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#108 - Staffing in Neonatology (Women in Neonatology)



Hello friends 👋

This week we have the pleasure of hosting three incredible neonatologists who authored an important op-ed published in August of 2022. This article (link below) focused on the current work model in neonatology and the impact it is having on our workforce and, just as importantly, on the future of our field. Daphna and I feel truly honored to host this group of talented physicians to discuss such a crucial topic. We hope you enjoy this episode.

Have a good Sunday!


Contact information for our guests this week:


Links to the article mentioned on today's episode:



Key References for Neonatology Staffing

Cuevas Guaman M, Miller ER, Dammann CEL, Bishop CE, Machut KZ. Neonatologist staffing Models: Urgent Change is Needed. J Perinatol. 2022. PMID: 36207513.


Machut K, Bishop C, Miller E, Cuevas Guaman M, Dammann C. The Cruel Paradigm of Working in Neonatology. Doximity Op-Med, Aug 2022. https://www.doximity.com/articles/1699adbc-4e74-48e2-a090-7ecf1a1cfb85


Bishop C, Machut K, Cuevas Guaman M. Resolution: Promote Sustainable Staffing Models for Pediatric Physicians and Their Healthcare Teams. American Academy of Pediatrics Annual Leadership Forum, 2022, voted a Top 10 Resolution.


Lakshminrusimha S, Olsen SL, Lubarsky DA. Behavioral Economics in Neonatology-Balancing Provider Wellness and Departmental Finances. J Perinatol. 2022. PMID: 35318428.


Olsen S, Gautham K, Kilbride H, Artman M, Lakshminrusimha S. Defining Clinical Effort for Hospital-based Pediatricians. J Pediatr. 2021. PMID: 34843709.


Mercurio MR. Neonatology's Race to the Bottom: RVUs, cFTEs, and Physician Time. J Perinatol. 2021. PMID: 34471217.


Horowitz E, Samnaliev M, Savich R. Seeking Racial and Ethnic Equity Among Neonatologists. J Perinatol. 2021. PMID: 33495537.


Horowitz E, Randis TM, Samnaliev M, Savich R. Equity for Women in Medicine-Neonatologists Identify Issues. J Perinatol. 2021. PMID: 33303937.


Tawfik DS, Shanafelt TD, Dyrbye LN, Sinsky CA, West CP, Davis AS, et al. Personal and Professional Factors Associated With Work-Life Integration Among US Physicians. JAMA

Netw Open. 2021. PMID: 34042994.


Freed GL, Boyer DM, Van KD, Macy ML, McCormick J, Leslie LK. Variation in Part-Time Work among Pediatric Subspecialties. J Pediatr. 2018. PMID: 29395185.


Olsen S, Kilbride H. Development of a Points-Based System for Determining Workload for a Neonatology Full-Time Equivalent. J Perinatol. 2018. PMID: 30291322.


Mercurio MR, Peterec SM. Attending Physician Work Hours: Ethical Considerations and the Last Doctor Standing. Pediatrics. 2009. PMID: 19581262.


Mercurio MR. A Day Too Long: Rethinking Physician Work Hours. Hastings Center Report. 2008. PMID: 18709917.





 

The transcript of today's episode can be found below 👇


Ben 1:02

Hello, everybody. Welcome back to the incubator podcast. It is Sunday. We have an interview scheduled for you guys today. It's actually something that people have been talking a lot about how are you?


Speaker 1 1:14

I'm doing great. I'm I'm really have been looking forward to this interview because like you said, it's been a hot topic. People


Daphna 1:21

are always asking us about staffing models. So this is just a piece of that puzzle. Yeah,


Ben 1:29

there's been so there has been an article in op ed, or they call them up med on the Doximity network. So the article was published on August 1 2022. It's called the cruel paradigm of working in neonatology. It has a star studded lineup, that includes four neonatologist carry Mudchute Milenko, quiver scwoman, Emily Miller, Christian demand and Christine Bishop. We, this article has been shared and talked about and talked about a lot in the circles of neonatology. And, and it's we wanted, we're very excited to have the opportunity to give some of these authors our platform to talk a little bit about some of the issues that they are raising in this article. We're not really we're going to put the BIOS and the information on all these authors in our in our website. But just just briefly to introduce them. Dr. Massoud Dr. Bishop, Dr. Miller, Dr. quivers, woman and Dr. Demand are a neonatologist that are passionate about improving the health of the pediatric workforce for workforce alongside their patients. They actively addressed workforce gender inequities with the American Academy of Pediatrics section on neonatal perinatal medicine, women in neonatology special interest group. And we highly recommend that you follow that group on Twitter at women. Neil Dufner, anything else to add, before we bring on our guests?


Daphna 3:01

Now, I think you're gonna I think everybody's going to learn a lot. And I like I said, I think this is just a piece of the puzzle. They've really been working on this conversation for some time, and we're going to do everything we can to, to support the workforce, for sure.


Ben 3:17

That's right. In terms of some other before we, before we bring our guests on, we just want to thank again, everybody who has entered our interview giveaway, we want to thank the winner for winning the for participating and congratulate him on winning the iPad Pro. We're very excited. We're finalizing details on our Delphi conference on innovation in neonatology. It's taking place March 27 28th, and 29. Please make sure you register we have limited seating. And we're very excited to see you all in South Florida in March. We have a star studded lineup of speakers coming from all around the world and opportunities for poster presentations if you are interested in presented presenting your research to this amazing crowd. Alright, I think that does it. I think we can we can bring them on. Please join us in welcoming to the show. Dr. Kerry Mudchute, Dr. Blanca quiver scwoman and Dr. Christine Bishop. Christine Malenko. Carrie, thank you so much for joining the podcast with us this morning.


Unknown Speaker 4:25

Thanks for having us. Good morning.


Ben 4:26

This is very, this is very exciting. We have a lot of questions prepared for you and we're very eager to talk to you about a lot of various topics. So definitely do you want to kick us off now?


Daphna 4:39

I sure do. Well, um, like we said, and for people who don't know you that you guys are part of the women in neonatology advocacy group. And and the priority for your group I'm in this season is really advocating for the best staff thing practices. So maybe you can tell us a little bit just about what the group has been up to. And for people who maybe don't understand like, what's the deal with staffing practices? Why you guys are working so hard.


Speaker 3 5:14

So I'm the the women and neonatology advocacy group we, we work as a group together. And it really there's about five or six of us. Carrie and I are the current co leader of the group and Carrie has been in the in the group I think longer probably then most of the rest of us but the group every year, every couple of years decides to take on a certain issue to work towards. And so this year after much discussion, we decided to take on staffing issues and specifically neonatology staffing issues. And there were a lot of different factors that came together. The effective COVID You know, watching for me personally, it was watching. Actually, many of my my colleagues, junior colleagues, usually and usually female, leaving the academic world of neonatology or in some cases, leaving neonatology altogether. Because the the staffing models and the the way that they were being asked to work was just unsustainable. And so we all sort of took our personal experiences and brought them together and said, You know what this is, this is something that's really important. And then we dug deeper and started finding a lot of evidence and people starting to write about it. And so we took that on as our as our theme this year. And I'll I'll kind of pitch off to Carrie or Melinda Fiona keeps the conversation going.


Speaker 4 6:39

I think I just would add to that, that although we are the women in neonatology group or stem from that, that we really recognize that this actually is an issue for for all neonatologist across gender, irrespective of gender. And so this isn't any sort of specific focus necessarily, for women, but really something that really is a change that needs to happen across our field.


