#350 - What Happened to You? Dena Hubbard on Curiosity, Compassion, and Changing Neonatology

Hello friends 👋

In this episode of The Incubator Podcast, Ben and Daphna sit down with Dr. Dena Hubbard, neonatologist and Director of Quality at Santa Barbara Cottage Hospital’s NICU. Dr. Hubbard is widely recognized for her leadership in trauma-informed care, physician well-being, and advocacy work within the American Academy of Pediatrics.

She shares her journey from private practice to becoming a national voice for trauma-informed approaches in neonatal care. Dr. Hubbard explains how an early encounter with a NICU family transformed her understanding of parental stress, judgment, and resilience—and how that moment shaped her mission to change the way care is delivered. She outlines the principles of trauma-informed care and how these practices differ from traditional family-centered models, emphasizing curiosity over judgment and building trust across the care team.

The conversation also explores physician wellness. Dr. Hubbard speaks candidly about burnout, the role of coaching and therapy, and how she redefined her professional path after personal challenges, including grief and illness. Her perspective offers both practical insights for the bedside and a message of hope for healthcare providers navigating stress and systemic pressures.

This episode highlights the importance of culture change in NICUs and the value of caring for both families and providers.

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Short Bio: Dr. Dena K. Hubbard, MD is a neonatologist and Director of Quality at Santa Barbara Cottage Hospital’s NICU. A dedicated advocate for trauma-informed care (TIC), she is passionate about improving outcomes for infants and families by integrating TIC principles into neonatal care. Dr. Hubbard’s work focuses on mitigating trauma for parents and healthcare staff, improving multidisciplinary communication, and empowering families as advocates for their babies. 

 As one of the inaugural American Academy of Pediatrics (AAP) Trauma-Informed Care Champions, Dr. Hubbard has helped lead initiatives to educate and implement TIC practices in neonatal settings. She spearheaded a year-long project assessing the impact of TIC education on NICU staff, recently published in the Journal of Perinatology. Additionally, she serves as physician lead for the Kansas AAP chapter TIC grant, now in its second year, and on the advisory committee for a national program addressing health disparities among infants and children with birth defects and related conditions.  

In addition to her clinical roles, Dr. Hubbard is an advocate for physician well-being and healthcare system improvements. She is actively involved in the AAP, serving on the Committee on State Government Affairs and leading the Women in Neonatology (WiN) subgroup as immediate past-chair. She also champions policy initiatives through the Kansas AAP chapter, where she chairs the Public Policy Committee and serves on the Board of Directors.  

Dr. Hubbard completed her medical degree and residency in Child Health at the University of Missouri-Columbia, followed by a fellowship in Neonatal-Perinatal Medicine at Children’s Mercy and the University of Missouri-Kansas City. 

Based in Kansas City with her husband and two daughters, she commutes to Santa Barbara, embodying her commitment to both her family and her professional mission. Her personal journey with TIC has transformed her approach to medicine, reinforcing the power of curiosity over judgment—asking “What happened to this person?” rather than “What’s wrong with them?” 

Through advocacy, education, and systemic change, Dr. Hubbard is dedicated to fostering resilience, healing, and joy in healthcare.

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

The Incubator (00:00.738)

Hello everybody. Welcome back to the incubator podcast. We are back this Sunday with a special interview with Dr. Dina Hubbard. Daphne, how are you?

Daphna Yasova Barbeau, MD (00:08.623)

I'm pumped. I, I'm going to go out on a limb here and say, I think some of the topics we're going to talk about today are some of the like most important things we've covered. We will cover our all year. So, I'm, I'm gearing this up for a very, I hope valuable interview. Yeah, yeah, I am. I think I can say that I am completely biased. These are personal, professional interests of mine. So I hope other people will find them.

The Incubator (00:26.336)

All journalistic credibility went down the window. You are completely biased.

The Incubator (00:36.43)

All right.

Daphna Yasova Barbeau, MD (00:38.233)

Quite interesting also.

The Incubator (00:39.318)

Yeah. Dr. Dina Hubbard, thank you so much for joining us on the podcast.

Dena K. Hubbard, MD, FAAP (00:43.661)

Thank you, Ben and Daphna. I feel like this is the most celebrity type thing that I've ever experienced and ever will. So it is truly my honor and pleasure to be here.

The Incubator (00:49.496)

Ha ha ha.

Daphna Yasova Barbeau, MD (00:51.097)

Let's stay civil.

The Incubator (00:53.099)

No, the pleasure is all ours. You're a neonatologist. You're the director of quality at Santa Barbara Cottage Hospitals NICU. You're a leader in trauma informed care. You focus on reducing trauma for infants, families, and importantly as well, health care staff while improving multidisciplinary communication. You are a trauma informed care champion for the American Academy of Pediatrics. You have led national initiatives.

and research on this particular subject in neonatal settings. You advocate for physician wellbeing, policy change, and healthcare improvements through both the AAP and the Kansas AAP chapter. You trained at the University of Missouri, Columbia, and Children's Mercy. You're based in Kansas City with your family and you commute to Santa Barbara for your work. We'll definitely talk about that. And you are driven.

Daphna Yasova Barbeau, MD (01:39.863)

Wow.

The Incubator (01:43.553)

by your commitment to fostering resilience and healing and healthcare. We're very excited to talk to you today. My first question for you is that I have a personal feeling that our consensus, our general realization that trauma-informed care is something that matters significantly in our community, that physician well-being as well. This feels to me like when I was learning back in Europe about the French Enlightenment, when these ideas sort of came to light and we were like, this is actually

quite important. And so you are the enlightened neonatologist. Can you tell us when, at what point of your career did it sort of dawn on you that this was really important, these were important subjects and that you needed to dedicate your time to them? And what were the factors that surrounded sort of this realization?

