All right. Thank you everyone for taking the time out to kick off community week. I actually found out that today or this session is the first one of the community sessions. So we get to be the official start. And I was talking with Dr. Verduzco Gutierrez and a while back and we wanted to talk about the impacts of the pandemic on women in medicine and a little bit a play on we don't talk about Bruno, that, you know, we don't talk about boundaries and how the pandemic has affected women in medicine and boundaries in medicine. And, you know, people used to be able to, you know, finish work at work and now there's a lot more working from home and just a lot more ways that women who are physicians or providers can be pulled in multiple different directions and have, you know, multiple hats to play. And I was originally going to do this as a webinar where we could type questions, but I did ask them to open it up so that we could have some open dialogue just for to share your experiences that you've been noticing throughout the pandemic and everything as well. And so, Dr. Gutierrez, I don't know if you're ready or if you need a couple minutes. I know I am. I have slides, but some I'm going to try to like cut out the ones I'm not going to talk about. Okay, sure. But I can also just stop it when I'm ready to stop it. Okay, and it's like a pretty small group, so, you know, people can unmute and we can chat as needed. Yeah, okay. Well, I'll leave it to you then if you feel like you're ready to kind of take over. Yeah, okay. All right, so this talk takes a lot of knowledge of things, like, actually, I hope you watched Encanto, because if you didn't watch Encanto, then you might not get some of the references. Did anyone not watch Encanto? So, stop this. Go watch it. Watch this later and film. Okay, so, you know, we're going to talk about boundaries. We're going to talk about Bruno, as we say. We're going to talk about, there's a picture of the Chicago Marathon, because it was yesterday. We're going to have a lot of fun, kind of talk about building yourself up and also putting boundaries around yourself. And so, I'll start with this question, and you can answer in the chat. Is it really easy to do all this stuff? Practice physician, practicing doctor, leader, researcher, whatever else you want to do? Okay, thanks, Dr. Russell. All right, Dr. Fleming also thinks it can be very hard. Yes, thank you. Lots of... Okay, yeah, so very, very difficult. Interestingly enough, I sometimes ask this at different talks, and I get different answers. I'll tell you, mostly, always women say one. Men don't always say one, because they always have a woman that's helping them do things. And, you know, sometimes I get a none of the above. But, you know, even I feel that, you know, this is... I had started being a chair in 2020, and then it got very I had to get very wise very quickly. And so, that's how things go. And, you know, we're in PM&R, and, you know, PM&R stands for, you know, everyone says that PM&R stands for, anyone heard of that? Plenty of money and relaxation, right? So, it's not plenty of money and relaxation, or maybe not all relaxation. And, you know, how it started, it wasn't always, you know, not a lot of... I had both my kids during residency, so things were look very different for me then than it does now. And in the picture on the far right, only the two big kids are mine. The other ones are my nephews that live with us also, because they have a single mom that we have to help support. So, we have a very big family, like nine people. So, it's a very much like a familia madre doll type situation in our house. And so, there's very little even relaxation at home, and there's a lot of stuff that has to be done. So, that's... So, these are some of the lessons that I got from this movie, and it's where I'm going to start talking about boundaries some too, is that, you know, they went through a hard time at the beginning, you know, or that what that the grandma went through, and that these hard times shape who you are. And sometimes, whether that be the hard time that, you know, whether it be getting through medical school, or working now, or living how you had to live through COVID, or doing what you had to do for COVID for your family, or for your work. And that you have to find that these things, you know, make you stronger, and you find some gift out of it, and figuring out what that is. And then you have to sometimes work hard for others. Like, they all each had kind of a gift or something that they did, and they, you know, wanted to help each other or the community get better. And so, in that, you also have to, I mean, there's more lessons that we're going to talk about. But my other question is that you can put in the chat too. Like, if you watched the movie, then did you, you know, one thing that it's very powerful, some people identified with characters just based on maybe their own experiences, or their own like families. And if you did, and you watched it, you could put in the chat if you felt like you identified with someone. Ah, Dr. Russell. Like I said, go watch it. Disney Plus. Ah, see, everyone's like, you need to know the characters. All right. I'm just bald to the end. So, yeah, a