Podcast Episode 9 | Finding Sanity Through Stress as a Doctor - Part 2

With Dr. Carmen Teague, Director of Internal Medicine for Atrium Healthcare

About the Prosperous Doc® Podcast

The Prosperous Doc® podcast by Spaugh Dameron Tenny highlights real-life stories from doctors and dentist to encourage and inspire listeners through discussions of professional successes and failures in addition to personal stories and financial wellness advice.

Shane Tenny, CFP® is our podcast host and Partner at SDT. He has lectured numerous times for hospitals and physician groups and, most importantly, helped hundreds of clients develop strategies to navigate through turbulent times toward their financial goals.

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Intro: 00:02 From Spaugh Dameron Tenny, it's White Coat Wellness, a show for doctors who are ready to improve their financial wellness. We know you work hard to help your patients, but you can't be at your best if you don't have your own finances in order. In White Coat Wellness, we highlight real life stories from physicians and dentists to educate, encourage, and inspire you to personal, professional, and financial wellness.

Intro: 00:25 Now from Spaugh Dameron Tenny, please welcome your host, Shane Tenny.

Shane Tenny: 00:31 Today's episode brought to you by SunTrust Mortgage and our good friend Jason Watkins, specializing in flexible mortgage financing options specifically for doctors and dentists. To have a conversation with Jason, you can Google search Jason Watkins SunTrust Mortgage, or call him directly, (704) 654-6058.

Shane Tenny: 00:56 All right, today we're back for part two in the conversation with Dr. Carmen Teague, and today we're picking up the topic of physician burnout and trends in medicine. If you missed part one, you'll definitely want to go back and listen to that episode about juggling marriage, kids, adoption, and sanity, just mixed in for fun.

Carmen Teague: 01:15 Or lack thereof.

Shane Tenny: 01:16 Or lack thereof. That's right. Dr. Carmen Teague is not only the director of internal medicine for Atrium Healthcare, but is first and foremost a wife to her high school sweetheart, a dedicated mother to her four kids, a board member of Bless Back Worldwide, and has published a book titled Motherhood, Medicine, and Mayhem, and joins us today to share a little bit of her story on finding sanity in the stress. Carmen, thanks again for being here.

Carmen Teague: 01:41 Thanks for having me.

Shane Tenny: 01:42 Now you've got some thoughtful perspective around trends in medicine and physician burnout, and so I wanted to kind of dive into that and understand a little bit of your background clinically and maybe just start by your work at Atrium Healthcare in Charlotte and how you have found yourself in the role of internal medicine director.

Carmen Teague: 02:03 Wow. Again, a torturous path. I talked about in part one how my life has not turned out how I planned it. And being in medicine was not my plan, and certainly being in hospital and medical administration, never in a million years my plan. But again, life doesn't always turn out how you plan it and sometimes you find yourself in roles that open in front of you and you walk in and you think, huh, maybe this is a better fit than I thought.

Carmen Teague: 02:26 So I came to Charlotte for residency and trained here. You come out of residency green as all get out and you're trying to figure out just how to be a doctor. And I joined a wonderful group here in town called Mecklenburg Medical Group, and in the first two years, so I finished residency in '04, so '04 to '06, you just try to figure out how to be a doc, what's going on. But by 2006 there was a lot of chatter on the horizon about the Affordable Care Act and healthcare changing, and I pulled my head out of the sand and thought, wow, my job's going to look very different over the next couple years. I do not want to be sitting back and having this done to me, but I'd really like to be at the table being part of the conversation.

Carmen Teague: 03:05 And so over the next couple of years I volunteered to be the local leader of my practice, and that morphed into being a regional leader for groups of practices. And then in 2009, the opportunity arose to be the director of internal medicine for what was then Carolina's Physicians Network, which is now morphed into Atrium. And at that point I had two 10 month old little boys, and let's see, four year old, six year old. Life was a little chaotic at home. And this opportunity arose and I brought the job description home and I remember laying it on the table thinking, wow, I really just have a passion for this. I see where medicine is headed. I really want to make the practice of medicine better. But I convinced myself that I had too much on my plate. I really couldn't do it.