Dena K. Hubbard, MD, FAAP (02:37.997)

Yes, well, thanks for that excellent question. There is so much I can share and much of it is mistakes that I made and things that I wish I could have done better and I vow to do better. I love the Maya Angelou quote, you know, when we do better, we do better. And so when I learned about trauma-informed care, I had this aha moment. And so my purpose in spreading this message is in the hopes that everyone has that aha moment because

Daphna Yasova Barbeau, MD (02:47.705)

Hmm.

Dena K. Hubbard, MD, FAAP (03:07.595)

It has changed my career. And the way I was explaining it last week, we had a meeting, our first in-person meeting of the trauma-informed care champions at the AAP headquarters. And I said, it's like a superpower in a way, like superhero glasses that once you see the world through the lens of trauma-informed care, you can't unsee it. You see it in everything. And so I'll tell you a little bit about how

I came upon trauma-informed care. It was actually a concept. I didn't know the name was trauma-informed care, but when I learned about it, I was like, this is what I've been looking for. So I was in private practice for the first nine years of my career with the Sunflower Group in Kansas City, wonderful group. I had actually planned to never, ever leave there. mean, the community was great. The job was great. Everything was perfect.

And I was suffering burnout and there's a lot in that, but I'm a burnout survivor. So I want to give listeners hope. and, but it, needed something in addition to the clinical work. And so that led me back to academics. And before I made that change, I had noticed and was reading, hearing more about parents in the NICU, having experienced post-traumatic stress.

And so that was one thing I wanted to work on was how can we mitigate that trauma for them, that additional trauma. And I'm from a small town in Southwest Missouri. I feel like I'm a nice, non-judgmental person. And once I was at Children's Mercy, I attended a noon conference on trauma-informed care, just one of those offerings, you know, that it's like, oh, this looks interesting. Let me learn more about this.

Dena K. Hubbard, MD, FAAP (05:05.249)

I was sitting in this conference and I learned about the safety, trust, choice, empowerment, collaboration, cultural humility, the principles of trauma-informed care. And as I was sitting there, I thought specifically of this preemie baby I had taken care of like six months before that. And I thought, no, I judged this mother.

And if I can, I'll just tell you briefly this story because it's so powerful for me. I was in my 40s, 40s were a powerful time for me. And I was all about setting boundaries and I was working with a therapist and a physician coach to do better with boundaries. And so this pre-me, we had admitted

The mother got really upset with the nurse practitioner. She saw something about drug use on the history on the nurse practitioner's papers and really seemed like she overreacted.

Dena K. Hubbard, MD, FAAP (06:22.817)

And she, it seemed out of character and seemed like she was responding in a way that I wouldn't have. And I was like, we are trying to help your baby. Like what is wrong with you? Why are you so upset with this? I mean, your history does have a history of drug use. Why are you so upset? And so I said, we're going to have a family meeting. We're going to set some boundaries and you know, she can't behave like this. By the time we met,

The baby had had intraventricular hemorrhage and so we needed to talk about a shunt. And so the first thing, know, trying to level set, I was asking her, do you know anybody who has a shunt? And she said, yes, my mom had a shunt in her brain. She was shot in the head when she was pregnant with me.

Daphna Yasova Barbeau, MD (07:09.998)

Wow.

Dena K. Hubbard, MD, FAAP (07:10.519)

Wow. I was like, okay, this, my agenda for this family meeting has suddenly changed. And it was really an eye-opener for me, almost like a slap in the face, like, wake up, Dina, this isn't about you, and you have no idea what this woman has been through. And so as, when I learned, you know, we know about the biology of stress, but I hadn't connected.

Daphna Yasova Barbeau, MD (07:34.319)

Mm.

Dena K. Hubbard, MD, FAAP (07:39.327)

that fight, flight, freeze response and those hormones to behaviors and how over time, if someone is in fight, flight, freeze all the time, like the tiger is chasing them all the time and that stress level never drops, how it really changes their brain and they're in survival mode all the time. So then when she's in the NICU with her baby and who's premature and

fighting for his life. She's in fight, flight or freeze. And so it was really a moment where I recognized I wasn't curious. I judged her and was thinking she was behaving inappropriately and out of context and overreacting. And in fact, she had been in fight or flight from before she was born. And so that was really a pivotal moment for me. And then it was down the road that I

I put the connection together that, hey, this is kind of like us in healthcare too, if we don't process the stress and trauma that we deal with vicariously.

Daphna Yasova Barbeau, MD (08:49.805)

I love that. And thank you for sharing and being so open about a mistake that I'm sure every mistake, a misstep that every one of us have made at some point in time and judging the reactions of others. want to take it, there's so much to unpack here. I want to take a step back because I recognizing that some people may not be familiar with the term trauma informed care at all. You've kind of highlighted some of the tenants.

I also think that family integrated care, family centered care is a hot topic now. And so I think some people may confuse the two and say, if my unit is family centered care, we're taking care of this trauma business. And I don't, that's not true. So maybe you can highlight for us, is, what, what, what does it mean when you say trauma informed care? And I think your story paints that beautifully is recognizing what families are already coming to this healthcare.

situation with, but how it's also different than family-centered care.

Dena K. Hubbard, MD, FAAP (09:54.841)

You know, that's a really great point. And I actually hadn't thought of that before. So I'm learning from you, Daphna, during this. Yes, trauma-informed care, I think of it as universal precautions, universal hand hygiene, how we never know.

you know, what we're encountering when we go into a patient room or before we examine a patient. And so we always use hand hygiene before and after. Similarly, trauma-informed care is about being aware and recognizing that everyone has a story before they meet us. And we don't know what we don't know. So we need to be aware and recognize and then provide care that is

that acknowledges that and.

tries to meet them where they are and again empower those or apply those principles of trauma-informed care. So making them feel safe, making them trust, you know, it's not a one-time thing, it's a relationship. So trauma-informed care is really relational care.