lot of sort of also here giving this like a lot of women physicians, especially identify with Louisa, who is kind of one of the older daughters, she has to be very strong, she has to do a lot of stuff for the community, and everyone relies on her. And then there's, you know, she talks about the pressure that she's under. I also kind of identified with Isabel, the Isabella, the oldest daughter, she's, or I think she's the oldest daughter. You see, there's me in my flowery dress, or I even dressed like her one day, not on purpose, but happen to have that dress. And she's also the daughter that has like is seen as perfect and feels like she has to follow the perfect path and do everything that's right. And so sometimes we also identify with like being forced into a pathway of perfection, and doing everything right as other people expect of you. So those are kind of like a couple of ways that the women even in this family fit a lot of the kind of what women have stereotypes that women have, especially in medicine as well. And so this was also like one of the songs that's like you're waiting on a miracle. And so when I was a junior faculty, then I made like a lot of rookie mistakes. I was, you know, just did a lot of work, a lot of clinical work. And I was seeing, I'm really good at seeing a lot of patients and making RVUs. And I did the citizenship tasks. Those are the things that you don't get paid for, but that you have to do. But, and if you're in an academic setting, then, you know, you need to be well-rounded as far as like doing your research and administration and teaching and clinical service as well. And it's really hard to do all of that, but also with the RVUs, but I was very good at the RVUs. So it was okay for me just to do that because I needed someone to make money, but then that didn't really get me promoted anywhere. And then I also tried to be a good mom and you just kind of like, you know, always have to, you know, then I'd just be waiting for a promotion for a raise and things that you don't come in academics. So you, you know, one of the first thing is like, you have to know what it takes, whether you be in academics or private practice. And that's something that, you know, where are you valued and where, what's going to help you make the outcome that you need. And so, you know, I had to open my eyes. I had to know my priorities, even when I was a young mom. And then, you know, you remember I said I was the RVU queen, but I had to open my eyes, like it says in one of those songs, and then it's going to be a miracle to get a promotion and a raise if you don't do it the right way, or you're going to burn out because that's the other way. You either go and you, you know, leave because you burn out and you don't have boundaries, or you don't say, no, I have to stop doing that so I can do this, so I can get promoted. I can't just do clinical work only because then I'll never get promoted. So that's another reason, like I had to learn boundaries and learned what it takes to get to the next step. So there's also, you know, this song about surface pressure. That's the one that Louisa, so again, early on, I had a lot of interests. I didn't have grant money. I was just a baby researcher and was like, so, so tired. And just, you know, you kind of do everything. There's a lot of stuff that's put on you. And then actually, this is one of the lines from the song. It's like, you feel worthless if you can't be of service. That's like that line from the song, just, I know resonates with me a lot. And I know it resonates a lot with women. Like you feel like you have to work, you have to take care of your patients, your family, your department, your residents. And so we kind of have to, that's kind of creating boundaries because we feel all of that's on us. And I'll tell you what happens also to women in medicine. So in this study, when they looked at EHR use by sex in academic healthcare system. And so females spent 33 minutes more per day in the EMR. And that's the equivalent of three additional 40 hour work weeks per year that in general, women are spending more in the EMR more than men are. So that's time away from families, times away from home, time away from our lives. So that is something that first happens. Then this study was more, it was in journal of general internal medicine. And yes, it was looking at more primary care, but I still think it makes kind of the same points that female PCPs spent 20% more time, which was about two hours a month in the EHR in basket. And then 22% more time or almost four hours a month on notes than their male colleagues. Also female PCPs received 24% more staff messages and 26% more patient messages. So that means that actually patients and the staff in your office are asking more of the women physicians than they are of the men physicians. And that's something I even see in my own practice. And the MAs will send me messages that belong to someone else or else they're like, have you done this form? I didn't see the patient last. Why am I getting sent the form? And why are they just feeling like maybe they can open up to women more or feel okay giving that kind of task to a woman, especially it's a task that's not paid. So just