Carmen Teague: 03:46 My husband, who saw the job description lying on the kitchen table, came and found me. He's like, what are you waiting on? He's like, this was written for you. This is your passion. This is what you want to do. He said, apply for the job. And so I did, and I have not looked back. It's been an incredible blessing.

Carmen Teague: 04:03 And the reason I wanted to be part of leading other physicians that I have such a passion for the practice of medicine and for what I think people go into medicine for. Doctors don't go into medicine to be experts in the electronic medical record or to be data entry clerks. We go into medicine to take care of people and because we have a passion of caring for people and learning about the human body and doing the right thing. And I saw that all these changes encroaching on healthcare had the potential to really encroach on that sacred nature of medicine, and I thought, hmm, if I can stand in the gap and be part of the conversation and do something to make it better and represent my physician colleagues, I want to be there. That's the spot I want to be in.

Carmen Teague: 04:46 And it has been a fun, torturous path, but it has been such a privilege to be part of leading healthcare change and to continue to make the practice of medicine better for providers, because that makes medicine better for patients. A happy doctor is a good doctor.

Shane Tenny: 05:02 Medicine has changed so much over the last decade. And even in your book, again, Motherhood, Medicine, and Mayhem, you wrote we have our priorities all screwed up when it comes to medicine in the U.S. We confuse quantity with quality, I think I read somewhere. What was going through your mind when you wrote those words?

Carmen Teague: 05:24 So even in residency, I recognized that life is sacred, the good Lord is the giver and taker of life, and sometimes we expend extraordinary measures to prolong life when it's probably not the right thing to do in the sense that we can't prolong life, but we can keep somebody on life support a really long time, and that's a really awkward place to be. It's also also not necessarily the right thing to do just because we can do it. I've jokingly said just because we can do something in medicine doesn't necessarily mean we have the ethics to know how to use that knowledge. And I've been very passionate about that through the years.

Carmen Teague: 06:01 If you look at the way healthcare money is spent, sometimes we expend lots and lots of money on curing things that we should have prevented in the first place. And we have so much of our priority on managing chronic illness and not as much on prevention. And that's where my passion is. For example, diabetes and COPD are diseases that are very much mediated by diet and lifestyle choices, smoking, eating too much. And I think we need to focus and put our priorities and our money, not necessarily on new drugs to treat those illnesses, but on ways that we teach people how to eat healthy and how to avoid things that ultimately lead to those illnesses.

Carmen Teague: 06:41 So I think that's what I was referring to. You know, we need to look at the quality of life, and we try to prolong quantity of life at the end where we have diseases that are debilitating and people are miserable. Life and living are two different things.

Shane Tenny: 06:54 Yeah. The Affordable Care Act, you mentioned a little bit ago, introduced a whole lot of change that [crosstalk 00:07:01].

Carmen Teague: 07:00 At an exponential rate.

Shane Tenny: 07:00 Yeah, at an exponential rate. And not the least of which is something that I hear a fair amount about, often begrudgingly, and that is just all the quality metrics that are in place now. Do you think kind of the adoption of quality metrics by hospital systems, insurance companies, are helping patient outcomes or ultimately hurting patient outcomes?

Carmen Teague: 07:21 That's a great question. I don't think a doctor goes into medicine and wants to have bad outcomes. You know, in our system we do measure quality outcomes and we have phenomenal quality outcomes. Around diabetes, we're top decile, around prevention metrics, we're top quartile. But we were there when we started measuring it. So just measuring it just does not change behavior. What we need to do is put infrastructure in place as a medical system so that it's easy to do the right thing every time and get patients the right care every time they walk in our doors. It's not when they come see us that's the problem, it's when they don't. And it gets back to prevention and how do we help people stay healthy?

Carmen Teague: 08:02 I don't think measuring quality metrics is a bad thing. But I also don't think because you have a metric that says the diabetics under our care get topped decile care doesn't mean we have the healthiest population in our area, it just means the ones that we're seeing. So I agree that we need to measure and I agree that we need to work toward bettering those measures, but I don't think quality metrics in and of themselves equate to quality care.

Shane Tenny: 08:28 Mm-hmm (affirmative), mm-hmm (affirmative). If you could change something that's going on in medicine right now, what would it be?

