicine and rehab has the most amount of time from a self-report on the amount of time that somebody spent on paperwork or administrative tasks per week. And that doesn't necessarily surprise, I think, any of us, but sometimes those kinds of things can lead to aspect of being one of the most burned out specialties. And I think this is data all of us have seen. Starting, I think, in 2015 or 16 was kind of the first time I had seen PM&R rise to the top three, which was one of those things that to me was a very surprising thing because even when I was on radiology rotations as a medical student, which the medical students called radio holiday rotation, they thought that physical medicine rehabilitation was going to be a great specialty to choose, even though radio holiday, as it was called at that time, was one that I think most people would look at and say that was a great medical specialty to enter. Even more surprising to me was a stat about whether or not people would choose medicine again. And they did it based on specialty. And we are at the very last specialty when it says whether or not somebody would choose medicine again. This was all of the most recent Medscape survey I had seen. And so it was really kind of a surprising thing to me that really kind of got me to thinking about why are we not as happy as we thought we would be maybe entering the field? And what are the things that we could specifically do to change that? And so my own path to physiatry is kind of a little bit interesting. The guy there on my right, this is me as a young man without hair and with very little hair and with very little teeth. So I imagine that's what I'm gonna look like in about 60 years. But the guy on the right there was my mentor and my parents, literally my parents' drinking buddies in college and that's Bob Conway who was an Elkins Award winner. And for those of you who don't know, that's given to the highest board score in the country. And so the guy was literally a genius and hung out with my parents, so go figure. But that was my introduction to physiatry. Here I am helping him study actually for his pediatric section of the ABPMNR test. So I do take a little bit of credit for his success showing him what normal developmental milestones look like. But my own path into physiatry was because I saw Dr. Conway extremely engaged with his patients and feeling like what he was doing was the right thing because as I went through so many different aspects of medical school and training, one of the things that hit me about physiatry was that it was more about what happens outside patients, outside of the hospital to patients as opposed to what happened inside the hospital with patients. And so as I progressed through residency and you understand that you have to ask about how many flights of stairs somebody has and how many steps there are to enter a home and those basic kind of functional questions you get to, you stop thinking and meeting patients where they are. And that was one of the biggest things that I found dissatisfying about my job was that I started to talk to patients only about things that they occurred within their hospital and I didn't actually see them outside of their hospital. In pediatrics, I love to have this saying that our gyms should literally look like a war zone because that's what my house looks like with two kids. It looks like a war zone in there with plastic toys and Fisher-Price and that's literally what our gym should look like because if we are doing our jobs well, kids are running and kids are playing. But we've separated this aspect of physiatry in the hospital setting or physiatry in our clinic spaces and what we're doing outside of that. And so I had the unique opportunity during my fellowship to start going to medical mission trips and so here I am going to Ecuador and this was one of the first times I had seen patients or met patients outside of the clinic space. And this was one that was a very impactful trip for me and I believe that we think we don't have the opportunity in physiatry to do medical mission trips because we believe that that's primarily reserved for primary care specialists or oral facial surgeons or somebody that's outside of the field of physical medicine and rehab. But there's still such a need and such a value that you can provide on a certain trip like this. So for instance, this guy in the middle had a proximal focal femoral deficiency and we had two orthotics and prosthetics providers on the trip along with myself and we essentially custom make this orthoses every time we go down to Ecuador for this trip. And so this guy does really well with it and actually was one of the first kids that I had seen that we actually took outside of the hospital clinics and had him run around the parking lot which was very fun to see because his mom knew we weren't gonna be back for six months or the program wasn't gonna be back for six months or a year. And so we were running around the parking lot with him up and off curbs, jumping and landing on that side itself just to ensure the integrity was good. And to me, that was my first introduction to what made me happy about physiatry was outside of the hospital stuff, not so much inside the hospital stuff. And so we occasionally still get videos of this little guy, at least the orthopedic surgeon does, it goes on that trip and he'll send it to me. So it's really kind of one of those things that was my first introduction to remembering what joy I had and thinking about what life was like outside the hospital. And then I've been given the unique opportunity now that I have been very involved with the United States Olympic and Paralympic cycling team. I'm a classifier for Paralympic cycling on both a national and international stage. And so they've been able to send me to all sorts of exotic places like, this year I'll be in Rio, Switzerland, I've been in North Italy, Quebec, and Huntsville, Alabama. So very exotic places, I'm just teasing. Huntsville is actually one of my favorite cities that I've been to. But what's really provided me the value with this is it's helped merge some of my things that I enjoy doing outside of work, cycling and eating barbecue, but cycling with helping patients with disabilities. I don't know that I would have thought about something like this if it were not for the fact that I treat athletes in my clinic and I treat athletes with limb differences in my clinics. And so that's one of the things that I think got my mind going of, this is true function and this is true high-level function and this is something I wanted to be involved in. And so here's just aspects of different cities I've been in and different races I've gone to. So here's obviously different hand cycles that are starting at the World World Championships that I was able to attend and classify. But at the same time, when you go and you see patients from other countries, and that's the general crux of this, is that when you see patients from other countries, it gives you so much more perspective, I think, on the way that we're able to do so many wonderful things in the United States, that you see disease progression, sadly, that you wouldn't see in the United States that happens internationally. And so that was one of those things that I appreciate what we're able to do here, maybe even a little bit more. And that was one of the ways that I found significant joy in the field of physiatry, again, was meeting patients outside of the clinic setting and volunteering my time in ways that both met my love, a vocationally and vocationally. And so that was one of the things I wanted to bring from a message today for everybody. And so with that, I'll let student Dr. Stodola present her portion. Hi, my name is Megan Stodola, and I'm a fourth year medical student at St. Louis University, pursuing a career in pediatric physiatry. So I want to start by saying that I recognize that I am very early on in my career, but my goal of this presentation is really to highlight how I got interested in PMNR and how I practice wellness throughout medical training and how I hope to find joy in my future career of physiatry and hopefully along the way to remind you of why you chose this specialty for yourself. So before I had even heard of PMNR, my initial exposure to rehab medicine was through my twin cousins. So this is