Speaker 5 7:04

Then, for me, the thing to realize, and I always make a joke about this, I say I'm a late bloomer, because I know really am I kidding, I really really didn't think I could make a change in the world. And I'm talking about the world of neonatology. And so then I realized that actually advocacy works. And if we don't bring up the, the problems, or the things that we think are gonna become a problem soon, are very important in a personal way, is an AMA to household physician, not just to working parents, but to household physician. And so sometimes we have to, we really have to sit down and say, okay, which which career we're going to work this year on. And that's what we do, because that's the only way that we can be good parents, you know, and Google our careers. And so we take priorities on who's gonna work on, and at the same time, if one of us needs to be happy, and the other one can survive, and then we can decide in a couple of years if we're gonna move for normal. So, I mean, probably there are other ways to approach it, but that's the way we approach it.


Ben 8:17

And so I guess my follow up questions to all of you is, considering that we have, as audience members, a lot of a lot of students a lot of trainees who may not be in in yet in neonatology or other providers who are not physicians. What are some of these staffing? or or hours? What are these issues that you're referring to? Can you give us examples as to where does this stress come from, so that people can get an idea of what we're talking about here?


Speaker 4 8:49

All right. I think there are a few that we feel like are kind of the most prominent currently. And I think one of the most provocative ones. I think that that is especially relevant as trainees are kind of moving through into the ranks of junior faculty or their first attorney career is is the matter of hours. So certainly neonatologist work long hours, I don't think that that's a surprise to any of us in certain studies that really demonstrated this Laura Leslie's at the ABP has shown and one of her studies on with dairy free that really almost half an intelligence report that 60 hours a week. And so that that is one thing and that may that may be par for the course community ology, but I think what within that there are also long shifts. And this is something maybe that really is where the change should be focused upon. You know, a lot of times because you know, intelligence or doing de service combined with in house nights sometimes shifts can last up to to over 30 hours and this is something that is normal, really not any longer held at the trainee level. It really we're seeing that you pretty uniformly moved away from in in a trainee capacity with duty our restrictions and such like that. I think within that this is especially relevant not only for trainees but also as people age, you know, neonatology has one of the oldest hospital based workforces of all pediatric subspecialties. And there are not currently a lot of options for community ologists to necessarily opt out of these longer shifts or even night shifts at all, as they move through the through their career.


Daphna 10:39

Yeah, it seems like there's certainly been a shift in in medicine over time, and you guys actually allude to this in the Op Ed, the Op Ed, that you wrote the cruel paradigm of working in neonatology and I think that school is so important that I'll start here increasing professional expectations, administrative duties, business travel, mandatory education, licensure, and certification, Qi and academic work are all piled on top of clinical responsibility. Regardless, most neonatologist deeply enjoy their work, and consider it a Colin. So they have progressively absorbed these demands, prioritize professional over personal commitments and created a quote unquote, new normal to adapt over time. And I feel like most people in medicine and especially in our community in neonatology feel that, and I what I think is so powerful about what you guys are doing is saying like, how do we, how do we kind of walk ourselves out of this, this hole that we've willingly dug, right, like we thought we were doing what was right for patients, and even sometimes our own kind of self sacrifice? And it's hard to, it's hard to walk it back, right? It's hard for the system to accept doctors saying, Whoa, like, what happened to us in this equation? And how do we walk it back while still keeping our commitment to patients?


Speaker 5 12:04

And I think you're bringing a group tone deaf now. Because if we don't take care of us, how can we take care of the patients? Right? So if, if we are the last one leaving, or the last one taking care of Do you really want me to be after 40? plus hours? The one taking care of the most accused kid in the system? Probably not. Right? I mean, if we would have to choose, probably we wouldn't necessarily be. And I think that brings back to the system. This is the way it's been done. This is the way we're doing? Do we really want to leave these to the next generation? And I think that's surrounding No, right. We cannot keep going with I did it our you know, our staff? You know, I was great. I didn't who know, you know, imagine that picture. I'm sorry, when you have the man in that picture without saying many words? No, that's not the way to think. And I think that they would push me to actually bring up talking in the in this podcast, is you guys go to innovation, right? What you're doing is innovating, right education, using the podcast reaching out to all these people. We want to we want to bring that up to the neonatology world and say, It's time to think it's time to it's time to go and stop saying this is the way it's been done. This is the way I did it. This is the way everybody should do it. No, we need to shift that paradigm, that way of thinking, that's not going to bring it up to the next generation. That's not going to help us that's not going to help the next generation. So now is the time. And by the same token, we need you to speak cap. And so that goes to the next step, which is very important for me is transparency, right? So if we talk about you do whatever, so many hours, many weeks, a year, whichever it is that your section talks, points, our fears, whatever it is that they're doing the staffing, that they're talking, just have all the clinical work. So where are your other expectations? Where do your other expectations fit into this? And we need to talk about details. What are the weekends? What are you because petitions whether you call us petitions, are that the same for every single person that is higher on your level? And is that the same for you know, the next generic degeneration ahead of you if you become Associate Professor, does that change? If you become professor, does that change? When is it change? How you making change? That we need to speak up early enough? Because I think most of the people in academic you know, although we talked about negotiation, we do have kind of the standard contract and at the end, who decides and it's our choice, right? And there's no written contract about your hours, your times or any


Unknown Speaker 15:01

Yeah, it's very exactly


Speaker 5 15:03

supervised by besides being vague, can you be transparent? Okay, so I always tell my fellows and now everybody that we're interviewing it's, it's that red flag when if you ask every single person, can you spare explain your staffing, and they cannot explain the staffing for the next person sit into them? If they can't do it just not transparent. They don't know. They don't understand it. And we cannot keep leaving like that.


Ben 15:33

Malenko I want to I want to jump on what you're saying. And maybe maybe one of you can take this question because I'm going to put myself from the position of a prospective neonatologist, right? And, and I feel like, when you go through this transition from fellowship, to attending life, asking those questions during the hiring process is so stigmatized that you're like, Oh, they're gonna think I'm a lazy person asking, When am I gonna get my weekends off? Right? You almost, it's almost almost as if you feel like, I should actually volunteer for more weekends, and then they will like me even better. How do we change? What is it going to take to change the culture so that this new generation doesn't fall prey to the same traps that we fell prey to? Where they can say, Well, I would like to know, when am I going to have time with my family? In a way I did


Daphna 16:19

at this blog? I signed up for Mauritius?