like realize when that kind of goes on, or if that's going on, or if that can be looked at in your own practice, and that's a good way to create boundaries too. And then in this study, JAMA internal medicine, actually female hospitalized patients treated by female internist had lower morbidity and mortality and lower readmissions compared to those that were cared for by male interns. So that's another reason like, okay, we're spending more time, we're doing better work in some studies. And people of course are giving us more work. And then, you know, that's the Louisa holding the whole village and everything on top of her on her shoulders. And then COVID just makes everything heavier. And so, you know, I want people to aim your strengths. So you can see like, okay, what, you know, we talked about boundaries, and it's like, okay, find what you're good at, find what your strengths are. So you can hustle in that thing. And then, you know, kind of say no and create boundaries around the other stuff. So, you know, I'd recommend either doing a strength assessment online, it's okay to hustle, it's okay to work hard, but you have to give yourself permission just to do certain things, you know, you have to be okay with not doing everything like part of the EMR might be, are you okay with, you know, doing B notes and not A notes. Sometimes I tell the residents that like, it's okay if you have a B note and not an A plus note, because if you save a little bit of time, but I still understand what's going on, then that's fine. And it probably decreases note load anyway. So, you know, when you find what your strength is something that S is for success, or it's something that you feel effective and that you're effective in doing, I is instinct. So, you know, it's something that you just look forward to, that's something that I want to do, then that might be something that you feel like, ah, that makes me happy and fulfills me. So that may be something that you're good with putting your effort into and then creating boundaries around that stuff that is not. G or growth, it's also something that you feel like you could do all day long, you know, it brings happiness to you and that you want to continue to do it. And that kind of goes with needs and then like afterwards that you feel fulfilled in what you do. So what's going on during the pandemic? And I'm going to touch upon that, this a little bit. And so what is going on is that, so there's been a couple of studies coming out on more, more recently on burnout related to the pandemic. And so this is us health care workers where they compared it before and after the pandemic. And this is like one of the was in JAMA network open. So they looked at physicians, but also nurses, because you have to remember, we work with a whole colleague of teams. And then EE is emotional exhaustion. So there was, you know, emotional exhaustion, about 31% in physicians. And then it actually went down a little bit, you know, when they looked at 2019, and then it went down in 2020. So this is kind of when the COVID happened. And then a lot of people were super excited, like, I'm here to help, I feel so energized, I want to, you know, save everyone and, and work hard and use my, you know, paper and cover inpatient and do whatever it is. And then it by the second year of the pandemic, it went, it increased to higher than it had been to 37.8%. And then in nurses, it was up to the second year of the pandemic, almost 50%. So you have to think also about the people that are working around with you, and their emotional exhaustion is very, very high. This study came out this last month, actually. And they had 2400 plus physicians participate in their survey, it's probably not one of their, they usually do a survey most years, it's like with Tate, Shannon Felton, his colleagues, and they do on most years, and actually, they found that in 2020, the burnout, at least one manifestation of burnout was only 38%. And now, at the end of, you know, for 2021, it was 62.8%. So we're seeing a lot of burnout now at this point, that we've gotten this far in the pandemic is yes, we a lot of us are feeling some kind of manifestation of burnout. So again, what, what happened to Bruno, if you watch this, then you know, he told, he was a, his gift was supposed to be like, telling the future. And so some of it actually was like, he just told things as it was, as you could tell, like, oh, you have a goldfish, your fish is gonna die. You're gonna maybe, you know, gain weight one day, you know, these were part of the songs where they said, we don't talk about Bruno. So there was some stuff that he was just like telling him, like things were and so we don't talk. Yeah. So burnout, we talked about what the rate is now it's gonna, you know, it's even 50% or more in medical students as well. In some surveys, the prevalence of burnout can be as much as 20 to 60% higher in women physicians than compared to men physicians. And so, you know, we have to start talking about these things. We have to start talking about burnout and what is it, you know, what else do we need? We need mentors, we need to be networking. So it's good that we're here and we'll have time to talk, but we need to go back to like