Chase and Connor. Chase is on the right side in that middle picture and Connor's on the left. And they were monochorionic, monoamnionic twins born at 31 and a half weeks, and they now have spastic diplegic cerebral palsy. So growing up, I would go to some of their therapies and just found it's really neat to watch them grow and accomplish those goals that they were working towards. So I'll come back to them in a bit, but next I want to talk about our mission as physiatrists or future physiatrists. So early on in medical school, I had an attending recommend to me to make a mission statement for my life. And that was both to prioritize wellness and joy for myself and also to make sure that everything I was doing really aligned with my core values. So for example, my mission statement is that I want to be a Catholic wife, sister, and physician that is fully present and a source of comfort, support, and love for my family, friends, and patients. So I encourage you to think of what your personal mission statement could be. I'll revisit mine every now and then to see how I'm doing with my goals, but I found that it's actually really helpful to have a concrete statement to look back on and make sure that all my core values align with what I'm doing in my personal life and with my career goals as well. And then also that align with that mission of being fully present with my family and friends. So here are some pictures of me trying to live that out. On the left side, I'm the oldest of seven. So my two biological siblings are standing next to me on either side. And then my four siblings that were fostered and adopted are there as well. And then on the right side, just working on being fully present with my friends and taking time off to go out to ice cream or to a baseball game or to brunch. And I found though that I'm best able to live out this mission when I prioritize my wellness. So wellness is something that is a little bit different for everyone. And these are some pictures of what I found brings me joy. And you heard how Dr. McLaughlin finds joy with paracycling and mission work. And I find joy when I have a longer period of time with traveling or going to a board game competition. My husband and I just went and won some of those games and also got a puppy that was my wellness gift to myself for interview season with some uncertainty of the future. But also I think it's important to recognize that it looks different because we don't always have a significant amount of time to give towards wellness, but we can still be well in those times as well. So I think sometimes if I just have a few minutes, I'll play a 10 minute board game or instead of singing in choir, I'll play a song when I'm making dinner. So you guys have dedicated your lives to improving the quality of life of other people. And I think that's really something to be proud of, but it's something that you also should have the same standard for yourself as well. So what can you do to prioritize your wellness? And especially in a field that prioritizes function, we're out there trying to help our patients realize what they can do. So what can you do for your wellness when you may not have a lot of time? So for example, on my surgery rotation, I didn't have as much time, but I had a big bag of Swedish fish in my backpack and then would treat myself before and after every surgery. So that was one way I practiced wellness there or would stand up and stretch when I'm studying and would look up like a five minute meditation or take a lap around the floor. And I think these are ways that we can incorporate wellness even if we don't have a long period of time. So now coming back to my cousins. So something that I think is really special about physiatry is that we get to have a longitudinal relationship with our patients and get to watch them grow throughout their life. And so to look at what Chase and Connor are doing now, they have traveled to Europe and they're pursuing PhDs. Connor's is in statistics and Chase in history. And they've gone on to give back that joy that they have found in their life through some advocacy work through the hospitals that they were treated at. So I think that's really neat to get to see what you get to help your patients achieve. So why PM&R? I mean, look at these pictures. Look at the joy that you can help your patients achieve. You get to help them with the things that matter most to them, whether that's pain management, function, mobility, independence. You are the person that gets to be there after the shock of that initial trauma or after that scary diagnosis and help them with not only medical expertise, but being a source of comfort and compassion and encouragement along the way. For me, I found that PM&R really fits perfectly into my mission statement of being fully present and supportive for the people around me while still also allowing myself to promote wellness for those people as well. So I want joy to be the main focus of what we do. Take a look back at your journey, remember your why, and choose joy. Thank you. Hi, everybody. I'm Nate Olofsen. I'm at Washington University in St. Louis. I'm going to be talking about how I connect joy with teaching. So I'm not very good at pronouncing Latin, so you'll forgive me if I don't pronounce this word correctly, but docere, potentially is how it's pronounced, is really the kind of origin of the word doctor. It means to teach. And so originally the word doctor was a teacher. And so I was introduced to this concept when someone had introduced the idea of the etymology of the word to me, you know, early in being and attending, kind of at the end of my fellowship, kind of in that transition period, and it really struck me as something that would sort of drive me forward throughout my career. So similar to a lot of other folks, I had no idea what physiatry was when I started the process of medical school. I was fortunate to go to a great institution, University of Missouri, where I met Dr. McLaughlin, and I learned about how my passion for movement, my passion for helping support people's function, my interests in anatomy were really all connected into one specialty. And that was exciting, and I was very excited to go into this field, but I still didn't have necessarily my mission statement clear. I didn't have that other passion really fully developed just yet. Again, as with other people, I had a personal connection as to why to choose physiatry. So my grandfather was diagnosed with multiple sclerosis and lived most of his life with it. Fortunately for me and most of my family, his diagnosis was, or his diagnosis, whatever it was at the time, was made around World War II, and he did not see combat, but was very impaired for most of his life. My grandmother and him faced all of these challenges together, and I was able to learn about some of the realities of impairments in function from an early age. And then I have always been really passionate about movement. You can very well critique my rock climbing technique if you would like. I'm only okay at best, but movement has always been a passion of mine. So I was searching through medical school and choosing my specialty, which is sports medicine and musculoskeletal medicine, finding a way to bridge these desires to help people's function and to find ways that I can connect with movement. But again, I still didn't have my mission statement or my passion fully fleshed out. As I progressed through my training and reference to prior training, I played a lot of athletics. This is me as a sports fellow. This is with me and some of my trainees at the time. And again, I loved teamwork. I loved athletics. I played a lot of them. That has not anything to do with my abilities, just the small pool of talent in rural Iowa. So as I started to reflect on my time in athletics as my abilities decreased and my age increased, really it was about teaching and coaching is what I started to see, that my most effective coaches were teachers. When they were conveying material in a way that was the most accessible and individualized for their athletes, those athletes did better, even if it wasn't achieving a better result at the end of the game. Then, even though it probably was obvious to everyone around me, I didn't really go into medicine thinking I was going to be an educator as well, even though both