Carmen Teague: 08:37 I think we are really headed in the right direction with trying to manage populations of care and getting back to this prevention, et cetera. I think the hard part now is the way medicine is paid for. I think the most difficult thing in medicine that I would change if I was queen for a day is that we have third party payers between health care systems, i.e. providers and their patients, determining what is paid for, what's not paid for, what should be paid for.

Carmen Teague: 09:08 Looking back on history, before my time, I think the biggest struggle or biggest bump we had in healthcare in our country happened at the end of World War II when we made health care benefits something that was provided by employers. And if I could change one thing, I would take employers insurance companies out of the position of being between a patient and healthcare. I think they have a place, but I think individuals would do a better job of managing cost and managing their care if they had the responsibility of the cost.

Carmen Teague: 09:41 We have an entire generation of Americans who have no idea what it costs to provide healthcare. They equate the $20 copay, that's how much it costs for the doctor to see me, not understanding all of the thousands and thousands of dollars it costs just to turn the lights on, to run the lab equipment, to do the simple things that all have to happen to take good care of a patient. And that's just on the outpatient side.

Carmen Teague: 10:03 So if I could change anything, it would be shift the way medicine has been paid for and how individuals understand their responsibility in caring for themselves.

Will Koster: 10:17 I'm Will Koster, and this episode's White Coat Wisdom is sponsored by SunTrust Mortgage.

Will Koster: 10:21 We often get questions about physician mortgages. What are the pros and the cons of these types of programs? Well, I can't say if they're right for you. I wanted to use my time on this episode to discuss some of the details of physician mortgage programs.

Will Koster: 10:35 In general, these programs are designed to be flexible to meet the unique needs of physicians. The mortgage companies know that physicians typically carry higher than average debt loads because of their student loans. They also know that income during training hinders their ability to save for a down payment. SunTrust's physician loan program is available for physicians during residency and fellowship, and for practicing physicians and dentists who have completed their training within the last 15 years. MDs, Dos, DDSs, and more are eligible for this program.

Will Koster: 11:06 Specifications of these loans will vary from lender to lender, but SunTrust's program, which is one of the best our team has come across, offers 100% financing for homes up to $750,000 with no PMI, or private mortgage insurance. Now there are credit score requirements for this program, but in our experience SunTrust has been able to be flexible and find solutions for physicians with certain circumstances.

Will Koster: 11:30 Bottom line and the takeaway for all of this, if you're a physician in the market for a new home, you'll want to consider if a physician loan is right for you. If you'd like some more information, we'll put some links in the show notes, and as always, drop us a line if you'd like to talk to a professional about your specific situation.

Will Koster: 11:46 I'm Will Koster, and thanks again to SunTrust for sponsoring this episode's White Coat Wisdom.

Shane Tenny: 11:53 You are pretty passionate about the now ubiquitous topic called physician burnout.

Carmen Teague: 12:00 Oh, yes.

Shane Tenny: 12:00 Or moral injury, I think I've seen in some articles. And I think you've had some pretty personal experiences around this topic.

Carmen Teague: 12:06 I have.

Shane Tenny: 12:06 Can you talk about those?

Carmen Teague: 12:07 I can. I came from a counseling background. I have a degree in Christian counseling. I am passionate about anxiety, depression, treating it. And every patient that walks in our door gets a depression screen. We do that as a system. But I was doing that for years before because I don't want to miss something in taking care of patients. I think we are mind, body, spirit, soul, and you can't care for the health of somebody unless you look at all of those components.

Carmen Teague: 12:34 But a couple of years ago, one of my medical partners with whom I had practiced for 18 years took his own life unexpectedly, and I was blindsided and devastated. This was a provider who was an icon in the community, who had been in practice over 30 years. I had ridden up and down the elevator with my partner for years and years and years, and never once even had the inkling that he was struggling with depression.

Carmen Teague: 13:01 When I got the call that he had taken his life, I was blindsided, and I was guilt ridden because I thought, what did I miss? What could I have done? And many of us in medicine probably have a messiah complex. We want to fix everybody. But at that point, I recognized that I was not asking those questions as often as I should be with my own colleagues. Are you okay? Are you struggling with depression? Are you angry? Are you anxious? Because depression manifests itself very differently in men and women and in certain professionals and other walks of life or other ways that we don't necessarily look for in medicine. I'm not going to make that mistake again. I'm not going to allow my desire to respect privacy, or not ask questions, get in the way of asking the real substance of what's going on with you.