But again, making them feel safe, whether that's a physical environment or sitting down or not approaching them from behind if someone's had a history of a physical trauma. So making them feel safe, trying to develop that trust, giving them choice, which when you think about it in the NICU, parents, no one chooses to be in the NICU. And so where are there little moments where we can give them choice?

Daphna Yasova Barbeau, MD (11:26.276)

Mm-hmm.

Mm-hmm.

Dena K. Hubbard, MD, FAAP (11:30.381)

How can we empower them as the parents to be the heroes? You know, they see us as saving their baby. But again, that relation, it's our job, and I didn't see this early in my career, but it's our job to empower them as the heroes so that they see themselves as the heroes because that infant parent dyad is so important for relational care going forward. And then collaborate with them. I tell the...

the parents, that you're part of our team. You have a role that no one else has. We all come and go, but you are the most consistent people in your baby's life. so collaborating with them. And then the basis of cultural humility. And I want to focus on that humility part because I think that is a frame shift from when we were in training.

where I am the doctor, I am in charge, and you can still be a leader, but you can lead with humility. And so again, recognizing we don't know what we don't know, and that it's so much more, just like the social drivers of health. The healthcare we provide is a very small percentage of that overall, what affects a patient's care. And I think the other really huge aha moment for me was when I learned that

early adverse childhood events without appropriate buffering and stable nurturing relationships leads to poor adult health outcomes. Even more than your cholesterol levels or your diabetes or your hypertension, your lifespan is shortened and your chronic illness is much worse related to

early trauma and it has to do with that chronic stress and inflammation and back to the biology of the, you know, our pituitary and the hypothalamic pituitary axis.

The Incubator (13:29.189)

Yeah, is cultural humility reminds me of something that we discussed with Satya on the podcast where for his vision of leadership and neonatology, he talks about courage with humility. think this echoes this perfectly. I want to then ask you a little bit more of a mechanical question, which is that how do then, right? mean, I think we're

As neonatologists, we're trained to do things in a certain way. to be fair, the way we're told to do certain things is our refuge and where we feel safe. So when we have this realization, and sometimes it's a minority of people who are sort of echoing some of these sentiments and these ideas, it's hard to say, like, I'm going to make this like the moral compass of my career. I'm going to shift my career a little bit to let this drive me in the direction that it leads me to.

how do you navigate maybe the inertia and also the questions that may be coming from your peers when you're taking on these subjects that other people are like, this is just through, just focus on the PDA.

Dena K. Hubbard, MD, FAAP (14:41.845)

Yes, you know that is so true. It's because it has felt like the softer science. And so that's where I think it's really important to point out that no, this is based in science. This is science and we know this and you know it's challenging because it's not like I can just

treat your PDA. Trauma-informed care is so much more complex and it's dynamic. And it also, it's not only about the trauma that the parent has experienced before they meet us in the NICU, but what are we bringing to it? What is our story, our trauma? Are we having a bad day? The staff, you know, it's a huge staff to take care of this little baby. And so all those interactions. So I think

Part of it is, again, relationship building with our team. One thing I did try to point out when we were doing this education unit-wide was...

Dena K. Hubbard, MD, FAAP (15:48.439)

Dena K. Hubbard, MD, FAAP (15:56.309)

It's trauma-informed care is not an excuse for bad behavior because I think that is some, that's a myth that sometimes people think of with trauma-informed care that, and that's not true. You can still have boundaries, but if we ask what's happened to this person instead of what's wrong with this person,

we're being curious, we're seeking to understand rather than what's wrong with this person so I can judge them, so I can fix them. And so I think that was a big thing that I wanted to impress upon staff. And then it takes some accountability and I invite staff to say something to me if they notice that.

you know, I'm not acting myself or if I could have done things better. And you can do that in a polite, respectful way, but giving staff permission to call us out on it. Also, the other thing I've been trying to do proactively is verbalize, I'm having a really hard time. I'm judging right now. I am in the middle of an amygdala hijack. I am having a hard time engaging my prefrontal cortex.

which is what happens in a state of fight or flight, right? I remember a patient recently that the mom had E. coli bacteremia and she didn't want the baby to come to the NICU. And so of course, for us that have seen babies die with E. coli sepsis, that's really, really scary. And so I just verbalized to the staff as a way for me to recognize and call out and engage my prefrontal cortex that I am judging

because this is not what I know. And when I tried, it was still hard. I'm not going to lie, it was not easy, but I went into that room and talked with the mom and listened, actively listened. And she had had antibiotics previously and felt like it had been responsible for some of the changes in her health. And so I listened. We still came to a plan where we had to treat the baby initially.

Dena K. Hubbard, MD, FAAP (18:13.603)

but it was much better than if I would have just gone into that room and said, if you don't let us treat your baby, you know, we're going to call child welfare services, you know, or something like that. But those are times where it's challenging. And so I try to verbalize that and model it for staff so they know that I'm very human and perfectly imperfect myself and to hopefully give them permission to do the same.

The Incubator (18:20.441)

Yeah.

The Incubator (18:34.072)

Ha ha.

The Incubator (18:38.789)

I wanted to then follow up with another question because I feel that you hint to that as well, this idea of curiosity over judgment and asking what happened to this person instead of saying what's wrong with them. I think this is a beautiful message for our approach to our patients and their families, but I feel that it is also a very applicable model for how we interact with our colleagues and our staff.

And I'm wondering if you've seen this sort of mentality transpire and through osmosis just basically permeates the staffing in the NICU.

Dena K. Hubbard, MD, FAAP (19:18.893)

You know, it is really interesting.