my parents were public school teachers for 35 years. I thought that when I was pursuing a career in medicine as the only person in my family that was really a science person of any kind, I was venturing far afield from what my family had done. But as I progressed through my training, I realized that I was actually returning to where I had come from with my developing love for teaching. Really why I love teaching, it's a really, I would say, hard thing to summarize in just a soundbite, but I really like what Megan said about finding a mission statement. Early in my role as an educator, I was presented with this phrase that has really driven me since then, which was, be the person you needed when you were younger. So I have not faced necessarily a lot of adversity in my life, but we all have faced different challenges. I would have loved someone, before medical school started, to be like, you should go into physiatry. That would have been great. I would have loved to meet someone in college to say, you know what, you have this interest in education, you're just not quite there yet. That phrase, be the person you needed when you were younger, can take on all sorts of different expressions. I'm not trying to turn all of my trainees into sports medicine doctors. I'm trying to figure out how to support them in what they need, wherever they are, and whatever they want to do. And then I've had the great fortune to be able to do that through my time at Washington University, so here are some pictures of us doing ultrasound teaching, fluoro training, some teaching at AAPMNR, a prior ultrasound course, more ultrasound courses. And really why I love teaching is the people. Being able to connect to learners from the spectrum of medical student through fellow, seeing the development of their passions, their knowledge, their professional acumen, everything, that fulfills me. I love taking care of patients. I don't think that I would have the same fulfillment in my life and in my job if I wasn't an educator as well. So that's how I find joy, is I always lean into teaching whenever I can, and I remember that phrase of being the person you needed when you were younger, whenever I'm with a trainee of any level. Thanks. Good morning. I don't have a PowerPoint because myself is PowerPoint. Slide. My name is Hyekyong Kim. I'm a pediatric physiatrist and chair at UT Southwestern in Dallas. So how I become physiatrist is that I always want to be a doctor, and because of my grandmother, she always want to have one of her child or whoever wants to be a doctor, so I'll be a doctor. After then, I watched a movie and it was written by English cerebral palsy adult, and I said, that's what I want to do, and I was going to change to social worker. That was all about social system, and then I still want to be a doctor, right? And then I went to medical school and my father was very upset at me that I become a doctor. I went to medical school. He, you should be a comedian. I'm very funny actually. Funny person. So he said, I'll give you more allowance. Quit and move to some other specialty so you don't need to be a doctor. Work hard. Then my priest want me to be a nun because I was in medical school, and he invited me to convent. I didn't know what was the reason that he invited me. I said, priest, father, why I'm here? And then all of a sudden, all the nuns coming to me, like, we really need you. And I said, oh, I love to dance, and I enjoy my life. I'm going to be Maria on the movie, and I'm going to break down everything. So father, I'm so sorry. I can't be nun. And then I really wanted to take care of people with cerebral palsy after I watched the movie. And then I met my senior, and he told me there's such things as physical medicine and rehabilitation. Ever since I learned the physical medicine and rehab, I never changed. And I was offered by plastic surgery because I'm very good with hand, you know? That's why I'm an injector. So I become a doctor, but the joy what I have being a doctor is being a leader. You guys are all leaders in this room, right? That makes me so happy because we help people, and it helps me, number one. Number two, moreover, we really help people. But being a PM, and I always give a lecture to residency candidates. Every time, 20 minutes, I have to give. And then I want them to know, I don't want to introduce you to Southwestern. I want to introduce PM&R. I congratulate them. You found the best medicine out of all the medicine. Now you take care of people as a whole. You don't see only eyes. You don't see only mouth, right? So you pick the, but we only, not only taking care of disease and disorder, but also we take care of function. We bring their life back to them, right? Their baseline. So we complete the care. We are the one who can really take care of patients. So you pick the right medicine. Then that's why I'm so proud to be physiatrist. Then people always think, oh, we have to go outside. Being a doctor is, my daughter says, she never want to be a doctor. She's not a doctor yet. She wants to go to medical school, but she doesn't see me as a doctor, right? Then mom never come home, so she never want to be a doctor. But while she was interviewing doctors, she realized that, oh, that's what I want to do. You guys go to the conference, you meet all the people, you go abroad, you get to eat all the delicious meal. That's what I want to be, right? So let's be honest. You come to the conference, you want to learn, but also you want to meet all the friends. You want to meet the nice people, but also you want to have a nice meal with the department money. Right? But once you become chair, you cannot. I become very stingy. I don't eat. I look for the free food. But anyway, so, and I think the thing what I want to say that the reason why I'm here, because I had a lot of mentors, right? I want to make sure that I want to address my mentors. When I become, when I graduate medical school, actually, while I was in medical school, I went to medical school in Korea, and my first mentor, PMNR doc, came from States. He was a Korean American, but he was trained at NYU. And I become his best student, and I learned everything from him, and he hired me, and he really want me to be a professor at the university. And then when I told him that I'm coming to States, he said, Hye-kyung, you're not going to States. You're never gonna come back. You're gonna have too much fun over there. He was right. He called my husband three times not to bring me to States. But number one, so I learned so much, and he was my sponsor, and I learned so much about administration and fundraising, how to make money, efficiency, everything from him. And then when I came to States, Dr. Findley, Tom Findley, I'm very sad that he passed away, but Dr. Findley hired me, and at that time, I couldn't speak English at all. I had pounding headache, but I wrote the letter to him that I like to work at Kessler. And one of the doctors say, oh, you're not coming to Kessler. You graduate the best program in Korea while you're coming to Kessler. But that's because that's Kessler, so I wanna be in the best setting, right? And, but I wrote the letter to him, and he said, okay, I'm gonna interview him. He was talking to me on the phone. I couldn't understand at all what he's saying, and I was vacuum cleaning at the time. I was a wife only, right? But I went to meet him. He was telling me something, but I was really shocked. I'm gonna tell you one thing. You're gonna be a leader, right? Don't be stingy. So he brought me to the cafeteria, and he was, okay, Hye-kyung, let's have coffee. That I understood. So I grabbed a coffee. I thought he was gonna pay. That was only 50 cents. In Korea, all senior pays everything, and I was standing like this, and he said he pays only his coffee. It was a hit me immediately after that. Oh, this is American life, okay, let me think. After that, he brought me to the computer, and he said, Hye-kyung, you're gonna do literature review now. What is literature review? Oh my God, no, but I was sitting very quietly three hours. I didn't know what I was doing, and I was having headache, I was hungry, and he came. I said, I practiced this one sentence. What is next, right? And then when I saw his face, I couldn't speak English at all. Anyway, he said, oh, you must be hungry. He brought me to cafeteria. This