what our passions are. Again, like what, do the strength assessment, find out what your strengths are or what you need for promotion or what's gonna make you have time with your family or whatever your goal may be, then advocate for yourself in that area. So I said, I always like these little, you know, lines from the songs and, you know, we're, it's a heavy lift. Like we're lifting a lot because we're, you know, want to be here. We want to be the caretakers. There's, they talk about, you know, the four shifts of the pandemic and I'll go into that a little bit more in a second. So, you know, we can't leave the women behind through this. And there's been papers now after papers, how COVID-19 is adversely impacting women physician, how it's gonna like send us back for years, you know, just when, oh, finally women are gonna be promoted as much. Oh, women, you know, so now we're behind still like pay gap, everything, scientists being behind. And so losing early career women, losing early career scientists, losing, you know, you can think about the nurses and the therapists that might've left. It may not all be physicians. So it's been tough. And so the four shifts that are, that are not the sustainable model, but that they talk about. So, you know, one first shift is the regular job. The second shift is what we do at home. So that's going to be, you know, women have the mental load at home usually as well. Childcare, elder care, household chores. And so we have that mental load. I always say like, I can do a lot because actually I don't have a lot of the home mental load. I kind of just am able to focus more on my regular job because my husband works from home. So you can take the kids to school and pick them up from school and be there when the plumber needs to be there. And then my in-laws, like, you know, I said, all these people live in my household, my in-laws, my mother-in-law does my laundry and cooks dinner every night. So I don't have to do this second shift that a lot of women put on themselves. The third shift is like it says, gender equity efforts. So women do the work to lift up other women as well. And we also do the work, most of the work when it comes to publishing on gender equity and talking about this and talking about pay gap and publishing about it. Most of that comes from women also who are doing this, usually a lot of unpaid gender equity work. I've never been gotten a grant to do gender equity work or publish on the stuff that I published on related to that. And the fourth shift is the pandemic work that's not related to your usual job. So that's like unfunded COVID research, some of the clinics, explaining vaccines, supporting trainees who are struggling, that often goes also to women positions. So we're like dealing with four shifts of work and it's not a sustainable model. So what are some of the other stuff we don't talk about? There needs to be a lot more talk about salary and about transparency in pay, especially where you are in leadership roles and how to get leadership roles and what it takes to be there, whether it be nationally or your own institute, sponsorship, research, negotiations, promotion, grants, publications, awards. So these are also the things that sometimes we need to start creating conversations about, which is why we have these meetings. So we can start and you can start thinking about this stuff as well. And then I want people who are in academia to know the path, like what does it take to go? And this is also part of your institute. It might be different per institute. And I know not everyone's in academia, but I am. So sometimes it goes back to this, like knowing once you're an assistant professor, usually to make money, you have to be promoted to associate and to professor. And when I started, I didn't know that much about those levels. We had a lot of junior faculty. I didn't know the P and T criteria. Again, remember, I was just working and making lots of RVUs. And so you have to figure out what are those steps and start actively engaging in those steps so that you can ultimately, you know, move up the ladder. And so this is, you know, myself with my siblings and we're little kids. And then I was like, OK, when I became an associate professor at first, it took too long. It also took me a year where they told me I'd have a 50-50 shot and I didn't do it because I was too worried about not being promoted. And then one of my co-faculty, who was a male, was also told he had a 50-50 shot and he went for it and got it. So it's, again, another year of lost pay and a year of, you know, not making that sort of money. And so when I became an associate professor, I became the eighth Latina associate professor of PM&R in the whole country. And then ultimately I took that mindset of like, OK, what do I have to do to continue to be promoted? And then when this job opened to be the chair of rehab medicine here in San Antonio, they said I had to be a full tenured professor, which I wasn't at that time. But I said, OK, I meet all the other criteria. Let me go for it. And so, you know, ultimately was made the chair. And when I became the chair and a professor, then I was the third professor who is a Hispanic woman in the country, including