If we all, I think this is why it's so important that anytime you want to implement trauma informed care, that it includes all disciplines simultaneously from the unit clerk who has the first contact with the parents to environmental services, changing out the trash at the baby's bedside to the nurse, to the respiratory therapist, our developmental care, all the pharmacists, all the team that's on rounds. Because there is a

palpable difference in a unit that has been doing trauma-informed care in my experience. I was so fortunate to join the group at Cottage Hospital in Santa Barbara. They had been doing trauma-informed care work for five years and the psychological safety that that unit has that I entered in

It was amazing because I just, felt like I belong here. I don't have to change myself to fit in. I belong as my authentic self. And so again, that's not something that happens overnight. That's something that Kathy Chung and Karen Rose, who are the leaders of that unit have been working on through a grant they received for five years and this community NICU. But it is, it's incredible how it changes.

Daphna Yasova Barbeau, MD (20:25.496)

and

Daphna Yasova Barbeau, MD (20:35.823)

So.

Daphna Yasova Barbeau, MD (20:43.629)

Hmm.

Dena K. Hubbard, MD, FAAP (20:48.107)

even the day-to-day work, know, the deliveries, the quality improvement work, everything that we do. And so it is really important, I think, to learn together to be vulnerable, which is another thing I think as physicians we were not trained to do. In fact, we were trained to be the opposite, almost like we are immortal. We are not humans. We don't have to have sleep. We don't need to drink water or have food or anything, and we just keep going.

Daphna Yasova Barbeau, MD (21:06.671)

Mm-hmm.

Dena K. Hubbard, MD, FAAP (21:17.561)

And we need to recognize our vulnerabilities and help one another and lift each other up through it. And I think that team approach and the multidisciplinary team is so incredible. I've also learned so much about trauma-informed care from nurses and social workers. Patti Davis was the social worker that gave the presentation at Children's Mercy. Denise Stout is an ER physician. She was my mentor in

Daphna Yasova Barbeau, MD (21:34.191)

Mm-hmm.

Dena K. Hubbard, MD, FAAP (21:45.185)

and coach who has been a leader in trauma-informed care, Jackie Ashbaugh, is a avid listener to your podcast. So I just want to give Jackie a shout out because she has taught me so much. And so I think, again, rather than feeling like as the doctor, we know everything. We know the ventilator better than the RTs, and we know pharmacy and the dietitian nutrition stuff better than anyone. It's, no, we...

we know it, but it's like the elephant in the room that everyone is looking at from a different angle and the perspective, that diversity of thought and expertise and experiences makes us better. And it helps me be a better physician for the baby. And so I think that's another part of the multidisciplinary care team and trauma-informed care is bringing us all together and

Daphna Yasova Barbeau, MD (22:21.071)

Hmm.

Dena K. Hubbard, MD, FAAP (22:40.575)

letting our egos be aside. But it's very different than how we were trained.

Daphna Yasova Barbeau, MD (22:42.159)

.

Daphna Yasova Barbeau, MD (22:46.467)

love that. I love this concept of learning from each other. I really wanted to highlight that and how trauma-informed care is not just for the families and the patients. It is a cultural shift that a unit really has to take on. And I think that it can, even if not everybody's ready, I think we can do some of that work on an individual basis.

And so we always like to leave people with like, what can I take to the bedside? I want to highlight something you said, that you said that we don't know what we don't know and that we can always be curious with our, I say families, we've been focusing on that, but the same is on the nurse who's upset for the day or the administrator who doesn't understand where you're coming from.

And maybe you can give us some examples of that. Like how can we take curiosity to the bedside today, tomorrow? Should everybody get training in trauma-informed care? Absolutely. But in the interim, I think we can be curious and I think that changes the culture a lot. You know, maybe how would that patient experience you presented in the first few minutes, how would that have gone differently? What would you do differently now?

Dena K. Hubbard, MD, FAAP (24:04.545)

Yeah, so now I would, I think the first part is the what's happened to this person instead of what's wrong with this person. It turns out that story that I told you, not only had her mother been shot in the head when she was pregnant with her, she had been a victim of intimate partner violence and the father of her other children was in jail for killing another woman. And so this woman actually felt

Regret shame guilt for not having put him in prison before that could happen the father of this baby had been murdered a month before this baby was born and She had another child that was not in her custody. She was trying to get back custody. She had been sober she was doing the things she needed to and She also had another preterm baby that had been in our unit and so she had a reputation

Daphna Yasova Barbeau, MD (24:45.081)

Hmm.

Dena K. Hubbard, MD, FAAP (25:04.479)

that baby had been taken out of her care for concerns of child safety. That baby had died in the care of DFS and a foster care family. so right. So she, so it wasn't about me. That's what I also learned. It's like, you know, why are you upset with us? I'm trying to help your baby. Do you know how many hours I've spent at your baby's? It's not about me.

Daphna Yasova Barbeau, MD (25:15.599)

So she doesn't trust the system at all. Rightfully so.

Dena K. Hubbard, MD, FAAP (25:32.781)

So I think that's one thing when parents get upset that it's not about me, they're in a state of fight or flight.

And so I would go into that thinking what's happened and not assume, recognizing that while I grew up from very humble beginnings, there are people that have had a lot worse experiences than I have that I can't even fathom. I respect this mother so much. I can't believe that she's still living every day. You know, that's so much for a human being to go through.

And so I think modeling it as physicians, so when you get the 14 year old who is delivering a baby, instead of making assumptions like, wow, I wonder what happened to her. If there's a mom that has a substance use history, I think most people when they think about having babies growing up, they don't want to be using substances.