time, I paid. Okay, I paid my own lunch, and I had lunch. But anyways, after then, he hired me one month later. I was able to ask him, why did you hire me? And he gave full salary even. Right, I was foreigner. I wanted to go back to Korea. But anyway, so he gave me full salary, so I was very curious why he was hiring me. What was his answer? He said, intuition. You're gonna do something in the future. I knew it. It hit me, so you need mentor, right? He saw who I am. I didn't know who I am at that time, still. But anyway, and then I look up to Dr. DeLisa. I never gonna forget about him. Dr. DeLisa, I never able to talk to him because my English doesn't work, and he's very big. And then whenever I stand up in front of him. But anyway, I got into combined program. He asked me not to apply combined program because it's very competitive. And he asked me to apply only straight PM&R. I said, I did already, I'm the best. So I applied the combined program. But anyway, I got it. But Dr. DeLisa is such an amazing mentor. And he's teaching us, not the PM&R knowledge, but how we can be a leader, how we can promote PM&R. And I wanna be like him. I really try to learn from all his behavior, who he is. After then, I got hired, and I went to job to work as a pediatric physiatrist. I really enjoyed being physiatrist and changing the healthcare system by promoting the disease prevention, actually. So I was, by five or six years after I become attending, I start to have questions. Why I become physiatrist? Who I am? What I'm doing? That's what the question is, right? As a physiatrist, what I'm doing? I realized that I am the preventative medicine doctor. I'm preventing so many different disease I was able to prevent. So buying Continuum of Care, by preventing comprehensive care, I was able to bring orthopedic surgery from 100% to 30% over five years. It took only five years. Orthopedic surgeon didn't need to do surgery for sleepy children anymore because we are providing multilevel injections, regular base. And by doing salivary gland injection to prevent aspiration pneumonia, I was able to save $10 million over only three years with 34 patients. So that's why we are doing it. So I want us to be very proud and then we should be in the front of the medicine. That's why I wanted to become, be a leader, not chair, but be a leader. So we can really change the healthcare system. Thank you. I think my own faculty know that, be careful the stories you tell, Dr. Kim, because now you may be referred to as Sister Kim since you went to a convent for me from now on. So clearly some of these people are truly like walking advertisements for the field of physiatry. And I'm eternally grateful that whenever I come to a conference like this, it really actually truly re-energizes me and gives me that excitement to remember why I chose this field in the first place. But kind of this portion of this presentation, we're just gonna have a panel discussion, but at any point if somebody has something they'd like to come out and ask or have a question, know that the first thing that you're going to have to say is your name, the second thing I'd like you to say is for what you are joyful, or as we're coming into Thanksgiving week next week, because I think too often we focus on a negative occurrence or a negative thing that has happened, and we don't often spend time being thankful or appreciative of the stuff that we did. And so in one of my leadership trainings that is sponsored by our hospital, they had introduced this concept of three good things. And so at the end of every day, consider three things that you had an impact on or three things that you found joy in doing, and that gives you kind of a continued sense of purpose or continued sense of happiness and why you choose to do the things that you do. And so with the first question, I have kind of noticed a theme actually from each of you is that either you just did or you will in the next year do a change in your title or a change in what you're doing. And so we're very first name basis in this group, but Megan, for you, that's starting residency. Nate, for you, that was becoming involved in the Resonance Program. Hank Young, for you, that was less than a year ago becoming a chair, I believe, at a major institution. And I think whenever you have confidence in what you're doing, it gives you joy. But when you feel like you are having symptoms or feelings of like imposter syndrome, at times that can be a thing that robs your joy. And so how do you guys either deal with that at this stage or how are you anticipating handling that as you move forward with big career changes? I think there's some degree of imposter syndrome that always exists. I think it gets quieter. I know that now at almost seven years into practice, it feels quieter. I think in some regards, I leaned into the value that it provided me, the sense of imposter syndrome and that it was a driving force to continue to grow and learn and be better. And then I also tried to lean into that wasn't an internal voice, that wasn't an external reality, that my moving up in a leadership role in our residency program was validated by all these people that I put trust and value in. So if they can value me and believe in me, then I should do that for myself. So a theme that I have about finding joy is a lot about just analyzing how I'm thinking about the situation. And sometimes my biggest barrier to joy is what's going on between my ears. And if I can sit with myself and think through those things, I can realize there's a lot of reasons for me to be happy and joyful. And that imposter syndrome that I might be feeling, there's a value to it, there's a purpose potentially to help me, but also it might not be an actual external reality that I need to think about. Yeah, I think, so actually it reminds me, early on in medical school we had, I was struggling with imposter syndrome a little bit and we were actually as a class assigned to listen to this podcast. And during the podcast at one portion, an attending was talking to a bunch of medical students and he said, look around, everybody here is smart. You distinguish yourself by being kind. And I think that really helped me focus on, and I've tried to do that throughout my training so far. And just instead of comparing myself to other people, just really focusing on how can I be kind to the person and the patient in front of me today. And I think that's helped silence some of those thoughts a bit. And Haekyung, do department chairs have imposter syndrome? Absolutely. So imposter syndrome is, I always have, right? Because of a language barrier, I always have. I have to confess that. But how I overcome, I did not overcome yet. That's why I get migraine a lot. But how I. then I forget about myself because I think about myself too much. That's why I think it's important. But, when you forget about yourself... imposter syndrome, but I'm always win in the game, because I forget about myself. And then the first question I hear is for you actually, Megan, about something you mentioned during your presentation about having your own mission statement. And I know that in many of our institutions, we have a mission statement. Some of them are about four paragraphs long, and nobody in your institution can actually remember what they are inside them, which is not what a mission statement should be, right? Mission statement should be something a higher organization can say, this is what we believe in, and it should be a sentence or two that everybody can memorize. So you essentially rattled off your mission statement immediately, and you have it memorized. Do you ever go back and revisit that and change it, or do you just always feel that that's exactly the person you need to be, and that's what provides you joy? So if it doesn't provide you joy, it shouldn't be something that you're doing. Yeah, I have revisited it a bit, mainly just changing, I think, as things change in my life. So as I became a wife, that added it into my mission statement. But I think the core things of support and love and being present, those I'm not willing to change. And so if those are lacking, and since those are things I'm not willing to sacrifice, then I have to change something else to make sure I get back to that. Yeah. And then, Dr. Kim, this question is for you. It was a question about