Puerto Rico. So, you know, you do have to continue to. And part of the reason that I was able to finally like move up was also creating boundaries around some things. So my husband's very good at telling me, like, why do you keep saying yes to some things? You have to say no, especially when I had to make my CV better to be promoted. I knew I was missing in the research or the national presentation. So it's like say no to the other stuff and say yes to the things that are going to get you promoted or get you more money or get you the next level up. So that is part of me learning how to create boundaries. I want you also to think about this was a paper that I wrote with two other physicians that came out in MedPage today, actually. And we talked about, you know, changing the culture at work to help women in medicine and to promote gender equity. So some of it was like looking at a culture audit of the place of where you work and make sure that voices have a seat at the table. And this can be anywhere. And, you know, ensuring that people who are women, people who have intersectional identities are at that table as well and that their ideas are being heard. One other thing about creating boundaries is distributing citizenship tasks equitably. So this means that like women can't only be the ones doing citizenship task work that don't provide a return on investment. Also, like they often want to rely on impacted marginalized communities to complete this invisible work. So either the work needs to be paid or it's divvied up. So like an example was, okay, it's nurses week and or rehab week. We need someone to bring, you know, come up with an idea and bring cards and food to all the nurses. That doesn't go on my CV, but somehow it always fell to women. And so we eventually at my old job, I was like, no, I'm not going to do it anymore. And, you know, whether that go to the admin assistants or go to a van, we had to just, you know, divvy that up or say no around that. Paid transparency is something that is very, very challenging, but really necessary step to move towards systemic equity in a work. And so, you know, whether that you, whether you ask for someone to come in and be an objective auditor, and then like find what it causes and implement a solution. Sponsorship and mentorship are really important, you know, and where you work, you have to be intentional on who's getting sponsored and mentored. Be an accomplice. So, and this was a paper that went to everyone. So a lot of the ones that happened to be in leadership continue to be men. And so we have to have men that are leading the change. And if not, it's going to continue to go as business as usual. And so we have to, when there's leadership training, provide men leadership training to know how to be inclusive leaders and know how to, you know, help women to, you know, bring up women at work. And also men can also decline to participate in all male speaking panels or mannels. And in 2019, the NIH director Francis Collins at the time did the same thing. So something that, you know, we should consider and work about. And then fix the system. So, you know, we have to know that half of the workforce is comprised of women when you think of, you know, nurses and, or more actually, when you think of everyone else who's in healthcare. And so we have to start thinking about the system when there's meetings that are either really late, late evening meetings, early morning meetings, it's not going to be feasible for everyone. Especially for women, if you have to do childcare pickup, if you have to, you know, be making dinner for your family at the end of the day. So in your teams at your place of work, can we adjust, adjust it according to the members of the team? Or can we, you know, keep meetings that can be virtual? So maybe you can just listen to it while you're making dinner at home, or turn it into an email if it's not that important. So the system needs to be. So kind of last thing I'll talk about before we just kind of can open talk, take questions, because a lot is just is, we'll talk more about boundaries. But you know, I want you to continue to work on your own self promotion. And that the number one thing is creating boundaries and finding out, you know, who you are, what your brand is, what you want to do, speak up for yourself, have a sponsor who is actually going to be like the action, the one who's doing something, because people who have sponsors are 23% more likely to move up in their career than those without sponsors. And, you know, find a way to talk about yourself positively, you know, take compliments, they, you know, women are very bad at taking compliments. You know, continue, yes, we have to rise and lift up others, but I want you to, you know, work on creating boundaries for yourself. So I'm going to stop share and just get kind of any. Oh, I didn't forget my best slide at the end that says how do you do it all? It says you can always count on me to bring my famous recipe of bag of ice to your summer cookout. Because I don't cook, I'm not gonna not bring up anything else than a bag of ice. No, it's just like, it's my boundary. I'm not gonna let go out of my way. I'm also that good parent that just donates money