They often avoid prenatal care because they've been judged by the healthcare system. And so I will, when I see polysubstance history, I will verbalize to the team, wow, I wonder what's happened to this woman. So I think that's one thing you can do at the bedside right away and encourage your team to hold us accountable. So if I say something that is not in alignment,

you know, say, know, can we pause and, you know, maybe redo that? Also, I think something we can do at the bedside is give choice where we can. So, you know, a baby's at 34 weeks and do we try them off CPAP or oxygen or do we stop the caffeine today? You know, if it doesn't really make it, if I don't have strong feelings from a medical standpoint why that is, I'll ask the family.

Dena K. Hubbard, MD, FAAP (27:30.369)

you know, little choices, engaging the family. have one of our residents has started a book project so that the families receive a book every week. so empowering them to like, there's a book here and you can read it to your baby. We have it in bilingual or we can say, you can just look at the pictures and tell a story, but the baby knows your voice. They know your scent, you know, empower them, educate them and empower them.

again, to be the hero, let them know how important it is that they're there. Because when they're ready to be discharged from the NICU, they're taking that baby home. They're with us for a very critical but short time. And so we really need to develop that relationship. And I think also when it comes to staff and healthcare workers, just be more attuned. Like, okay, this person seems like maybe they're struggling today. And of course you don't do it in the middle of rounds and ask everyone, but

you know, how are you doing? Because we don't, again, we don't know what we don't know. And it's okay to not hide all that. And it's also okay to be human and check on people because we're all human in a very stressful environment. And I think we've neglected the toll that that vicarious trauma takes. And so if you don't process that, it will catch up with you.

as a healthcare worker too.

Daphna Yasova Barbeau, MD (29:01.497)

Well, I think that's the perfect segue into the next topic we really wanted to discuss with you is about physician wellness. I'm using that term because you use that term and I like it so much better than using the term, you know, burnout because of the semantics involved with that, where we should really be focusing on what optimizes physician and workplace wellness.

I think you've been very open about your path to physician wellness. You told us you were a burnout survivor, and I know you've had some other personal experiences. what, same question Ben said before, what made you say like, this is something that I need to, I will make a career of because I think it is absolutely critical to our workforce.

Dena K. Hubbard, MD, FAAP (29:57.329)

Yes, I really wanted to highlight it again because we are human and I realized that my identity was tied up in being a physician and that's what I knew. That's where I felt safe even though we really don't have control over so many things. I knew how to be a doctor and

I think working excessively was a way to make me feel like I was good enough and that I was worthy. And again, it wasn't until my 40s with therapy and a coach that it's like, you are worthy and enough just as you are. You don't have to be productive to be that. it really...

reframed everything, my priorities. And again, I am not perfect and I'm still, I'm learning to do better. But the truth is work will never love you back. And while what we do is so critical and so important, it's not all on us.

And so sometimes letting go, which I think is hard as neonatologist, that's why discharge is so hard, as excited as I am for NICU graduations, like to send them out where they're not on a monitor and I'm not watching them all the time, is really hard. So I think that was part of it. And I've told the story when I was really like just looking for a way out. Again, I had the perfect group. I had the perfect

The Incubator (31:12.442)

I'm

Dena K. Hubbard, MD, FAAP (31:34.233)

I had a great team and there was something more that I needed in addition to the clinical care. I was feeling like I was fighting with insurance companies, documenting for malpractice prophylaxis and billing and coding rather than communicating between us. Fighting with Dr. Google, know, parents would come in with something. And again, that's where I felt like they were challenging my knowledge.

And really it wasn't about me. But so I needed something to really empower me, to give me choice. And that's where advocacy became a way for me to use my voice in a different way. And that was very empowering. Now, of course, advocacy, especially when it comes to policy and legislation is not an easy road. It's not a quick fix, but it was a way that I could use my medical knowledge, use my brain in an entirely different way.

one where I had a lot of, I still have a lot of imposter syndrome because I don't have a health policy background, but it was just a way to use my voice for kids in a different way. But when I, on one day on the way to work, I was just like, man, you if I could just have an uncomplicated case of appendicitis, I could be in the hospital for a couple of days, you know, maybe, and I wouldn't have to.

Daphna Yasova Barbeau, MD (32:58.953)

Hmm, mm-hmm.

Dena K. Hubbard, MD, FAAP (33:02.125)

to have an excuse for why I was off work. I just wanted a break. And when I verbalized that to my husband, we were both like, okay, this is not normal, this is not okay. And so it was really that kind of low that made me realize, okay, I need a change. And while my other eight partners were happy and content and doing great,

Daphna Yasova Barbeau, MD (33:06.767)

Mm-hmm.

Daphna Yasova Barbeau, MD (33:12.963)

Mm.

Dena K. Hubbard, MD, FAAP (33:30.061)

It was a lot of shame, a lot of guilt and shame. Like, what's wrong with me? Why am I not content and happy? Why is this bothering me? Why do these topics bother me so much? And that's another thing. I've just really learned to embrace my authentic self. And again, it was really important for me to find a place where I belong, where I don't have to change who I am to fit in. It doesn't mean that I'm not continuously improving myself. I am very much aware that I...

need to continuously improve. But they're your core values. It's really important to be able to live those because there is so much that you can't control. So back to your original question, it was after experiencing that that I was like, I just want to share this message so that other people know there's not something wrong with you. And I remember the first coach I talked to her first words were to me, Dina, you are not alone.

And how comforting is that when it's like, you are not alone. There's not something that's wrong with you. You need something different, which in our training, I don't feel like there was this, you you can do this and then your career, professional personal needs may be different and you can do this. There's different seasons of your career. And so I'm again, just trying to share with the world what I've learned from my challenges so that maybe it can be a little bit easier for someone else.

Daphna Yasova Barbeau, MD (34:28.663)

Mm-hmm.