one of my slides, which was the amount of hours we're spending administratively in PM&R compared to other specialties. And it feels like, for a lot of folks, it's like we are experiencing death by 1,000 cuts. And that's literally what causes some of the people's burnout, is that it's this note, it's this patient I need to respond to, it's this refill I need to do, it's this wheelchair prescription that's been denied, it's this orthobiologic I want to prescribe, but there's a problem with insurance to approve it, or something like that. So as a department chair, do you feel like that death by 1,000 cuts is something that we can work on to improve our joy, or is that something that you feel like is part of just our specialty? I think it's part of our specialty, but with the cuts, I am thinking that we can overcome, actually, because we end up giving up for fighting, right? We don't want to fight because we are too busy. But I think about two ways. When I was a clinician, I was always angry. It's not fair. Why I'm a paymenter doctor, you know? They deny everything, right? That's the way you feel. Then now I become chair. OK, it's not fair. Then what do we have to do instead of thinking about unfairness? Because unfairness, you bring it because you don't fight. So we have to analyze what we can do for that. So I become more joyful to finding out the way to get around, right? So let's say I work in the university hospital versus county hospital. And if the resources is not available, I look at the setting of the institution. If that is county hospital, I set the committee. I have 11, 13 committee in my department. All the faculty member has to be included in the committee. And I ask, I give them task. Your committee is going to work on this one, and you go and fight. So I don't think it's the right answer to you, because we don't have any answer for these questions, cutting, cutting. But I think that's why today PM and I are bold. We keep saying that, because a physiatrist is just given very nice. But I want us to be more strong, stronger than who we are. Because we are very kind enough not to fight with insurance company, with the government, health care system. So to answer to your question, I try to raise ourselves as leaders. That's my goal as a chair, to fight, to less have cuts. All the costs, I think we can bring that up. Not easily, but that can happen. I think your comment there about having things done to you, for lack of better words, versus figuring how to change things is exactly the mentality that helps us, I think, as a field. That's exactly what we do on an individual patient by patient basis. But then sometimes when we get into the business aspect of medicine, or we start to think about insurance companies, or how we can handle denials or authorizations, we throw our hands up and feel like we're victims, as opposed to figuring out the solution preemptively, or working on how we can improve something. So I love that point. Can I give one example? So this may not be very good, but as a physiatrist, very early career, I recommended a standard for one-year-old babies. I'm pediatric physiatrist. She said, I'm pediatrician. Also now we can talk, right? So as a human being, we have to stand up, even though she or he is not able to walk. So if my child cannot walk, at least I want him or her to stand. And she said, I cannot approve one-year-old doesn't need to walk. Oh, that's great. So I will, but I want my child to walk and stand. She said, I cannot approve. And then ask parents to hold the baby one hour per day for standing exercise. I said, thanks for the recommendations, but I'd like to invite you to my institution. I bring my baby. Why don't you hold one hour for exercise, standing exercise? She approved immediately. I will say I've, I've held my baby that way while I, while for like hours while they walked around. And I know how tough that is, but that's really well done. So Nate, I was going to ask you a question because you mentioned in your presentation that you found joy in people going into other specialties within physiatry or other aspects of physiatry, residents that have trained and instead of choosing to do sports medicine and being a miniature Nate Olson, which if I've lost a lot of weight and put on a lot of hair, maybe I could be a miniature version of you. But what, what are some of the things you have appreciated about having a network of trainees that graduate go on to other things that are not specifically right in your career field? Because I think we naturally gravitate only to those that are most like us. And so tell us the benefit of having that network that is not necessarily just like you from a happiness perspective. Absolutely. And I would, I'm gonna expand it just a little bit even, you know, I do a lot of mentorship of medical students and, you know, many of them go into physiatry, but not all of them do. And I think the value for me is connecting with, you know, again that mission statement of being the person that I need when I was, if I was younger. What if I didn't want to go into physiatry? What if I didn't want to go into sports medicine? What would that person need? So finding that fulfillment and joy in mentorship and coaching is the value for me, is figuring out whatever the person across the table or across the Zoom call for me, or on the other side of an email needs. And that oftentimes isn't just a miniature me. I mean, I'm already pretty small, so there's probably not a lot more miniature me's that are gonna happen, but... Nor am I gonna regrow hair, Nate. There's a lot of baldness in my family, so this is just... But leaning into that, and, you know, it's also about connecting with my own humanity rather than just saying, you know, I'm, I remember it being as a resident or as a medical student seeing someone who was in my position and being intimidated by the position they held. And I really want to undercut that notion in people who I'm mentoring or coaching. I want to connect to my humanity and then help them figure out whatever they want to do or help support them. And the other thing is just we're connecting to being a physiatrist. You know, even though I have a subspecialty in sports medicine, I'm a physiatrist first, and I think that makes me be better at my subspecialty. I think that's any, this is not new to any of the people in the room, but I think that's an important thing not to lose track of. And when it comes to education and mentorship, I have to connect to that, because it's important to me in my life and in my practice. It should also be important in the way that I express my mentorship to the people in front of me. So, that's what I would say. And, you know, we need all kinds of physiatrists, you know. I know there's a big trend to go into specialties like mine, but we don't nearly have enough of other types of physiatrists, and so I want to support the care of the full spectrum of all of our patients, not just creating mini-me's. I think this last question is maybe a more philosophical question, which worries those of you in the audience that I'm going to get philosophical for a moment. But one question I've always thought about whenever thinking about this presentation is, do we as a panel feel that happiness and joy is a set point within an individual, or do we feel like that changes with time or changes with aspects of our lives? Is happiness something you feel like you can change, or is it just you're an Eeyore or you're a piglet, you know? That's a Peds reference. So, are you just kind of, as you are, kind of, okay, I'm going along with things, I'm not too happy, or do you feel like you can do things that would drastically change or at least somewhat change the course of your happiness? Yeah, I don't think it's a set point. I think it's easier to be joyful in some situations than others, and I think it's important to give yourself grace with that and say, you know, this is a difficult situation for me to be happy. But then trying to make that next step of, okay, what can I do about that? How can I be conscious about choosing joy and taking one next step to helping myself be more well and be more joyful? And I think just taking one step forward at each time can get you a little bit closer from a place of less joy to a place of more joy. Yeah, I would agree. I think, you know, we all are