to the school thing. Like, I can't be there. I'm not gonna volunteer. Here's some I'm not gonna sell whatever you're selling. Here's my $500 donation. Mm hmm. How did it initially go for you when you started saying no, or you started being more selective instead of being a yes? It's hard. It's still hard. It's still hard. I had actually, Amy Haltrell send me a, she has a punch card. And every time she says no, she gets to like punch it. And when she gets 10, she goes and buys herself something nice. So she sent me her punch card. And I don't think I've hit 10 yet. But but I still buy myself stuff. And it's still hard at this level. And I have to, like, realize what's going to be, you know, what's actually going to help me. I'm already a professor, I don't need things really to, like get on my CV anymore. So I'm, you know, try to give opportunities to other people to do things, but help them succeed. Like, I don't, I can't give all the long COVID talks, how about someone else can, and I'll give you my slide deck to use what you want to use sort of thing. Anyone else going to tell me how they're creating batteries, or why it's hard not to do it? I mean, for me personally, it's hard because I feel like I'm at that transition from early to mid career. And so I would say I'm definitely burned out, but it's, you still get a lot of, I mean, there isn't really a lot of clinical assistance that you can get. And it seems like prior ops are getting more cumbersome and everything's getting more cumbersome. And then you also have the, yeah, I want to apply for associate professor and all that entails. And when you were talking about the unfunded research, that really hit home too, because trying to be involved in that is tough. And so it's really hard to put up boundaries. It's also, it is, and we ask more and more of academic physicians because now so much of academia used to be like, oh, we'd have all this money from the state and we could just, you know, everyone could have all this time where they, you know, pontificated in their office or something. And now it's like, no, clinic, we make money from clinical and we need you to see patients all the time. And we know, like Dr. Shapiro is here and we wrote a paper about inpatient rehab physicians and burnout and what comes and what we see in that too, because there's like, yeah, paperwork peer to peers, late admissions call, you know, that's all system issues that we, that are not as much, that are harder to control. That's a big deal. Yeah. Fixing burnout's not going to be like do some yoga and breathe in your, this is my very nice lavender candle that I don't like because I can't have a fire in my office, but fixes my burnout real fast, not a coach. Okay. Give us the tips. What does your coach say? Can you hear me? Yes. So I just, whenever I'm going to have like one of those really difficult conversations about setting boundaries, I pay this woman who's a physician and she helped me frame it in the way that is likely to be best perceived because it's so easy to say something that someone may take negatively. And it's just, they're brief discussions and she helped me come up with a script and then she holds me accountable so that the following time I meet with her, she makes sure I did it. Nice. I think sometimes I just even like ignore emails for a while. How often do you totally disconnect on vacations? Because I find that that's very hard to do. Very hard to do. This is what I've heard. Do as I say, not as I do, is that you can like take your email off your phone while you're gone. And then maybe you do want to check it, but it's only when you're at a computer, you know, every other day, not every time you look at your phone. And then the other things to do is like make someone else in charge of the things while you're gone. Like, okay, this person's going to get all my inbox messages. You just have to make patients understand that, okay, you're gone for this week or two. And someone can maybe address some things or refill your meds, but other stuff's going to have to wait. Yeah. If you're a leader in another way, you know, I have to be like, there's the acting chair while I'm gone who can, you know, sign forms that need to be signed or be available if something comes up. Acting program director. Does anyone have any tips or other things they'd like to share? My other, yeah, the big thing is also like, especially the how much time we spend in our EMR and our inbox is that, is there a way to make it more efficient so that you're not spending so much time in there? Like I said, especially now, like if you're doing outpatient, you know, there's some of the billing that's based on time. So you don't have to have all those elements in there. And if you're spending that amount of time, just, you know, document at the end, you spent that much time and you don't have to have everything else that's in there. And, you know, it doesn't have to be, you know, a Pulitzer prize winning note. It can be a, like I said, B level grade and still be fine. So what else is, and then, yeah, knowing what's going to help you get promoted or get more, get, you know, that's, that'll help you kind of set your boundaries too. The other thing is that, you