Carmen Teague: 13:51 So it did hit me like a ton of bricks. It also reminded me of why I have to step back and remind myself why I go into medicine. Medicine is not an easy calling, and I do believe it is a calling. There are stresses every day. My husband jokingly says he just moves other people's money around and I moved people's lives around, and I'm like, that's kind of a scary simplification, but it is true. If I make a mistake, it can be life altering. And that weight and that stress can really get to you.

Carmen Teague: 14:20 For me, I have found that engaging in international travel and doing medical mission work is a way to unplug and to step back and remind me of why I do medicine in the first place. International medicine is just that, you and a patient. It is not coding and billing and compliance and all those things that we have to do here with American medicine. Not that I think those things are bad, they just can taint your passion for medicine.

Carmen Teague: 14:47 So over the last five to six years, I've become very involved with an organization called Blessed Back Worldwide, and their focus, in one aspect, is medical care. They also focus on development as well as education. But I have been intimately involved in the medical side and have the opportunity to travel to Haiti a couple times a year and just be reminded of why I went into med school and why I chose to be involved in this profession.

Carmen Teague: 15:14 And I encourage all of my physicians with whom I work to find their passion and to step back and take time to do that.

Shane Tenny: 15:20 Mm-hmm (affirmative). Do you think with a greater awareness and publicity around the stress that is taking place in medicine, often as a byproduct, I think, of some of the regulatory changes and those sorts of things, not just the patient population, it's the external factors, are you seeing a greater willingness to talk about the issue? Or you mentioned a willingness on your part to ask colleagues, are you feeling depressed?

Carmen Teague: 15:48 Sometimes you have to ask.

Shane Tenny: 15:48 Are people willing to be self-aware and say yes, or...?

Carmen Teague: 15:51 I think that's generational as well.

Shane Tenny: 15:54 Yeah.

Carmen Teague: 15:55 You know, I am late forties, very late forties, came to medicine a little later, but I do think there is a generational difference to how you look at the stress of medicine. Many of us trained where there were no limits on how many hours you could work, and you just plowed through and it was just what you did and you sucked it up and you didn't say anything. And I think that generation may be harder to tap into are you feeling depressed, or are you anxious, or are you not? Whereas I think some of my younger colleagues talked more about this in training, they had more education on what does burnout look like, how do you manage stress, and I think they do a better job and are more willing to talk about that.

Carmen Teague: 16:30 I also think that my younger colleagues do a better job of setting boundaries and of saying, I don't want to work full time because I know I can't manage this stress. Where I have folks close to retirement that are working 90 hours a week because they've always worked 90 hours a week and they feel that that's normal. And I'm trying to navigate all the things that have to be done in medicine and helping different generations manage stress and ask those questions.

Carmen Teague: 16:59 What I do to relax is different than one of my colleagues who may be in their late sixties would do to relax, and that would be different than what one of my colleagues in their early thirties would want to do. You have to recognize, you've got to understand, what's your happy place? And figure out how to get there.

Shane Tenny: 17:15 Yeah. And with medicine being such a huge industry, and through the consolidation of the last decade or two, the healthcare systems are large. What are your words to someone who is listening and just feels like a tiny cog in a huge machine? You know, the system, no one doc, no one provider, can change this, can stop the craziness, can stop the insanity.

Carmen Teague: 17:44 I am that squeaky wheel yelling into the darkness. I believe that one person can make a difference. And I tell all of my providers with whom I work, what you do in that 10x10 exam room is sacred, and that relationship that you have with that patient, you are making a difference one patient at a time. And although you may not agree with everything changing in medicine, my job, and our job as a healthcare administration, as a healthcare system, is to put the pieces in place and to standardize the big stuff so you can individualize the little stuff and so that you can be the doctor that that patient needs at that moment while the other stuff happens in the background behind you.