The Incubator (34:55.76)

Thank you. Thank you for sharing that. And I would like to find out a little bit more about that particular juncture of your career, because I think that for the people going into neonatology, the stakes are very high. The pressure is high. And we are all what is known as I think a lot of us are what's known as type A. And I think one of the faults of that

particular personality trait is that we tend to take whatever we are told to do and we're doing it to the fullest extent. And sometimes we don't question things too much. But if you ask me to put a chest to you, I will do that as best as I can. And if you ask me to write a note, I will also do that the best as I can. But then we don't tend to realize that maybe some of the administrative tasks that are being demanded of us, like you were talking about dealing with insurance and things, really are not on the same level as patient care, taking care of families.

And I think that to me, lot of the burnout, mean, that there's been studies showing that the EMR is responsible for burnout in so many percentages of cases. What can you tell us a little bit about the realization that maybe all the things that are demanded of me are not on equal footing and maybe some of the things are, some things are more important than others. And I'm allowed to focus on those instead of stretching myself so that I can talk to the insurance in the same manner that I talk to a family, which

Maybe, maybe shouldn't.

Dena K. Hubbard, MD, FAAP (36:25.259)

Yes, I think this is another instance of being curious. There were times when I would get an email that said, you know, we need your, we need a W-9 tax form for something. I was a W-2 employee at Children's Mercy. And so instead of just doing it, which again, as

perfectionist and type A people and especially females, you know, be a good little girl. You do what you're told. I asked, I was like, can you help me understand why this is needed? And I posed the question to the president of the medical staff at the time and he replied back, he's like, you know, I've always wondered that too. And it turned out it was for Arkansas, Medicaid or something. I was in Missouri at the time. Didn't get a great answer, but even

Daphna Yasova Barbeau, MD (37:12.299)

Eh.

Dena K. Hubbard, MD, FAAP (37:19.893)

just there are times when by asking the question or asking the question again when the answer has been no under previous leadership but without great rationale and I'm squeaky wheel I'm going to admit it and there's also I have this it's in my office it says you may be too you will be too much for some people those aren't your people I recognize that I am too much for some people and that squeaky wheel

gets annoying at times, but also my intent is really not only to make it better for me, you know, if we don't really need this W-9 form, not only is that beneficial to me, that's beneficial for the other medical staff. And not everyone is at the career stage. I was mid-career. I was more empowered at that time. Our colleagues that are international medical graduates,

I feel like I'm speaking up for them because they may not have the luxury of being able to challenge some of these rules and regulations. So think it's another way to that being curious, asking questions, also using quality improvement methodology. Is there a way to do this better? Lean, which is a four letter word that some people really consider a bad four letter word. I happen to love lean because it's about decreasing waste.

And so then also in the quality improvement work in the NICU, if I'm asking the team to look into something to solve this problem and they're like, we just don't have time for that because we have, you know, X, Y, or Z. I'll also say, hey, we have quality improvement tools to identify waste. Is there something you're doing that you feel is wasteful and how can I help you with the quality improvement tool to remove that? So you can put, you know, other priority meaningful things.

We want to do things that are meaningful and there is literature to support that if you can spend at least 20 % of your time doing something that is, that you find meaningful in your work, then you're less likely to have burnout. The last thing that I'll say on that is that I also hate the word burnout and the R word resilience because we already are resilient. But this is another thing I've learned about through trauma-informed care is we talk about the fight, flight or freeze response.

Dena K. Hubbard, MD, FAAP (39:40.515)

But we haven't talked about the affiliate response, which is the oxytocin pathway. And that's the buffering. So when we're talking about trauma-informed care, whether it be for children or adults, parents, or for us as healthcare workers, it's not about summing the suffering, it's building the buffering. And so that affiliate response is so important. And I think it's important for us as healthcare workers, especially

physicians with all the, every discipline has challenges. It's a hard time to be in healthcare right now. I can only speak to those that I know of as in my personal experience as a physician, but we need to build that affiliate response. So what lights our fire? What is in alignment with our core values? What makes us excited to go to work? And when I,

What I have now, I love going to work. I know that there's going to be challenges, that there are sick patients and challenging situations, but I feel safe. I feel seen. I feel like I can be authentic Dina. And that's really important. And that's building my affiliate response and back to the science that releases that oxytocin and...

is really important. And so that can help me when those times where I'm in that fight flight freeze and breathe, engage that vagus nerve and use that prefrontal cortex instead of that primitive amygdala hijack.

Daphna Yasova Barbeau, MD (41:21.679)

I really appreciate this concept of building the buffering. And I think so many of us in medicine are saying like, I think I know it would make me happy, but I have this grant that I'm tied to, or I have to be in this city for whatever reason, or gosh, I'm in Korea, I already put 10, 15 years here, how can I start over? And I think that your story

You describe it as one of necessity, but I really think what you've done is quite brave and courageous to find this happiness. didn't fall into your lap. I think that you created that for yourself. And I hope that people will walk away with that message that there's a lot of flexibility in neonatology and a job or combinations of jobs exist where people can be happy. And I hope you can.

Dena K. Hubbard, MD, FAAP (42:15.341)

Thank you.

Daphna Yasova Barbeau, MD (42:20.499)

share a little bit about how you did that, the importance of kind of knowing your priorities and fighting for them. I think more and more people are creating a non-traditional work life situation. But not everybody knows how to get there. So maybe you could talk a little bit about how you created that for yourself. You searched out those opportunities that would do the things that you said, provide you the passion to do what you

enjoy the safety to do what you do. And I think the work-life balance you've created is very non-traditional, and there are give and takes to making something like that work, but it can be done.

Dena K. Hubbard, MD, FAAP (43:03.905)

It can be done and that's really.