know, part of the, there is a checklist was like, are you going to get paid for it? You know, do you like, do you like it? Is it going to help me be promoted? And are you going to get paid for it? Is there like at least two out of three of those things might make me do it? Hi, can you hear me? So what do you think about like the quiet quitting stuff? I think Dr. Fleming was going to ask something, but I'll talk about quiet quitting. Oh, sorry. I'm not even sure what background that is. Okay. As I'm leaving work a little bit later than I had attended, speaking of boundaries a couple of things that I've found that have helped me a couple of strategies. Number one, there've been times when I found that I've had to put on my CEO hat of my own life and say, okay, you workaholic people pleaser version of you, Talia, you need to go sit down because the CEO part of you needs to take over and make this business decision in terms of whether or not you're doing the extra work, whether or not you're saying yes to more projects, whether or not you're agreeing to do whatever the extra thing is, because I find that sometimes the people pleaser workaholic part of me says, sure, no problem. And then I'm the one up at midnight, one o'clock in the morning, still working on whatever the project is. That's good. She got frozen. She got frozen for other people. Talia, are you still there? But I like that. Okay, so who's heard of quiet quitting. Have y'all seen that the news, or, you know, there's an article even in the New York Times about it. Yes. Yeah. Yes. Yeah, so it's a new phenomenon where people are kind of just doing the bare minimums the basics that they need in their work and are doing as little kind of as possible and just to get by. Yeah. Yeah. I can see you know a lot of people are feel that they're being underpaid and being not appreciated for what they do and they're burned out they want to make you know their life be more about outside of work. So, I mean I still feel like take care of your patients and do what you're supposed to do, but think it's going around. Another thing I recommend doing like I talked about a strength assessment I love those personality assessment things because then it tells me a little bit more there's one that's called the four tendencies and people can fill it out and it's a free kind of thing and you can see what kind of person you are when it comes to like, who you answer, who you're more willing to answer to and there's questioner rebel. And, my gosh, what's the other one. And so that was interesting because when I did that it told me I was an obliger and when you're an obliger that means that you are more, you're more likely to meet outer expectations but resist inner expectations so that means I will like continue to do stuff to please other people, or because other people need me to do things like, oh my gosh I'm going to add on extra clinic because my patients have to wait and I'm going to, you know, do x do this this this this and like it doesn't matter that I don't eat or that I don't sleep or that I have to miss working out sometimes, versus people who are upholders kind of meet outer expectations and inner expectations so they will do those things but they're going to do it. As long as they're meeting the stuff that they need to meet so they will like, okay, I'll do that as long as I'm home by dinner or I'm able to still, you know, do this thing that I want to do or no I'm not going to do that kind of clinic because I don't want to do that kind of clinic but I'm still willing to make that many are views but doing what I want to do which is kind of probably a very nice combination of things to be, and so it's just kind of nice to see like where I was or to see where your team members are as well as the people that you work with and work around, you know, the questioner is a person that resists outer expectations but meets inner expectations but if you like come to them and kind of help them understand. How to turn into an inner expert, you know, and make it kind of centered around them then they would meet that expectation. And so it's kind of funny I even made my family do it so it's like, and everyone's a different thing like I'm an obliger my husband's an upholder my son's a questioner. My daughter is a rebel. Just kind of know how other people's minds work and what drives them. So especially if you're going to be someone that like meets outer but resist inner, then you really have to create boundaries for yourself, because you just are only kind of thinking You have to put yourself towards meeting inner expectations but that's also part of like I said finding what your strengths are and other things. And what really makes you happy and what's going to get you promoted or more money or, and sometimes it doesn't have to be at one point you know when I was working it was like I would rather be paid less than have to work more. So, COVID has been stressful. COVID has been stressful, too. I think even patients and families have a lot of stress and anxiety, and they kind of bring that to the encounters with physicians, too. So it seems like there's some short fuses that can make it worse. And then, like we said, it's everyone. It's not just the