Speaker 3 16:21

Yeah, yeah, I, then I think that is, it's a really good point, because there's a power differential to isn't there. And, and it's, they talk about the the hidden curriculum of medical training, and it's like, trained into us, just take more, just do it, just stay that extra five hours and, and that has shifted a little bit with resident work hour restrictions and trainee work our restrictions. But there is a stigma when when you're asking those questions, and I would take that a step further. Even past being, you know, a fellow looking for a job and asking those questions. Even as a faculty or a junior faculty, mid career or senior faculty asking those questions can be very stigmatizing. So you know, perhaps the wake up call is the first step that we have to do is start talking about these things, and really being open and honest about them. And I think the wake up call is that, because there are worked our restrictions, and our trainees are not used to working like this. They look at us and they say, that is not what I want. For my lifestyle. Like, how do I how do I even do that work for 34 hours in a row? I've never done that before. And why would I do that. And so I think in a way, the new generation is sort of leading the way and they're leading the way by walking away from neonatology, we have less growth in our field, as far as new trainees, you know, going into the field than many other similar sort of, like critical care, high intensity fields like, like, Ed and and pick you. Is it because of the work hours, potentially, you know, but I think those are the questions we need to first ask. And I was in private practice for a while my husband was in the military, and we moved around a bunch. And so I've worked in private practice, I've worked in sort of medium sized academic centers, large academic centers, or university based practices as well. And so, and I've interviewed for lots of different jobs, because we, we moved so much. And so I'm usually the one that ends up counseling, the fellows, you know, the fellows will ask me questions like, How do I do this? How do I reach out to a division chief? How do I talk about this with this private, you know, with, with private practice, or non university based groups, and there's just no, not that there's not much out there T cam has done a lot to put information out there, which I think has helped immensely. Giving people that, that information to work with but the lack of transparency to even how to talk about full time equivalents? Or what does that even mean? Like, usually, I'm saying these words, and the fellows are like, I've never heard that word before. You know, it's like, oh, my gosh, okay. It's a whole different language. Let's talk about this. And so, you know, I think the answer is the trainees that are coming up are going to lead the way because they're not going to do it. They're just gonna say, No, this isn't for me. And then talking about it, destigmatizing talking about it, and getting it all out there saying, This is what we're dealing with. And you know, what, we recognize it as a problem. And we see that as our job. We're the, we're the advocacy people. Like we don't have the answers, you know, but we're saying, Hey, this is a wake up call. We need to start talking about this and educating ourselves about it. Or we're going to be in real trouble.


Ben 19:46

It reminds me, I'm sorry, Ben. Good to see you. It reminds me of this clip by Dr. Glock and flecken where he acts out like this doctor and then this friend of the doctor and the doctor says, Oh, I'm having a golden weekend this weekend. Oh, like, what is that he's like I get Saturday and Sunday off. And he's like, Isn't that like a normal weekend? No, it's like, and he's stumbling through the rest trying to explain the black weekend. And it's just very funny. But it goes to what you're saying. Christine was like we've lost complete perception of what's normal, not normal. So if you haven't if for the people listening who haven't checked that out, go to this Google watch this will link to the show.


Speaker 4 20:22

Yeah, I think that, and I think it highlights that there's really, this is something much broader than Madison, this this change that we're seeing, I mean, I think there's been plenty of plenty of awareness about the millennial generation and, and their different priorities in terms of wellness and what they want out of their careers, again, in fields much broader than just within medicine. And then I think when you throw COVID, on top of it, it really highlighted as a societal shift as well, and when, and how people thought about work and balance and things within that. And I even see it sometimes reflected back from the patient and family level. They're at the end of my 32 hour shift. They look at me like I'm crazy. What are you still doing here? Oh, I promise I took a nap during the night.


Daphna 21:09

Yeah, you look so tired, and you're guilty, right? I feel I feel guilty that they realized how tired I am. And that's actually what I wanted to bring up in terms of people sounding the alarm. You know, there's not a lot of what's the word empathy for, for physicians in general, were quote unquote, you know, well compensated, which is true, I'm very grateful for my stable work, before the hours we put in the compensation is not would not be acceptable in like almost any other field. And so that, that's interesting. And when you ask people in other fields, and you say, Okay, well, let's just compare the the, you know, the hours for pay, it changes people's minds a little bit. And, you know, we follow a lot of parent groups on Twitter, and, and the parents are saying, why would I want a doctor who's exhausted taking care of, of my, my, my infant? And so I wonder for some people who, who still feel that guilt saying like, well, this is just what I'm supposed to do. And if I'm not here, who's going to take care of the babies to say like, is this the right thing for babies? Right? Yes.


Speaker 5 22:24

So I think I want to bring up to kind of lean on one thing next step and the stories that we hear. So as trying to figure it out, you know, what's the next step, and we're talking about Grant, I grant and try to get some money to get some data and also bring up the stakeholders to the table. Now, now we have these data. And now we want you to, you know, review this data with the help with us and some other coordinators and try to create a standard, right? That doesn't mean that, you know, it's going to apply to every single program or every single practice, but at least we need to know where we exactly are and where we want to go. And when we talk about all these things, it was very, very, very impressive when we needed a while No, Satya, but Satya actually writes a lot about this. So we met with him and his enthusiasm. It was okay, you want to collect the data. I'm gonna sit down and make sure this survey, I'm gonna call every single person that I know. And he's not talking about, you know, the next the all his neonatologist. He's talking about the chairs that are neonatologist that the bishop chiefs that are neonatologist, and I'm gonna get these data. It is doesn't take me more than 10 minutes. And so that inspiration, you know, it's coming, it's also coming from above. But if we, if we wait, you know, that the little ants don't start really putting words and actions, or thoughts into this is probably not gonna change. Because when you look at our specialities, I was talking to the ER physicians, they actually have pretty, they're not totally happy, but they have restricted to 28 to 32 hours a week. And they say, How did you get that? You know, how happened? How did he happen? And he say happened at the tournament level, we happen to the chairman level determined decided that, you know, you needed to work through these, that it wasn't right for the ER physicians to just, you know, keep working and keep working hours and shifts and Thiessen, that so that's how they started trimming down and they even even in the fellowship level at the ACGME, which I thought I found really fascinating. Is that Are they in the hours the fellows do, and also predetermine where they, how big the ER is. And that equates acuity, right. So you might do more hours if you're not at that acute and less hours if you're acute. I mean, those are models that we can seek and look and try to discuss about it. Because we know that you know, neonatologist, you're not always in the delivery room. Right? Or you're not always in level four, we have different levels, different way of practicing. But I think it's very important to look at that. But that comes also into a little bit what you talked about without talking about money, there is a lot of data saying that our we use protections for neonatologist far exceed far exceed more than 20% All their super specialities. Bq er. And so why is that? Is that because, and something that is stuck with me? And I'm not 100%? Sure if Sathyan say, or Dr. Mark Mercuria told is this, but is this because our patients are still seen as less? Right? It's different because their babies, the fetus, the baby. So and because of that, that reflects on us, our team, the medical team still being seen as less. And so those those are the populations that we meet, continue to change medicine, right.


Daphna 26:29

Yeah, that's so interesting. You know, I, I've experienced this at a number of institutions and lots of people we brought on have have have talked about how the NICU is kind of this like bubble in the hospital, right? We're kind of self sufficient. Nobody really gets what we do. So we just like handle the problem. And, and again, like you said, at the leadership level, saying, like, we don't need any help, like, we'll just keep managing this way. Yeah. So what's the answer to putting, you know, pressure on our administrations to to get help right to get locums when you need it, or to reduce committee expectations? When acuity is high? Any tips for that? I hear you have something coming for us?