wired a little bit differently. That's not news to anyone. And so I think, you know, there are predilections in various directions in terms of joy, happiness, sadness, whatever. And I also think it's not just as if we have complete control over those things. It's sort of a both, a yes, both. I think that something that has been really important for me in the fostering of my own happiness is being mindful and practicing mindfulness. So there's a lot of things that I didn't appreciate as a learner that are on the weight of the shoulders of the attendings that we don't always see. And it's a lot of this, you know, death by a thousand cuts that was just mentioned. So finding a moment and a moment in the day or a time to sit with myself and be mindful about what was I proud of today? What was I happy with today? What was joyful today? But also why was I upset if I was upset? What was the purpose there? And then what can I do to potentially act against that? Maybe it's, I just want to feel upset right now. Maybe I need to share that with my partner or share that with my friends that this is what's going on in my life right now. But I think the root of that, the control, although it's not universal, complete control over our happiness, I think some of the control we have is practicing mindfulness. That's been really helpful for me. I think joy by this age, I'm happy for with anything. I think joy is basically is coming from you. You know, people think I'm always happy. I always smile. I am happy. But what I'm thinking is if you don't choose what you like to do, then you become unhappy. Right? So I always just say, now people say, oh, are you happy? You're a chair now. How can you be happy? I'm very happy because I'm chair. I'm not faking it because I chose to be chair. Even though there's a lot of difficulties, I can overcome. If I cannot, if I don't like it, I'm going to drop it. I don't want to be chair. Right? And then if I make people's life miserable, I don't want to be chair. I hope my faculty member is not in the room. Tomorrow maybe I lose my job. But I think about it because I work literally very long hours, even now. I thought everybody, when I left New York City, they were praying for me that Dr. Kim, when you move to Dallas, you're not going to work hard. You remember, right? You are the chair. You can do whatever you want to do. But I work much longer hours now. But I'm very happy. And then I never show my face that I'm very tired. I see patients. I go to all the meetings. But I know if I move, my department is going to get better. If I move, if I be efficient, I can see more patients while I'm in between the meetings. And then I can go home. I can see my family. And without worrying about my work because I worked so hard. And I become happy. So my philosophy is that the life is all about what you choose. And then once you become a physiatrist, you chose. I don't think your father knew what is PM&R. I don't think your grandmother knows. They know physical therapist, but they don't know you're a doctor. So you chose this very uncertainty specialty. So you have to be happy. I think the reason why when you showed the slide, because if you want to become a doctor, would you be PM&R doc again? It was lowest one, right? Because you are not proud to be physiatrist. You did not know what is PM&R exactly. So that's why I like to give a presentation to medical student. I meet each medical student who come to my department to introduce what is PM&R. So basically I like to say that your happiness is coming from what you choose. That is a very philosophical way to end it. Your happiness is what you choose. So at this point, if anybody has any questions for the group or if they'd like to share their own joy and physiatry, Dr. Rosenberg, the rules were introduce yourself and one thing for which you are joyful as we're going into the week of Thanksgiving and then any comment or question you have. Nathan Rosenberg, Ohio State Nationwide Children's Hospital. I was sitting here trying to think because I knew you'd ask me that question of the joy thing. I'm thankful to be trying to pick something right now and I'm listing through these things. You know, I'm thankful for my friendship with Matt McLaughlin. That's the one I'll pick. But there's so many more things professionally that I'm thankful for and I hope that, I'm looking to see if there's any Ohio State residents in here. No. I hope that I impart that I love my job. I hope I impart that. But I'm wondering from panelists there, I'm wondering, and maybe even people in the room, how, I feel like people are, when they're approaching their careers and they're making these plans and like, I want to make sure I'm making this money or I'm doing this thing. And very rarely do I see folks saying, I want to go the path of joy. I want to go the direction of, like, I want to be pleased. I want to have time for my family, these different things. And it's more so, I want to make sure that I'm doing this aspect of academia or something. And I'm wondering, how can we direct our trainees and the people that we mentor towards joy as opposed to towards, let's say, achievement? I love that question. Is this on? Yeah. I love that question. You know, I think there's a lot of focus in many specialties, ours is no different, of what goes on the CV as a reflection of worth and reflection of value or how much money someone's earning or the research dollars someone's bringing in. But the worth is really the stuff behind that that's not on the CV. I completely agree. So one of the things that I try to do when I am mentoring folks, whether they be residents or medical students, is really try to foster them thinking about what they want, what they like, making intentional choices, not just I need to do a research project so that I can get a competitive specialty, et cetera, but figuring out what drives them, what makes them excited, what do they like, what do they want. So I think if we as mentors can sort of frame shift, not just facilitating, which we should, helping them get the project or helping them get the rotation, but help frame shift focusing on the why and the stuff behind that, that's not just written on the CV, that will bring them joy, that will bring them more fulfillment. And also, I think being vulnerable as a mentor, that your joy is not going to be a linear thing throughout your career. It's going to have troughs, it's going to have peaks. And that's okay. That's normal. And being able to roll with that and be able to sort of navigate that is another tool. So I would say being vulnerable and helping our mentees just frame shift a little bit, not just focusing on the CV. Yeah, I think also from like a medical student perspective, medicine tends to attract very hard workers that will, you know, spend hours and hours and hours doing what they can to advance the field, to advance their career. But I think, and there's that hierarchy, you know, regardless of how much we try to minimize it, like you're being overseen by attendings, residents, what have you. And so I think protecting your students and trainees' time off, like if they, and enabling them to do that and saying, okay, if you finished your work, like go for a walk or like you can go home and like read about this and then we'll come back and talk about it. And just enabling them to have that built into their training of like, oh, I do take time off and I do spend time with my family outside of work so that when I am at work, I can work as hard as I can and be present and really maximize my productivity at that time. With that, I really start to think about, you know, the work-life balance, which I hate because the work and work balance we have, right, there's a lot of life. But I always allow my trainees to go home anytime when I was a fellowship director. Because if I were there, I would think of myself as them, right? So if they need, if I need the time off, they need a time off. So we think about the burnout. I am changing the template of our outpatient clinic. I think I, whenever I go to ophthalmology, ENT, they look at my eyes or my ear, not even taking a look, my ear sometimes. They charge triple, quadruple high bill I'm going to get, right? But they are very efficient. And then they go home at four. We go home at eight. Our salary is a half of their salary. What's wrong