I really do hope the listeners hear this message of hope because there is hope. hopefully those that have watched Ted Lasso or seen those themes come out, the hope and the be curious, not judgmental. But in Ted Lasso, he said, it's not the hope that kills you, it's the lack of hope. And I think that's really true. And

You know, it's crazy where my career is taking. This is not anything like what I would have ever imagined. When I left Sunflower, that was the hardest thing. mean, was professionally that felt like a divorce. I loved and still do love my team members there and I learned so much from them. Kathleen Weatherstone was the leader of that group and really

developed my leadership when I was fresh out of fellowship. So I'm so grateful.

That was such a hard decision and it really took time to pause and reflect. And my coach at the time, Starla Fitch, asking me, what do you like about your job? What do you not like about your job? What can you take off your plate? What are your hobbies? I don't know. I'm a mom and a wife and I don't feel like I'm doing those that great. My family kind of got the

Dena K. Hubbard, MD, FAAP (44:38.041)

crumbles because I couldn't give any less to the babies, right? And so that certainly left less for me. But once I survived that change, then I was like, you know what? If I can survive that, I can do anything. And so that also was very empowering for me. And then I was at Children's Mercy for five and a half years and really benefited greatly from mentors and sponsors. Bill Truog was my fellowship director, recruited me there for fellowship. And he's the one who connected me with Denise Dowd and who interested me more to even trauma-informed care. And she sponsored me. She was the one for the AAP Trauma-Informed Care Champions Program that said, hey, this application is due tomorrow, but it's super easy. I think you should fill it out. I was just getting back from vacation. I was like, it is short. I'll fill it out.

And then I got it and then I, it's opened my world to Heather Forkey and Moira Szilagyi and the AAP team was just incredible. Also, I had the opportunity to lead QI. I never aspired to do QI. If you would have told me anytime in my career that I would love QI, I would not have believed you. And so I gained so much from that experience. And then there was a time when it just wasn't the best.

fit. And so I was at a crossroads and again other people it's working for them fine and that's great. And it wasn't working for me and so I chose me. I rather than changing myself to fit in to where I didn't belong anymore and again I'm so grateful for all that I took away from that but I recognize that

I needed something different and I needed to make a change. What also empowered that change was I was already looking for other places and thankfully I had some great connections from activities within the AAP section on neonatal perinatal medicine.

Dena K. Hubbard, MD, FAAP (46:52.889)

But my brother tragically died of suicide by suicide in July of 2023. And that was, he was 10 years older than I was. And that was obviously a very traumatic event. And then I had turned in my resignation even without a job lined up, which I wouldn't necessarily advise that routinely, but.

You do what you got to do, especially because it's a, you know, at least a 90 day time period. And so within a month from July 2nd, when my brother died three days before his birthday, I was on call the night of his birthday. And it wasn't until early that morning that I called and said, I can't work tonight. You know?

How crazy is that that we, that it's not assumed like shame on me for even thinking I could still work that shift. But it's like, no, I am in shock. I am in grief and how can I be my best self for any critical baby and the leader of the team? And so I was like, I can't do, I can't do this. And, and I was supposed to, to work the, couple of days later and I was like, I need time, you know,

Daphna Yasova Barbeau, MD (47:51.694)

Yeah.

Daphna Yasova Barbeau, MD (47:58.691)

Mm-hmm.

Daphna Yasova Barbeau, MD (48:03.299)

Mm-hmm.

Dena K. Hubbard, MD, FAAP (48:20.021)

I am in fight flight right now. So that was July 2nd. I submitted my resignation after two weeks on service on July 28th. And then August 1st, I ended up in the ER with sepsis, a urosepsis, a kidney stone, and was very, very sick. Ended up having a couple surgeries and in the hospital a week.

Daphna Yasova Barbeau, MD (48:22.211)

Mm-hmm.

Daphna Yasova Barbeau, MD (48:37.551)

Mm.

Dena K. Hubbard, MD, FAAP (48:48.625)

and end up taking time off work. Did you know that you can do that when you're sick or have a medical emergency? Like you are allowed to not work. Yes, want all of our listeners to hear that. That was also a very pivotal moment for me that what I had been doing and the enduring and not taking time to rest and recover while I thought it was

Daphna Yasova Barbeau, MD (48:52.419)

Hmm.

Yeah, thank you for sharing that. Yeah, it's good for people to know that that can be done.

Dena K. Hubbard, MD, FAAP (49:18.423)

Honorable to just keep going keep going like the Energizer Bunny. It wasn't and it wasn't good For my personal health and so that's another thing with burnout That term burnout is because at a cellular level Your cells are so inflamed they're burning out and that's what leads to chronic disease and so that was a big eye-opener for me and So it's through that that I was like life is too short

You know, there are no guarantees for any of us. And while it is, it's a huge risk to leave a job, especially a job that you've been there a long time, especially with, you know, if you're a single income family or even a dual income family as physicians often we, you know, are the breadwinner, it's a big risk. We also underestimate

the risk of not making a change for ourselves. And so this was a big eye-opener for me that, hey, Dina, life is short. And the things that you've been missing with your kids and family and friends, and even especially friends that are non-medical, do you know you can have those too? And I was like, you know, this life is so precious.

And I went into medicine because I wanted to make a difference. And if I can't be me, if I'm not in a space where I have the psychological safety and trust and empowered to be my best, empowered to learn and grow, to collaborate in my growth and learning, cultural humility, then am I really living my best? And I felt like I owed it to myself.

So yes, very non-traditional. When I first interviewed with Kathy Chung and the group virtually in California, I loved it. It was a great interview. They invited me out. And then at first I didn't take the offer to go out there. Because it's like, I lived in Missouri my whole life. I just don't think I'm a California girl. That was scary. And then a couple of weeks later, Kathy texted me and said, hey, what about

Dena K. Hubbard, MD, FAAP (51:43.853)

you know, 0.75 clinical will create a QI role for you and you don't have to move. And I said, deal, let me come out there. And it's been the best thing ever. And really I do tell people I'm living my best life. And again, I know it's very non-traditional and I'm not saying that this is...