Speaker 4 27:18

Yeah, I don't know. I am happy to take it or Chris, if you wanted to. But I think again, I just don't want to actually come back to your earlier question definite about the baby's in the family. So don't let me forget, but because we have some other thoughts about that. But you know, I think one of the reasons why this is so hard to tackle and you kind of asked earlier, like, how did we get here? How do we take this whole for ourselves? You know, there's so many different models of care. I mean, there are probably as many models of care and delivering the analogy medicine as there are centers. And I think that this, you know, there's private practice, there's academic models, within academic centers, there's all sorts of different ways to how to structure your health care delivery. And, you know, none of those models are perfect, but but the models all have some advantages to them. And then they also have some disadvantages. So it's, I think, because of that variation between centers, it's been hard to kind of collectively identify these issues. And there hasn't really been a forum for that. And kind of with that, there, there haven't really been any sort of standards across the country or benchmarks and things like that. And then I think about although we are starting to realize that why this has become a problem that they're still, you know, this is still not anybody's primary job, right, even for leadership roles, like division, chairs, group, presidents, department chairs, it's, it's, it's just one more thing on their list there, people are busy. And even when our group meets, I mean, half the time somebody's in the lab, somebody's on service, somebody's POST call somebody's driving between hospitals, one time one of us was even at work happy hour, you know, trying to have wellness. And it's just, it's just so hard to organize and get together to move some of this change forward, I think is part of why we are still kind of in neglect, and why we still don't have the answers. But that's kind of what Malenko was was getting that is that there's really a actually a growing sense of need. And we really have had overwhelming support from the US division chief group, to kind of tackle this problem, they are really seeing their faculty and realizing kind of the implications of this. And so they they really are hoping to kind of make change. And so that's what we're kind of hoping to band together with them and try to kind of create some benchmarks around this, or at least some opportunities and options for different models. And there actually have been several publication again winlink has mentioned Satya and but he also works with Dr. Steve Olson at Kansas City they published on their model that gets it a little better of transparency and equity as well. When you start to think about how to factor in all of the other pieces of the care we provide. It's not just the clinical care, but it's the research is the QI projects. It's medical education and how do we I appropriately accounted for all that so that people are not working 60 clinical hours and then doing all that stuff on top of that, or, or how are they, making sure that those very important elements of driving unit technology forward are still happening while people are trying to take care of the babies? Go ahead, Christine. I


Speaker 3 30:21

feel like oh, yeah, so I, you know, I think that, when you, when you think about all of the pieces of the puzzle that come together, patient care, taking care of the babies in their families is always at at the top. And that is what, you know, covering clinical care, making sure we provide, you know, remarkable and excellent care for our patients, is the biggest piece of all of that. We have other missions too, though, you know, quality improvement, leadership. You know, like Carrie and Melinda mentioned research, it's so important to move our field forward. And then additionally training the next generation of neonatologist and, you know, some people might say, well, you know, what, if if it's too much, then just leave and go work in a non university based setting or decrease your hours and work part time. And, you know, recent studies on burnout have shown that that's what a lot of people do, they, you know, try and decrease their hours and go part time. And if that is the answer, you know, you have the freedom to do these things. Not even mentioning I mean, a whole you all could probably do a whole nother podcast on the concept of if we want to change jobs, we have to move in many cases, right because of non compete. So you know, we do have the freedom to change our work environments. But But what will that do to to the system to everything as a whole and, and prioritizing patient care means prioritizing, training. The next generation of neonatologist. It means prioritizing training residents and medical students, it means prioritizing, moving the field forward with with research. And those are all really, really important pieces. And I think when we're talking to the leadership, and it is not easy, because they you know, back to Ben's comment about the stigmas, there are stigmas. And sometimes people can feel like they're personally penalized for speaking up and, but, but painting that that picture, you know, with all the pieces of the puzzle and saying, you know, here we are, we will always focus on patient care, we will always take care of our patients, but but everything else is going to slide and there's going to be attrition, we're going to leave, we're going to lose brilliant minds, you know, we're going to lose really capable people who bring a lot to a university based practice or even bring a lot to a non university based practice work. Really, when I was in private practice, we did incredible Qi we had great developmental care, you know, there, there's a lot in both areas that that's really important outside of just direct patient care. And I think using the data like to speak to your question, Daphna, how do we talk to to leadership? How do we bring these things up? Taking that data, using the stories talking about parents saying, jeez, Dr. Bishop, do you ever go home, you know, when that when I'm on Route, rounding and POST call and they noticed I have the same T shirt on that I had on yesterday, because I've been running and I haven't had time to change. You know, bringing those stories up and then backing it up with the evidence and talking about what it's already doing to our field and what we think it's going to do. And that's why we're working so hard. And Melinda has been working on this grant to pull these people together to have these conversations, so that we can stop the attrition and really fortify our, our, our subspecialty so that we can keep taking excellent care of babies and their families.


Ben 33:53

This episode is proudly sponsored by rocket meat Johnson recognized Johnson is dedicated to the research and development of nutrition products that help support baby development at every stage, including an extensive and female portfolio for premature and low birth weight infants learn more at HCP dot meet johnson.com. I think I think Kristin, it's actually much worse than what you're describing. Because you said we're going to prioritize patient care and everything else is going to slide. But I think as individuals, we want to believe until the point of failure that like I'm going to manage everything I'm going to try right I'm going to I'm going to try to juggle everything. And it's only when you face the failure of that expectation that's been broken that you're like, I wasn't able and then it's the depression right? It's like I wasn't there enough for my kid and it's like, and that's what's terrifying to me, is because if at least people made the conscious decision of like saying yeah, everything else is going to slide and you've made the choice. But we are too involved in too passionate to even realize that on the front end, and that's that


Speaker 3 34:59

that's not Who we are right? Like, we, we're not people who say, Well, I'm just going to be mediocre at this. And, you know, so that I can maintain this. Like, that's not who we are. And most of us are, you know, we want to excel at everything. And I've talked to mentees, who say, you know, I'm leaving academics because I can't, I can't be a good parent, I can't be a good, you know, akademischen. And I can't be a good neonatologist, and do all of this at once. And it's heartbreaking. And when I was starting out, I had a similar conversation with a department chair to place I was interviewing, because I knew my husband was going to deploy, and I had a toddler, and I was pregnant. And I said, I recognize that my husband is going to be gone, you know, for six to eight months at a time in Afghanistan. And I think that I'm going to need to work part time so that I can be a good mom, and be a good akademischen and be a good clinician. And I was told, we don't support that we don't support, you know, working part time now, that was like, you know, 15 years ago, and I think there has been some change. But you know, I don't think there's been enough to support that kind of thinking. And then you still have to take a step back to and say, Well, why did I think I had to work 60% or 75% time in order to be able to manage my family and be a good parent, and teach and do research? And, you know, and do excel in my clinical work as well. I think that's the problem, right?


Ben 36:28

The case, the case, to me, that makes me hopeful is the NFL, somehow, where I think because most the general public will say you know what, you've agreed to this life, you're making a good amount of money, deal with it. But what's happening in the NFL, where you see very talented like superstars walking away, in the prime of their career, saying, I'm not injuring my brain for this, like you can I leave the money on the table. And now that is that it's I think it's this this massive walkout that is not yet happening in the NFL, but it's happening in medicine, it's going to get people it, I'm hopeful that it will force people to pause and say we can't let that happen. Because we will pray. I think our generation at least is understanding that we must prioritize our, our personal well being.


Daphna 37:14

I disagree with you, Ben. I worry that the system has always benefited from compassionate, energetic physicians. So we've always benefited, and they're just, they'll fill our spots.


Ben 37:33

I think I'm gonna, I'm going to I'm going to refer everybody to watch the episode that we recorded with Jimmy Turner and his podcast, where I think the key to what you're describing is financial independence. And that's something that Jimmy Turner talks about, and I think it's the loans. It's the noncompetes that basically lock you in. But if you are savvy enough, and you you and you instruct yourself in how to, for example, pay back these loans fast, and you have no debt quickly into your career than walking away is. It's very, very, I mean,


Daphna 38:05

I certainly agree on an individual level. Absolutely. Absolutely.