with this picture? So we have to also teach our trainees, you can be a great comprehensive or whatever doctor you can be, but the other side, you have to be very efficient and focused patient care. Therefore, you can have your life back. But you, you write that, did you read that report? That we spend 19 hours over 40 hours for the report, writing report. Who reads a rehabilitation note? Nobody. So how I teach my resident fellow, I say, you don't, you don't need to write the note at all. Look at the patient, examine the patient, and then look for the referring physician. You have to find that referring physician. If you're not there, make the phone call. And then we talk about the findings. We talk about the recommendations. I don't talk about PTOT. I don't talk about disposition at all. I talk about medical management. I find out medical problems always related to rehab outcome. And I educate them. After then, they cannot survive without us, because we give the real comments. So what I'm trying to say is, bring your value up, be efficient. Then your work-life balance, you make more money because you're efficient, right? And then you finish earlier. You go home. You can enjoy your life. That's the way I talk to my trainees. Don't spend unnecessary time for your note. Make it, get to the point. I learned from myself, because I cannot write beautiful notes. You know me, right? My English, this is a book, but I was getting to the point. So I finished my note very fast, right? That's the way I would like to teach our residents, our fellows. Dr. Tillman, good to see you. Good to see you, too. My name is Jerron Tillman. I'm an interventional pain management provider in Kansas City, Missouri. Yes, thank you. So I'm thankful to Dr. McLaughlin, Dr. Oliveson. I trained, we were co-residents together, and I think we were residents when Dr. Oliveson was a medical student at University of Missouri. But truly, it's just an honor to see you guys being so successful at, you know, this stage of your careers. That brings me so much joy, because it's a validation that, you know, we were, you know, well trained, and it's just so good to see you guys. So I really mean that. I don't have a mission statement. That's something I'm definitely going to think about, but going to my question, you know, I have a passion for what I do, but one of the kind of bloodsuckers, if you will, for my joy is, you know, seeing the difficult patients, the patients that are difficult to treat, and having staff that are, you know, burned out, and having to expend so much energy trying to lift up the spirits of the people around me, even if I'm passionate about what I do, you know, what advice do you guys have in terms of being able to not only maintain that joy, but infect the people around you so that you kind of get the benefits of that on an ongoing basis? It's a great question, and it's great to see you. Yeah, I was a fourth-year med student when those two were PGY2s. I had a really, really great start into seeing what physiatry was all about. So I, it's a tough question. It's a tough, there's not great solutions per se. I've had, I've experienced that myself in my own clinic, and what I have tried to do as I start with myself, I try to be very covetous of my own energy and what I do with it. Relating to the prior question, and, you know, one thing that I'm starting to do a better job of mentoring about is don't be boundaryless, you know. Have your boundaries. Develop them. I think other medical training often fosters a boundaryless life where you're like, I'm going to say yes to this. I'm going to say yes to this. I'm going to stay late because it probably is going to reflect better on my performance, and then the grade, and then the residency, and it's this arms race for doing more, and that's how I was, and then I got into being an attending, and I kept saying yes to everything, and then I'm like, oh my gosh, I don't have the time for this. I don't have the time to do the things outside of medicine that also bring me joy, and that was, that was a tricky transition. So I would say that I start with myself and how I'm going to let my energy flow so that I can fill my tank back up, and then when I'm in clinic, when I'm around the people who are burnt out, frustrated, struggling, I'm going to have more energy to help in that situation, and if I'm not covetous of my own energy and my own time, I'm going to be in the same position they are, and then I can't be a leader. I can't help fill them up, so that's what I would do. That's what I, that's what I've tried to do successfully or unsuccessfully. Yeah, I think that's a great point, Nate, because if you didn't know, Dr. Tillman has written his own autobiography. He's a recording artist, so there's things that like define you outside of medicine, and so I think it's a question of what you're saying is don't just only be a physician, and I hate to say that because it's such a big part of sometimes who you are, but you're a cocktail. At a cocktail reception, you're the physician. You know, if you're going to a friend's house, you're the physician, you know, and sometimes you need to be the recording artist or the writer or, you know, the poet or the runner or, you know, you name your kind of thing there. So did anybody else have any follow-up on Nate's point there? Herb Villaflores, St. Louis SSM. Not that we have a Missouri contingent here, but it's kind of nice to see a lot of the Missouri folks. So first, The Joy. I guess finding my second chapter, if you will, with PM&R. The first time I was in this meeting and last time was almost 20 years ago, so I want to age myself, but my question for you, and I know it's going to vary because you're all in various stages in your career, and admittedly it's going to be harder on the left side towards the right, but a big part of burnout and a big part of finding your joy is being able to say no, right? How do you draw the line, and so what advice can you give to others to say, hey, no, me first, or let's take care of this so that I don't get burned out and protecting myself? I'll go first because I like to hear my own voice. So it's, again, a really astute question. As an early career faculty, this is something that I very much struggled with after kind of finishing being attending. So I had a mentor tell me that you really need to be going in and out. To practice saying no in a constructive, polite, genuinely kind way, and practice it outside of medicine first. So I started practicing it with like friends and family when they would say like, hey, can you help me with this, and hey, I want to do this thing, you know, can you come over for this, and I would say no anyway in my normal life if I was busy. I would obviously yes if I had the opportunity, but sort of growing that confidence in being able to do that in a way that leaves the person on the other end not upset, not questioning my abilities or questioning my person. And then also, again, connecting through, you know, for me, mindfulness of like, do I really want to do this thing? And if I want to, I'm going to figure out how to do it, and maybe I may need to make a hard choice of something I'm going to let go, but if I don't want to do it, that's okay, you know, maybe it's not the right time, maybe I don't have the the right bandwidth, and just being clear and vulnerable in that discussion I think is my approach. Still growing on how to say no. I still swing and miss, I think, sometimes, and probably for any of the medical students that I've mentored that are in the audience, they know that I'm not the quickest at emails, so maybe I'm taking some time to figure out what I want to say. So practice, I guess, but it's hard, it's hard. I think the other thing is sometimes whenever I'd say no, there's other people out there that are trying to, like, want these new opportunities and are trying to find them, and I think connecting other people who are trying to still grow their career in that way, so saying like, I'm not able to do this, I appreciate that you asked me, but I think this other person would be a great person to reach out to, and then connecting them that way. The reason why I'm answering as last person, because I never say no, I always keep thinking how I'm going to explain this one, but what I learned is that once you start to say no, the opportunity