doctors. It's the nurses. And then all the staffing shortages. Everything's just like such a stress in the system right now. So, yeah, everything's, there's not enough of anyone for anything. There's shortage of services for your patients, for your, where you work, for the help that you get doing things, you're asked to do more stuff from insurance companies. So I was just talking today with one of our pharmacists at the hospital. And so she was, for the last two years, I guess she's been, you know, saying that she needs help and, you know, whatever. And so she finally, I guess, turned in her resignation and administration was like, oh, well, you know, they felt blindsided by this. And so I think there's also some disconnect or maybe not a good way that, you know, providers or physicians are asking for help and it kind of being heard. Because I think a lot of times, you know, it's that lack of the business sense for how to kind of ask what you want or negotiate what you want type of thing without getting to the point where you're looking for something else. Oh, the other thing that's really good for women to do is, I'm a big fan of letting go of the home, the home stuff, catch second shift, like, get some, you know, have someone help you clean your house once a week, it doesn't have to be you. One thing I, in treating patients with long COVID is you have to teach them a lot about pacing and prioritizing things because they can have energy to do what they want to do. And they literally, you know, only have this energy envelope they can use. But we almost, it's like a great idea for every, for us too. It's like, where do we want to put our efforts? And if that means that you have to be okay with your whole house not being clean. You know, with not having gourmet meals every day. I mean, make sure your kids are fed if you have them. Are they okay with just PB&J sometimes and not a gourmet meal they may not eat? Or can you just, you know, order in from a food service for a week. Yeah, that's my other idea. I did it yesterday I went, I had to be looking at application, doing holistic reviews of applications right now for residency because there's tons of good applicants right now. But my daughter wanted to go to a concert so we went instead to see Austin City Limits. And, you know, she's going to hopefully remember that forever and that special time that she had with her mom as a teenager. Her very cool mom. So again, you're creating boundaries around okay, well, there's still time to interview, you know, interviews aren't starting for another 20 days I'll have time to look at those. But I don't want that to happen on a Sunday when I was supposed to be, you know, with my family. Creating rules too helps like you might just create rules like okay on Sunday I'm not going to do work and that'd be like your role. But other than that, I not do extra work and really just focus that day on your significant other or your family. Dr. Fleming said she had connection trouble but thanks. Anyone else, thoughts? Oh, the other thing I always say, or most recently I'm realizing now, is that you really have to protect yourself, because even when I, or, and then, you know, protect those around you, like, even now that I'm chair and, you know, doing a lot of stuff, it's, you know, I asked the question, who's protecting me from me? Because I just feel like, you know, I always feel like, oh, I have to see more, I have to see more patients, I feel bad that they have to wait and let me just squeeze those people in, but then I just, you know, then that's also, it's a lot for, it ends up being a lot on that day when I'm seeing double amount of patients and it's going over and I'm missing other meetings and, or getting home later. So it gets, it doesn't get easier as you move up. Then sometimes you expect, like, okay, well, then maybe if you're a junior faculty, your chair will protect you, or if you're in a private practice, then the, you know, the person who's ahead of the practice will tell you like, okay, you're seeing too many people or only see this many people because otherwise you run too late. But then when, even at this level, it's like, who, there's no one to protect me from me. Oh, that's right, there is a new book on, oh, there's a comment. Comment, today I told a patient to ask their stroke prevention question to neurology. Nice, way to go, Beth. Make them ask it to neurology, yes, that's true. Oh, there is, okay, so Sasha Shilcut, she is a cardiac anesthesiologist and she's, you know, a woman leader who talks a lot as well. She has now her second book and her new book is called Brave, like, her first one's like, she does a Brave Enough conference and so her second book's called Brave Boundaries, so maybe a good read. I read her first book, but haven't, I did buy this one. I haven't read it yet because, you know, the free time. Strategies to say no, stand strong, and take control of your time. Right, we're, yeah, we always feel like we have to say, yeah, you know, people want help, we want to help them, but. So let's just fix our own problems. I think we're getting.

pandemic

women in medicine

setting boundaries

burnout

self-promotion

strength assessment

support

transparency

self-care