Ben 38:08

It's about it's about making financially smart decisions as young attendings. Because, I mean, I'm gonna give you my example, my wife and I are both physicians, and we're working extremely hard. And, and we feel like once our loans are paid off, the possibility of my wife, just stepping back and doing whatever she wants, whatever makes her happy is very much a possibility. But until those loans are paid off, we can't do where we're stuck. And I think that's to me, is the is the ball and chain that we have to break ourselves from? Yeah, but sorry, carry you. We're gonna so I


Speaker 5 38:39

just want to respond to what you just said. But But why do we have to do that? Why can we have both? Right? And so why, why? I mean, why do we have to be thinking that way? Instead of, you know, what, I want to have my career and I want to be a good mom, and I want to be a good painter, or whatever, it's that, you know, scratches, you makes you happy. Go for it. Because in other careers, that's what they do.


Ben 39:09

Yeah, but I think that's where the financial like, for example, we're not financially very ambitious. Like, we don't need to have a boat or anything like that. And so our paradigm, I mean, what we've talked to my wife about is always we need to always optimize for time and happiness. Money is very much at the bottom of that scale. And so if you optimize for time and happiness, I want to do with my time, whatever I want, that makes me happy. And that made me not want to teach at the university one day a week, I want to see patients in clinic two days a week and I want to be in the hospital and other day. I feel like if you if the financial burden is not really there, and you say I will do it for even less money than I'm supposed to be making to pay back my loans and all that stuff, then it becomes a possibility. But if you say, hey, if I do it at the rate at which I'm going to get paid, and I'm not going to be able to make my monthly payments, I just can't do it. Just it's not going to be financially possible. I'm going to be able to pay for my kids school, I'm not going to be able to pay them A mortgage and so on and so forth. So I agree with you, I agree with you. And and I think, yeah,


Daphna 40:06

but that's what you get. I mean, that's what you guys are saying that's the point, right? Like, how do we band together and say like, this is unacceptable for all of us, not just for individual families making sacrifices to make it work, saying, like, we, as a community are standing together and saying, like, we we all deserve, you know, a cap on clinical hours, or whatever it is. So I mean, I think what you guys are doing it is, is important, everybody should take note, everybody should try to get engaged as much as possible, because it impacts all of us. And it impacts nurses, it impacts everybody on the chain, it impacts families. And I know, Kerry, you're gonna mention your thoughts about families. But I think that's also an area where we say, we're doing it we're taking good care of, of patients, but the data shows that we don't take good care of patients, when we're working that many hours, or we're burnt out, or we haven't seen our families in a week, or we're not doing any of our own personal development, like painting. Like I said, you know, we don't even do the bare minimum of taking good care of patients.


Speaker 4 41:18

Right. And I think that that's what I wanted to reflect back to him and you mentioned burnout, the new B word, right? I mean, it's all over the place are so many studies of it. And in looking at neonatology specifically, easily affecting a third to half of our workforce in the mentality, and then still probably somewhat of an under diagnosis. And even if you're not burned out, I'm sure we've all experienced fatigue at the end of a long shift or a service block. Right. And there are there's a lot of studies also that show the negative impact, certainly medical errors, patient safety, quality of care, as well demonstrated and documented in the literature. There's a lot of references on that. And I think it's even the things that aren't documented, right? Like, are you You know, when you're feeling that tie down the ship? Are you taking that extra step to communicate a complex diagnosis to a family in a way that you might normally if you're not tired, you know, something like that? Are you taking extra time to teach the resident how to do the UV, are you just putting them in UVC by yourself, if you just want to get it done and get out of the hospital, those are the kinds of things that I think that we make a trade off, if we don't keep our clinical hours and check if we want to still provide these additional important, you know, professional academic responsibilities. And that even kind of gets into them, you know, if you're, like Chris mentioned earlier, like, you start to let the other things slide. And this is a little bit harder to quantify them, maybe medical errors or patient safety type metrics. But, you know, if you're working really hard, you just maybe don't get to writing the grant. And if you don't write the grant, you don't do the study. And if you don't do the study, you don't write the paper and you don't make that contribution, and move these scientific innovations forward that are really critical of what neonatology has been built on. And I think the models of care 30 or 40 years ago, were challenging in many other ways, for sure, but I think because of the more protections about in house time, there was more time to kind of devote to these things. And now, you know, our, the, you know, we have our, you know, physician scientist pool is, you know, not as strong as I think we would hope it would be in terms of because people are not getting the time. And then there's all the restrictions on federal funding, to be able to move and make some of these really important scientific advancements. It really takes somebody very dedicated to try to balance both clinical time and research or whatever other scholarly pursuits they might choose to go. And though that's where I'm really worried about, you know, it's not even just about us, but I really feel like the health of the workforce is so key to the health of both our patients and our science. And this is really what is compelling me to stay kind of engaged in this type of work.


Ben 43:53

It's so much worse, sometimes worse carry than what you're describing. I've been in a position where at the end of it, like 2425 26 hours shift. You're even wondering, like, if something were to happen right now, I'm not sure I'm going to be missing if it's 24 week, twins show up in l&d. I'm not ready for this like I don't have it in No, like you said,


Speaker 4 44:10

just happened to me. Last week. I just came off teaching service. I had a 32 hour shift. The resident went home in the morning then I fresh new residents, but there was like their second day that I had a fellow was POST call also she left at 11 o'clock we finished rounds. And what walks in l&d triage, but probably one of our most complex fetal patients and was, you know, potentially going to have to be delivered that afternoon is very complex coordination of care. Fortunately, the patient did not have to be delivered. Maybe the whole situation did fine. But yes, I was thinking, Oh, my goodness, I can't believe I'm the person responsible for this right now. And I'm the oldest person the most tired right now. And it just We have to think about what kind of structures how can we change the delivery of our healthcare so that we don't put ourselves and our patients in those situation.


Ben 45:07

So since we're talking about delivery of healthcare, I want to turn the light and shine a little bit on some of the healthcare systems because there's this great documentary that came out in 2014, called Code Black. They're making a series out of it. And I'm not recommending the series. I didn't watch the series, but the documentary is basically about these resit, the ER residents at the county hospital in LA. And their hospital is so busy that they can't implement an EMR, they said, you know, what, we are building a new hospital and for the time being, just keep using paper. And you see the residents are able to function and they were delivering good care. And then they contrast that to when they move to the new hospital, brand spanking new, everything is gorgeous, they have the EMR, and suddenly everything becomes difficult. They're basically behind the computer, they're documenting, the patients are getting frustrated. And I think that it's interesting to me that we like you've said in the beginning, you've all said this, that we're sort of perpetuating the paradigm that's been in place for many, many years. But number one, the the duties of the physicians in terms of billing and administrative tasks have gone through the roof. It's almost as if the EMR will read you your Miranda rights before you documents like everything you're going to write it can be held against you in a court of law, and it's so stressful, that's like everything I write could potentially be put in court, and that can be judged on this. It's very stressful. And


Speaker 4 46:29

and read by the parents now. So careful what you say.