doesn't come. It's blocked, so you pick and choose. Now I start to say no a little bit because I have so much work to do, so I say no, but mostly when they ask me something, mostly I like to do that. I enjoy those works, so as long as I am capable, I say yes, but as you get busier, I think you really have to pick and choose, so try to not to say no too many times, but a few of them, so I'm not the right person to ask that questions, but I'm always happy, and then my family is very happy too, so my joy from busy life is tasting different things. As I said, we get invited a lot to different countries, different places, different schools, all free. They show their best part of their school, their country, the most delicious food, so that becomes my joy after not saying no, but sometimes you get really exhausted at that point. You really have to pick and choose. That's the only one I can say. I'm not the right person. Dr. Lindenberg, I'm getting my step in today is all I'll say. I'm Amanda Lindenberg. I'm at Children's Mercy currently. How do you find joy? Oh, I have great mentors, so I appreciate all of you, and I find joy in that. I usually write down, number one, the task wise, there are so many things on my calendar, right? Calendar is not enough to put all my agenda or meetings. But in the morning, I usually start at 6 or 6.30 a.m., I sit down, I look at my calendar, I prioritize all my meetings first, number one, and if I choose what I have to do, then I don't need to rush too much because I know exactly what I have to do. And then at the end, I forgot your questions, but I prioritize my work, and then I try to achieve those goals over the day, and at the end, I look at my paper again, what I did, what I was not able to do. And then following days, I prioritize different ways because certain things I was not able to do, even though I wanted to. So then, the new comes, right? I can say, no, I am not able to do. So that's the way I try to make myself easy while I was very busy. If I heard you right, I think it was, how do you find joy when there's difficult patient interaction, difficult conversations, maybe things aren't, yes, things like that. I mean, I think that's a really smart strategy of being able to make sure that you're efficient outside of your clinic time, so your clinic time can be more expansive. For me, there's a couple ways that I try to approach it. This is another reason why I like teaching, is if I have a learner with me and they get to witness a difficult conversation, maybe they hear me over the phone with doing a peer-to-peer, or they see me counseling a patient who's upset, one of the ways that I can help process that is to externalize that to the person that's with me, that I can talk through, okay, you see me right now. I'm really frustrated. Let's talk about what we can do with this frustration. Let's talk about, it's okay that we're frustrated. You're going to be frustrated in the future when you're in my position when things go this way. The other thing is, as I start to feel a situation go in a frustrating way for the patient, I try to frame shift in my mind, okay, what do they need? They probably walked in thinking that they needed from me a diagnosis, maybe a medication, an injection, but I think maybe in that moment, I try to shift to, okay, what power do I have? Maybe my power is just listening. Maybe my power is just empathy. Maybe my power is connecting them with someone who can help them in a different way. Those are the approaches that I take, is I'm in the fortunate position that I can externalize my frustrations to my learners, not through complaining, but trying to use it in a productive way that's educational for them. That helps me process and fill my tank back up when it was just drained through a difficult situation. Maybe I misunderstood your questions. What I do, because we have a very limited time to deal with the patient, right, so now when I was in training, when I was a junior, I asked from A to Z all the questions, and I provided all the answers as much as I could. I don't do that anymore because the patient gets frustrated. At the end, they don't know what I was talking about. Not to cause the difficult conversation, number one is you have to get to the point. Why this patient came to your office? Ask them directly. Even though their age is something, I'm a pediatric physiatrist, but I am seeing all the stroke patients now, so I said, what is your reason to come to my clinic today? When I start with that, I focus on that examination only, because even though I'm PMNR doc, finish the shoulder pain first, then look through, very scan the patient, because you can do that, right? And then, if they couldn't understand, they get angry, and as Nathan says, let them talk, and you have to listen, and then answer to that question only. But if you talk too much, and it causes more problems, actually, more difficult conversations to start. So make it simple, actually. And I'm always kind of in the mindset that sometimes you just got to take three minutes and go think about something else in between patients. I mean, I hate to say it, there's metrics on everything these days, you know, when you entered the room, when you left the room, how long you were in the room. You know, your own billing, all these other things, the questions you got, the emails that you have to answer in between it, we never turn off our minds, and so sometimes I think you have to just turn off your mind for three minutes, and realize that those three minutes are worth it for you, especially if you're in the middle of two or three of those conversations. I'm thinking specifically about those new diagnosis of life-changing conditions, like spinal muscular atrophy, or Duchenne muscular atrophy, if you're doing two or three of those talks in an afternoon, that's earth-changing for the families you talk to, but it also is for you. And so sometimes finding that time in between those discussions is very valuable. I think this might be our last question, so go ahead here, Dr. Lambeth. I just had an additional comment with regard to that discussion, and I'm Amy Lambeth, I'm a pediatric rehab fellow at Children's Mercy. What am I thankful for? I'm thankful for a lot of things, but as I was thinking about that, I'm thankful for work that I enjoy, and I'm thankful for the opportunity to help people make their lives better, and thankful for my husband and my puppy. But I think that with regard to Dr. Lindenberg's question, when I decided to go to medical school, I think I initially had thought about it but been kind of unsure about it, and one thing that kind of shifted in my brain as I made that decision was thinking about bad things are happening to people all the time, and they're going to happen regardless of whether I'm the one helping them or not, but I can help make it better. Or if I can't make it better by changing their diagnosis, I can help make that conversation be as smooth as it can, as clear as it can. I can help be in those bad situations and optimize what that experience is like for the families as much as I'm able to do that. You know, obviously you can't make it good if it's, you know, horrible news, like your child isn't going to be able to walk again, like you can't change that, but they're going to be getting that news regardless of whether I'm the one giving it, and the way that I give that news can really make a difference in their processing and their experience in the hospital and all of that. So I think just kind of shifting the way I think about it and thinking about, like, these are really horrible, sad things, but they're going to be happening regardless of whether I'm here or not, and me being here I can help facilitate clear communication and I can help with the healing process and bring good into that horrible situation, I guess. Thank you all very much for coming. At the end of my day today, when I'm thinking about my three joyful things, I'll appreciate all of you for coming to this lecture and for providing your insight and your thoughts on better ways that we can experience or have joy within our field. So thank you guys very much, and I hope you enjoy the rest of the conference.

joy

physical medicine

rehabilitation

panel discussion

burnout

personalized care

wellness

imposter syndrome

values

mentors

mission statement