Carmen Teague: 18:28 I don't think being part of a big system is a bad thing. Because I'll be honest with you, I don't want to deal with coding and billing. I don't want to hire and fire my staff. I want to be the physician that my patients need every single day when they walk into a room. And I am more than willing to lean on my administrative colleagues to manage those things that I don't have the skill set to manage. I don't have an MBA. If you can get one by on the job training, maybe I could get one like that, but that is not how I've been gifted. But my job at the administrative table is to bring the clinical perspective, and to bring the perspective of what it's like to take care of a patient, of what it feels like when an administrative decision interferes with that sacred patient interaction. That is where I think you can make a difference.

Carmen Teague: 19:15 And I would tell every physician, do what you do best. Be the physician, be the doctor, be the nurse practitioner, be the physician's assistant, be the dentist, take care of that patient and rely on people that have a different skillset to take care of the other stuff that you shouldn't have to worry about.

Shane Tenny: 19:32 Mm-hmm (affirmative). Good words. Good words.

Shane Tenny: 19:35 Carmen, we'll adjourn here on a high note. I thank you so much for giving your time to come and talk to us and share your story.

Carmen Teague: 19:43 Sure. Thanks for having me.

Will Koster: 19:48 I'm Will Koster, bringing you White Coat Achievements, our segment that highlights noteworthy achievements by your friends and colleagues.

Will Koster: 19:55 It's no secret that there has been a crisis unfolding within the healthcare industry that has deeply affected clinicians across our country. On this episode, we are highlighting a psychiatrist who has dedicated her career to finding innovative ways to make medicine better for both patients and physicians. Dr. Wendy Dean is now the president and cofounder at Moral Injury of Healthcare, a nonprofit organization that claims they are dedicated to putting the care back in healthcare.

Will Koster: 20:23 Dr. Dean has a background in psychiatry and military medicine, and she was noticing a similarity in what she was seeing in PTSD patients and what her healthcare colleagues were experiencing. In 2018, Dr. Dean co-published an article confronting the burnout conversation head on, declaring that physicians aren't, quote, burnt out, they're suffering from moral injury.

Will Koster: 20:46 The article sparked international conversation among healthcare professionals and others about the moral foundations of medicine and has begun to change the language around clinician distress. One of their recent articles argues that the burnout epidemic continues because the moral injury at the root of the problem remains unaddressed. Burnout may be the symptom, but in many cases moral injury is the cause.

Will Koster: 21:11 Working with physicians every day, we are well aware of this issue facing the healthcare industry. We value Dr. Dean's passion and her contribution to help end moral injury. We think she's well deserving of a shout out in our White Coat Achievements segment.

Will Koster: 21:26 If you'd like to learn more about Dr. Wendy Dean and The Moral Injury of Healthcare, we'll put some links in the show notes. As always, if you know someone who is a wearing a white coat and is achieving something noteworthy, please drop us a line. We'd love to hear about it. We might even highlight them in a future episode. But again, this episode's White Coat Achievement goes to Dr. Wendy Dean.

Shane Tenny: 21:48 Carmen Teague, doctor, leader, mom, volunteer, navigator of life's craziness. And again, her book, you can find it on Amazon, it's Motherhood, Medicine, and Mayhem. You can also find her through her website, carmen-teague.com. You can find it in the show notes.

Shane Tenny: 22:05 Also, I mentioned last time, we're hoping to do a series on marriage and money in the coming months, so if you and your spouse would be willing to tell us how you've navigated money issues in your marriage, we'd love to know about it. You can drop me an email at Shane@whitecoatwell.com. And again, don't forget, subscribe to the podcast, give us a review on iTunes, Google play. You can also check out our private closed Facebook group called White Coat Wellness specifically to help you connect with others in medicine or dentistry who want to share life together.

Shane Tenny: 22:35 Thanks so much for joining us. We'll see you here next time.

Outro: 22:39 This episode of White Coat Wellness is over, but you're not alone on your journey towards financial wellness. Spaugh Dameron Tenny has been helping physicians and dentists with their financial planning for over 60 years, and we'd love to answer any questions that would be of help to you. Visit sdtplanning.com today and take your financial wellness to new levels. Once again, that's sdtplanning.com. And we'll see you on the next episode of White Coat Wellness