Ben 46:33

And, and also the patient population, we have an extremely efficient copyright provisions extremely complex. I mean, I had this attending that I always used to compare like the textbook when he was a resident, and today where it's like, it's like a 50 page book. And now it's like a two volume 1000 pages. So everything has gotten more complex. And yet we're still trying to grow our boat when everything is now. So I'm wondering as to how do we put the responsibility a little bit on the healthcare system and saying you're demanding all these things from us? We're demanding things in return. How do we how do we approach that? And that, because that also applies? I think, very much both in academia and in private practice. Yeah,


Speaker 3 47:14

you know, I think, I think you can, there's a couple of ways and these are not the, the answers. Like I said, we're not the answer people. But you know, to your question, I think, like you mentioned before, people can vote with their feet and leave and say, I'm done with this, or I'm done working full time. I'm, you know, we're at I'm in a place where I can financially handle just working 50% time, and thank you very much. See you later. We don't want it to get to that though, right? Because one, some people can't do that they're not in position to do it to it will, inevitably affects underrepresented minorities and women more because studies have shown that that that that is the case. And so then you go up a level and looking at how do we affect systemic change. And, and I think you can apply, you know, lots of different principles to this. But I think that the data needs to be there, we need to have data data, you know, to, to show people it needs to be a conversation that can happen without fear of repercussion, or retaliation from from leadership. And then leadership needs to take it on it at a systemic level. And it needs to be not just us on on this podcast talking about it, not just you know, the the fellows in their, in their, you know, their work room talking about Boy, this, this is a terrible system, like I don't want to have to work like this, and trying to figure out where they want to take their lives. And these conversations need to start happening at a higher level, the Division Chief level, the department chair level, and bringing it to I mean, there's other powers at play, too. You mentioned EMRs, and expectations of hospital systems, a lot of physician groups are really sort of the money is more managed by a physician group. You know, like a, like a, I don't know if some of them are like private practice. Some of them are hospital, Incorporated, you know, but there are lots of different administrators, and then academic and university based settings and all of them working together. And I know when we have those conferences, those people are there. And it's almost like they're speaking a different language sometimes. And they'll say things like, well, this is really complex. But when we talk about the RV use and your work hours and your salaries, this is how it all fits together, and it's all fine. It's all within the norm, you know, and if I don't understand what goes into all of that, I might just accept it. And I can't have a conversation about it. And so we need to educate ourselves and start talking about this. The leaders we need to make sure that the leaders recognize that there's a problem and then you know, work it up a systemic level because you, as we're asked more, as we're documenting things, as parents are reading our notes, and so we have to, you know, be really careful that they don't catch any little thing that we, you know, that we document wrong or miss or whatever. Those sorts of those aren't going to change, you know, we're not going to change EMRs, we're not going to change those things. But we can, we can change the models within which we work so that we can manage those things. And I think it's going to take people outside of just us, it's going to take leaders and people at the higher levels of the hospital administration to really make that.


Speaker 4 50:45

That is just trying to think of how I could add to what Chris was saying. You know, I think, again, the change really does have to come with from within the systems. And that's what we're kind of helping this organization with departmental and divisional leadership will lead to it certainly the backing of professional organizations, like the AP, I think is going to be instrumental in that they have really recognized that the workforce is in crisis for a lot of different reasons for gender and racial inequities, for COVID effects. You know, especially due to the pandemic, and all of those things that have that bore out on pediatricians, especially in pediatrics of specialists, and especially those continuing to provide in person coverage and in a lot of different facets, but, but this is also kind of another issue that they have, you know, interested in supporting and kind of trying to help us with this. So that's where we're kind of hoping to get there. And then some of this is, you know, what can you as an individual do to promote this within your group that you work with your your faculty colleagues, or your private practice group. And part of our work, we are developing kind of a toolkit, both for leadership, but also one that's targeted at individuals. And that is still forthcoming in in the works. But you know, we do have, you know, part of op some key references, and I know, I bought this on to depot and Ben, and they can post those on the site for the podcast. But yeah, just kind of educating yourself on the models that are out there. And then I think asking your divisional leadership, like, how are things structured here? Can we learn a little bit more about it? Can we see how it's done at other centers? You know, I just reached out to a colleague at Milwaukee children's, because Malenko was like, Oh, they're restructuring to try to get a better balance of how to account for other measures and metrics of productivity, such as, you know, scholarly work and things like that. And can we learn something from them and to build upon that? So I think I think some of it's that kind of that local advocacy, if you will, within your own group. And then I think, what can you do at a very individual level? What can you do for your partners? I mean, again, all those studies on burnout, want two of the main things that drive predictors of burnout or ameliorate its effects, I should say. One is scheduling flexibility, and control of hours. But another one is actually support from colleagues. And so how can you be a supportive colleague to your to your co workers? How can you promote the culture that you want to be in, you know, we haven't really spent much time on leave for medical family personal reasons. And that, again, probably could be a whole nother podcast topic. But certainly leave across the board tends to be fairly inadequate for all dependent on what type of leave you're talking about. But not only is the actual time that an individual can take tend to be an equity inadequate, but cultures tend to discourage it, right? Because it impacts your career advancement, it takes away from your time of your scholarly pursuits that you need to get promoted. But you also don't want to burden your colleagues, you know, you have everybody


Daphna 53:40

to leave, and then you pay it back. Right? Don't really leave. Yeah,


Speaker 4 53:44

yeah. And I think, you know, I had my head, my first two kids in training, read one and residency went to fellowship. So I got five weeks in six weeks with those kids, which, again, now seems completely inadequate fortune that was 12 or 15 years ago, hopefully, so that I had a third baby as an attending and I was like, Oh, I can finally take a real leave, I'm going to take the full 12 weeks. And then it just so happened that our group had like, I think five or six of us were pregnant that year, throughout the whole year. And it really burdened our group. And so I cut my leaf back only took nine weeks instead of the 12 that I wanted, because I didn't want to be unfair to my colleagues. And so some of that gets back to assist, you know, what can an individual promote, you know, to each other. And if somebody needs you to take up an extra call, because they're sick, or whatever, to maybe help them out, because you might need that favor. But then some of this gets back to the system change, right, making sure that there's enough flex in the system so that, you know, if somebody has to take leave that that those that do have to pick it up, right? Because at the end of the day, there's 24 hours in the day, seven days a week and those babies need to be taken care of all the time. But is there enough flex in the system to kind of account for that so that people can take the lead that they need? Yeah, I


Speaker 3 54:52

think that's so important. It's a personal issue in a lot of ways, but it relates back to the systemic issue just like you know, all the talk about burnout, it should not be a person and resilience, it's not a person's individual job to fix, you know, all of the systemic problems, they can't. And those are often what leads to burnout. And, you know, we are not just like we talked about, we're not the people who want to do a mediocre job at any part of our job, we're not the people that want to burden our cars, we're not the people that want to, you know, make other people work in our stead, or cause them to have to work more and make sacrifices. And so, you know, being there for each other and supporting each other, it is important, and at the same time, that change at the systemic level is all is the thing that's going to change everything, if I have no leeway to take leave, and I feel like, I'm going to burden my colleagues to the point where they might leave our practice. And I'm not going to take that leave, you know, and which could be to the detriment of myself. And, you know, honestly, at the end that the practices a whole. So, you know, I think that balancing those things, and really looking to changing the system, changing the way that we think about these things is really important.