Daphna Yasova Barbeau, MD (51:57.561)

Thanks.

Dena K. Hubbard, MD, FAAP (52:08.961)

right for anybody else. I'm not locums. This is my job. I'm very committed to this unit and do plan to relocate. But the message is don't be afraid to think outside the box. The wild ideas. Your job can look however it needs to look. And I think as a profession, we need to be more supportive and encouraging of these non-traditional arrangements.

What this has allowed me to do is love working again, love clinical medicine, to be a problem solver with a team. This unit has trauma-informed care. They have a new residency program, so I love teaching and it's just the right fit for me. And when I'm there, I'm there. And then when I'm home, I do the quality improvement work. I do advocacy work, all the AAP work that I like to do.

And then I close my laptop when, when my daughters are home and for the most part. And, it, so it's for someone like me that has struggled with boundaries. It's not a direct flight. So there's it's two plane rides. I was like, nothing like two plane rides to, to give you boundaries, but that has allowed me to build that affiliate response. And I will also say, I'm not paid to say this by AAP, but I will say that my work in the Kansas chapter.

and the neonatal section and now with the trauma-informed care group, the committee on state government affairs with the advocacy, which is only after applying four times and great sponsors. Those things build my affiliate response. That's what keeps me going. And as you recognize right now is a really hard time to do advocacy, but I'm reaching out to those people that

that are so inspiring, Ben Hoffman, Mark Del Monte, Pam Shaw, Dennis Cooley. And instead of acting like I've got it all together, I'm reaching out and saying, hey, how do you guys maintain? How do you sustain during these times? Because I'm having a really hard time. So that's something else that I've learned, that instead of trying to pretend like it's all great, I've got it all together.

Dena K. Hubbard, MD, FAAP (54:29.625)

We're all doing the best we can and it's not easy and we're human, but I'm seeking out help from others and kind of embracing that vulnerability. I love Brene Brown, so I've learned so much from that. And I also think that's made me a better leader. And then I really try to mentor and teach trainees, so medical students, residents, fellows, early career neonatologists in that.

You are enough, just as you are. It's not always easy, but we are here for you. That sense of connection and going back to that relationship is so, important. I think now more than ever, we need connection and sense of belonging. And fortunately, I've had this awesome community to be able to do that. And that's how I met the two of you.

And so, just it's amazing to see how paths can cross. So for anyone that's struggling and thinking, I want to make a change, but I'm scared. Yes, it is a risk. There's a risk that this wouldn't have turned out like it did. But also what if it turns out even better than you imagine? There's something that's fallen in my lap at cottage related to the Peds residency program and advocacy that wasn't even on my radar when I joined.

there and so that's what I would say is what if it's even better?

The Incubator (56:00.401)

I have one last question before we let you go, Dina, because this is so inspiring. You've mentioned this in passing throughout the episode, but I just want to ask you about how crucial was it for you to make the leap and reach out to a coach? Because I think this is something that many of us would like, no, I'm fine. I don't need any help. I'll figure this out.

lock myself in a box and figure it out. But it seems that having that intermediary to discuss things with, to get input from, seems to have played a significant role in your ability to navigate all these different situations.

Dena K. Hubbard, MD, FAAP (56:45.291)

Yes, I highly recommend a coach and simultaneously a therapist. really think, no joke, think having a therapist should be a benefit that every one of us has. This also goes along with the whole mental health versus physical health. The brain is a pretty important organ in our physical body. And so there are so many barriers to therapy, but I think it should be mandatory because you do need that objective, you know, kind of third party person.

to that gets to know you and that can help that will remind you, you you said that this is really important to you and you are, you either this path is really leading you that way or this, again, they're not giving you the answers, they're helping you find them, but I so highly value a coach. I've had two different coaches at different times and as well as therapists and it's

that objective voice and also they're kind of like your cheerleader in the background too. It's just very, very valuable and they can just see things the way that you sometimes don't. And I will tell you, my husband, after a therapy appointment, he'll be like, know, how to go, what did Emma say? And I will tell him, and he's like, that's what I said. Why don't you just pay me? And I was like, I know, and you are right, but you need to hear it from somebody else.

So I think sometimes having that objective person is necessary and just can really help you take out the emotion, not take out the emotion, I don't like that, help you engage that prefrontal cortex to really think about, what are my core values? What do I really enjoy doing? What can I give off to somebody else? And as much as we...

don't like to delegate or give things up, look at it, reframe it as, hey, I can give this to another colleague and this can help them build their leadership or their growth and development. And so even just reframing the way we look at things and challenging ourselves to think about things in a different way. And so I have to leave another Ted Lasso quote. He said, it's like riding a horse. If you're comfortable while you're doing it, you're probably doing it wrong.

Dena K. Hubbard, MD, FAAP (59:14.072)

Growth is hard. And while I wouldn't choose to go through the challenges I did in 2023, how else would I end up in Santa Barbara as a Missouri girl living my best life professionally and personally? It's working beautifully for my family too, because I'm mentally really present when I'm home. So embrace it, embrace the growth, take a risk. It's worth it.

The Incubator (59:40.623)

Dr. Dina Hubbard, thank you so much for these pearls of wisdom. Thank you for taking the time to be on with us today. And we hope that your message inspires a lot of other neonatologists to follow the path that is meant for them. So thank you. Thank you very much and have a good rest of your day.

Dena K. Hubbard, MD, FAAP (01:00:00.355)

Thank you so much and thanks for a wonderful podcast. It's really a gift to the world and I applaud the both of you so much. Thank you for the opportunity.