Speaker 5 56:08

Sorry, if I may, I think a couple of things. So as individual level. Now what you can do, I would say, there are two things that you can ask you, your whoever does your stuff in your division chief, or whoever or just your colleagues and kind of agree on, I would say, one is create a backup person, right? We all we're all gonna go with that burden, right? And it's no payback. Okay. And if we can ask even more, we will ask that that backup person, when is utilize, get that gets extra money, right? Even if it's less, still extra money, because we shouldn't just sell our time, you know, just just because we've been good to that exact, we're not working for free, and time matters. And so that's one and he shouldn't be paid back. But two, I think we need to also between us, and you know, our peers, don't feel guilty for taking that time. Right, don't feel guilty for taking time. I mean, that, that just takes forever. And we're probably not gonna get there easily, because that's been instructed on us for many reasons. And that's probably where we are right now. Because that comes with as it's just our nature. But if we don't start changing that, we cannot ask the system to change, right? Because we just we are we are part of the system too. So it has to count with him. And then we can move it a little more to you know, our colleagues, our decisions. One other thing that I would say if somebody gets sick, it shouldn't be that person or whatever, whatever the reason is, that person needs to take leave, it shouldn't be that person responsibility to find coverage. There's somebody somebody else.


Ben 58:02

Right up, you're so right about that you're so right about that. And


Speaker 5 58:05

I'm sorry, it should be right, it should be somebody else's responsibility, I don't care who we can designate who is that person is to be somebody else's responsibility to find that coverage, because we cannot data take that on, or we shouldn't take that on. Right. And so if we start with those little changes, even just in our institutions, you know, if nobody else can help us go through the rest, don't those little changes will make a difference. Because then we can show the generation that taking a leaf is not wrong, is not well, is always not seen as as as you're weaker, or you're not responsible, right. And so if we start in those little things, we can change the system. And going back to these podcasts, and hopefully a dozen people that listen to us or more, please start those changes, start a conversation and reach out to us. Because we limit if if if I if even if we don't get the grant, we want to get the data data jury when we want. And we want to hear from you because we're not going to just interview chairs, divisions, we actually want to know what they neonatology that just to the first year work, and even fellows think of stuffing should be because if not, we're not going to become innovative. If I just asked the head up there, you know the the leadership, we're not going to get to the innovation, we're not going to get to new ideas. We're not going to get to different way of thinking we're not going to get to diversity, we're not going to get to inclusion. So don't think that we're just going for the heads up and that's the only important thing to do it they make the change. Yes. So yes, we're gonna work the system by Are we every single neonatology is or every single person even awards in neonatology, not just neonatologist are part of the system and we want to hear from them. And so really reach out to us. Don't be afraid we all have to either. That's easy, right? Definitely. And then you will have even more information from us. And we want to hear from you guys.


Ben 1:00:25

We will definitely put your contact info as well on the on the episode page. Now, I want to I want to We're almost up on time. But I would be remiss if I didn't take the opportunity of having four female physician on the podcast and talk about this discrepancy between expectations for male physician and female physician. I like the Lanka I


Unknown Speaker 1:00:48

live in a physician with your brain


Unknown Speaker 1:00:53

been well trained?


Ben 1:00:55

Know, no, no, no, no, no, no. First of all, I'm going to make this clear. It's my wife is an adult cardiologist, I have a daughter and the the difference between the burden the expectation placed on female physician is just appalling. It's just really appalling. And what female physician perceive they have to do extra to make up for some form of difference is just completely mind boggling. And I do think that in our field, it could be it could be a misconception that's like a it's like it's a it's a female friendly field. And so so that doesn't exist. But can you talk to that a little bit? And I don't want to provide any leading questions. I just want to open the floor so that you could just address this this topic?


Speaker 4 1:01:41

Sure. That's a loaded question. a loaded topic for sure. Bad. Yeah, that's gonna be again another.


Ben 1:01:50

I know I said we were short on time. But I mean, I didn't mean to say you have to answer to this in 90 seconds or less. However, take your time. I mean, serious that


Daphna 1:01:57

I think then to your point, I think a lot of people feel like it's not a problem in neonatology right, because there are so many females in the in the work force or that there's still no pay wage gap in neonatology. And that's just not true. So yeah, I'd love for you guys to share some of that data.


Speaker 4 1:02:17

Again, we really wanted today to emphasize that this is really an issue irrespective of gender in terms of thinking about staffing and patient care and accounting for, you know, prefer other professional pursuits besides clinical care. But you do hit that this is an issue that is not shared equally amongst different genders and nails are probably that along with different are not shared equally along different racial ethnic lines as well. And deputy brought up like the pay gap, and that is kind of a, you know, potentially a misconception that I guess of in a predominantly female field. I mean, over 75% of our entering fellows are now female and junior faculty. The field overall by best estimates is about 56%. Female, but it's hard to get that data specifically because nobody tracks it comprehensively. But that is not true. There is still quite a disparity in those that hold leadership positions, promotion, timelines, academic accomplishments, grants, things like that. It is also different for sure, along with pay lines, Dr. Kent Tonight Show actually leads a lot of this effort. She's a pediatric neurologist at CHOP, and has really done some really remarkable financial modeling and specifically focusing on pediatric subspecialties, because again, they're predominantly women, you think there wouldn't be a problem, but has demonstrated quite a significant difference there. I think where this issue kind of intersects with the topic that we were focusing on today, the staffing and scheduling is some of that intersection with the personal and domestic type obligations, because those studies have also been done that show a big difference there in terms of which gender tends to be responsible for a lot of those household child rearing elder care type roles. And, though it is not, it's certainly not only women that are performing those roles, but that there are demonstrated published differences in who tends to be more responsible. And specifically those studies have been done around pediatrician, parents, they've been done around K authorities, there's a pretty impressive article and that one's actually a few years old that looked at even amongst K awardees that were male or female, and kind of what their differences in their home lives look like. And it's it's pretty interesting, but again, you know, my no library on that topic is 200 articles deep so there's a lot to dig through there.


Speaker 3 1:04:44

So, when I was a medical student, I went to this, you know, women in medicine interest group and there was a female attending who was kind of talking to the group and I asked her, you know, what, what do I need to do to be a successful one Men in Madison, and she was like she said, you know, get help. And I said, oh, like a therapist, and there's a second year medical student, not even in the clinical realm yet. And I said, Oh, you know, get a therapist to help me, you know, realize my goals and she was like, No, hire someone to do your laundry, hire someone to clean your house, outsource as much as possible. And that that stuck with me. And the end, I think there's all of the, you know, this things that Carrie just talked about, and there's a lot of data, there's a lot of, of stuff out there. But the bottom line is our field is predominantly neonatologist, predominantly women, and there's still a big need for a group called Women in neonatology because of those disparities. And so, I, you know, I think that they they exist some male leaders that I've heard talk have said that one of the reasons why neonatology has not progressed in in as far as like compensation per view and things like that, is because it is a predominantly female field. And it's part of that disparities. That's one of the reasons that potentially we're being held down. I think that's a really interesting idea. I mean, yeah, I think that it was not my original idea. But, you know, I think that there's still a lot to look at and talk about, and there's still a need for a group called Women and neonatology as part of the American Academy of Pediatrics section on neonatal perinatal medicine. And so, you know, maybe that's just a little plug to join our group. And, and, you know, and I think there's always roles for that, you know, the He for She because, because truly, like, we're all in this together, you know, you know, Ben, if you if your work model changes, then maybe your wife wouldn't have to be such a severe thing where you say you can cut back, do whatever you want dropped a part time, like, maybe if everybody had reasonable work models, people could could do fulfill, find more fulfillment and their job, and then the other areas of their life. And so I think it, you know, all boats will rise together if we if we do this.


Speaker 4 1:07:14

For sure, I think, you know, again, the thing about the personal balance thing, the reason why it matters is because there's still again, there's just 24 hours in a day. And there are a lot of studies that show that women actually do spend more time saved document in an EMR, returning patient in basket messages. Again, this is one way to be more in an outpatient field. But that those differences, again, play into their sense of burnout, because if they're working more at the same task, that has meant that that just leaves them less time to get engaged in maybe academic things, or to keep their personal lives in that in the order that they do. There's a study looking at work home conflict. And so it's about the kind of work that you do your homework that you end up having to do at work. So like, today, my daughter actually woke up with a little bit sore throat, she's COVID, negative, I sent her to school. But when that phone call comes, it's actually going to come to me, not my husband, right. And even though I'm here at the hospital today, taking care of those types of things, it will be ultimately my responsibility to kind of coordinate that and when what needs to happen there. Same thing, it's like what work is happening at home. And I remember this because I actually did work part time for eight years. And all of my academic work happened after eight o'clock when my kids went to bed right like that, because I didn't have any allocated time really, during my work day with my hours, that that's just kind of how and when that had to happen. So I think that even gets back to the things such as leave if we had paid parental leave that was irrespective of gender, and that men, or non birthing partners were afforded the same amount of protected leave. But it would have made it a lot easier for me to return to work at five, six and nine weeks after my babies were born. If I knew that, you know, there was a parent there, and that I wasn't worried about a brand new nanny who just didn't really know that well. And did she know how to, you know, warm the restaurant the right way, and all those kinds of things. So, you know, I think that, again, as Chris mentioned, you know, we can, if everybody gets a little bit better equity, it will actually help all of us again, all genders that are trying to tackle these issues. I


Daphna 1:09:14

think it's so interesting what you guys are saying about kind of like this trickle down trickle out effect, you know, for, for, say, my family, my husband's very involved in, in my daughter's life, but just because of, you know, and how, how do we if we change the system, how do we help, you know, make a shift in society? Because still, he'll say, you know, why doesn't the teacher call me like, why doesn't the teacher put me on the text app, even though all the mommies are on the text app? Like I want to know what's happening, and there's still some sort of societal barrier and keeping me from that information. And so I think what we're what you guys are trying to do here and we're helping in any way that we can is, you know, really push for a really societal change,


Speaker 5 1:10:02

which is, which is, but it goes back to the we are part of this system, we are part of the society, and we need to break those silos, right? We need to break those silos and say, you know, these times I call my husband or, you know, we're both involved and both need to do both things, or both do both need to be called wanting to be addressed and how things work in your household and not the same thing as my household. And then go from there, I think it's it is changing those, those perception, those biases are really difficult, but they're not impossible. They're not impossible. And they can be, they can be at least taught, right and might not come within you, but at least you can see the difference, or learn about the difference. And then maybe that will help out everybody.


Ben 1:11:03

I'm still on my school email list. My wife is we've been trying


Daphna 1:11:10

it's a real thing. Well, I think we could talk for another hour, but we we've we've exceeded our time I'm so I'm so glad about that. You guys have sent us a good extensive list of resources that we'll have on the page. And as a as a temporary toolkit until your you know, your more comprehensive toolkit comes out which we're really looking forward to. Are there any resources that you guys want to highlight for people who who want to take a look after we jack?


Speaker 4 1:11:44

I think one is actually our specific pediatric workforce survey, neonatology specific data. You know, the AAP does a survey of sections by annually and actually I'm Dr. Eric forwards, is sits on the committee of pediatric workforce and has done a lot of that work. He's got a very interactive display, the doc is in it is on the AP member sites, you'd have to get a payment to access, you can kind of look at some of these differences and work models across the country in terms of how many hours people are working. And so kind of gives you an idea of maybe how your center compares to that. Again, it also highlights the the wide inner center variability, but that would be one resource that I certainly would reach out to and along with Dr. Forwards and Dr. Renata savage his papers on this, they were kind of some of the early ones looking at some of these workforce issues. And then certainly, Dr. Lakshman gruesome, ha, ha, you're still seeing his last name. But he has written several papers on this Dr. Olson, Steve Olson, who had mentioned before, they were kind of the ones that have written some of the more recent articles, specifically about different models and maybe way things could evolve. And the Dr. Mark Mercuria has some really interesting kind of perspective type pieces. One of them is you know, attending work hours, you know, a day too long or you know, things like that. So,


Speaker 3 1:13:04

yeah, and I think the other place where people can go is the women in neonatology website, just Google women in neonatology follow the account on Twitter or Instagram because they're always posting information and groups like T can mid can, you know, those those groups of the section on of our section, you know, really, I think, have a lot of good information or do and are doing a lot to put information out there on both University and non university based practices to help educate the workforce as as everything moves forward. So I think those are really good resources as well.


Daphna 1:13:47

I'm glad you mentioned that I feel like a lot of people feel like oh, if I'm in private practice, which Ben and I are in private practice, and those groups aren't for me, but that's that's not true. So yeah, coming together on on, you know, as a community I think will move things forward faster.


Speaker 4 1:14:08

And I think the section really focuses on they really really want a combined effort when they think about you know, use again academic versus non academic even though there are differences that need to be you know, kind of counted for that really collectively we'll have a lot more power to make change


Ben 1:14:29

I'm trying to keep up with all the references I'm trying to copy paste them on a on a notepad so that I don't forget them but I think I got them all. I think I got them all.


Unknown Speaker 1:14:38

Well, any closing thoughts from you guys as we


Speaker 3 1:14:41

were just we're very thankful for for you all inviting us to do this podcast and help talk about these issues and spread the the word about what's out there and what's going on and hopefully, in an advocacy way, get people to start talking and thinking about it at a local level. So with it so that, you know, sort of a grassroots, you know, I love the concept of grassroots movements and moving, you know, moving change forward. So we're really just very a lot of gratitude for you all for being willing to have us on and talk about it.


Speaker 4 1:15:18

And I think, also grateful to the leaders in our field who, you know, have tried to make the changes that they've tried to make, but that are also open to making more and again, you know, we've had a lot of mentorship in this work. And we've also really had a lot of support from from leadership at AP level and within us division chiefs. And so we hope to kind of with that support, we'll be able to make these changes.


Speaker 5 1:15:42

Yes, definitely. Thank you. Thank you. Thank you, Ben. Thank you, Gary. Thank you, Christina. I think they're mentors to me, too. But I think to the listeners is just thank you for taking the time to listen to this. And there is more to come and it can come from you.


Ben 1:16:01

Yeah, and advocacy is something that we're going to try to pay a lot of attention to this this year on the podcast. So there's, there's many more episodes on various aspects of advocacy in our field. And so we're very thankful to have had the opportunity to discuss some of these, some of these topics with you all today. Thanks, everybody. All right. Have a good day, everybody.


Unknown Speaker 1:16:24

Thank you. And


Ben 1:16:28

thank you for listening to the incubator podcast. If you'd like this episode, please leave us a review on Apple podcast or the Apple podcast website. You can find other episodes of the show on Apple podcasts, Spotify, Google podcasts, or the podcast app of your choice. We would love to hear from you. So feel free to send us questions, comments or suggestions to our email address NICU podcast@gmail.com. You can also message the show on Instagram or Twitter, at NICU podcast or through our website at WWW dot v dash incubator.org. This podcast is intended to be purely for entertainment and informational purposes should not be construed as medical advice. If you have any medical concerns, please see your primary care professional. Thank you


Transcribed by https://otter.ai


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