Podcast Episode 44 | From Clinician to Physician Leader: How to Positively Impact More Patients

with Dr. Janelle White, Specialty Medical Director of Community Health at Atrium Health

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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These discussions are explicitly tailored to doctors and dentists, highlighting achievements to inspire you to reach personal, professional, and financial wellness. You will hear real-life stories of doctors’ winding career paths to turning practice wealth into personal wealth. 

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Full Transcript

Janelle White: 00:00 I just had to learn for myself and accept the fact that I can impact patient care without actually touching the patient.

Intro: 00:09 From Spaugh Dameron Tenny, it's The Prosperous Doc Podcast. Real stories, real inspiration, real growth, a show for doctors who are ready to improve their overall wellness in every aspect of life. Now, here's your host, Shane Tenny.

Shane Tenny: 00:26 Today, I'm here with Dr. Janelle White. Dr. White is a pediatrician with Atrium Healthcare in Charlotte, North Carolina, one of the largest employers in the area, and one of the largest healthcare systems in the country. Dr. White has a story that I think many of you will connect with. And it's a story that involves starting in clinical medicine, but feeling stirred, and called, and drawn into a role that can facilitate broader systemic change.

Shane Tenny: 00:54 She has a story that involves an awareness and a growing personal connection with community health and some of those issues. So I want to give her a chance to tell you a little bit about her journey. In addition to being a pediatrician, she is the system medical director for community health, for Atrium. She's also on the board of Carolinas Physicians Alliance. Dr. White, thanks so much for being with us today.

Janelle White: 01:15 Well, thank you for this opportunity to join the podcast and to discuss physician leadership and to also discuss health equity. Very excited and honored to be here, so thank you for your time

Shane Tenny: 01:26 For sure. I find that useful often just to start to rewind a little bit and start at the beginning. Can you just start giving us a little bit of your background and what drew you into medicine and into pediatrics at the outset?

Janelle White: 01:39 Absolutely. So I grew up in Miami, Florida, and it was one of those things growing up, through elementary, middle school, you get asked a question what you want to be when you grow up. I really, honestly, I didn't know. I love learning and I'm still a lifelong learner, but I of didn't have that answer of what is it that you want to do when you grow up? When I was in high school, I have an older brother, and he was actually involved in a hit and run accident. So it was pretty severe and he ended up in the trauma center in Miami. So, he again sustained very severe life-threatening injuries. So obviously my family and I were there at the trauma center day in and day out watching him and watching his recovery. That is what really motivated me and that was a life-changing experience for me, to see how those physicians, and not just the physicians, the entire care team, how they honestly saved my brother's life and revived him.

Janelle White: 02:38 So that again, spurred my interest in medicine and again, I just thought that those physicians, they were miracle workers. It was just amazing to me what they did. So, that started my path down this road to wanting to be a physician.

Shane Tenny: 02:55 I think that path took you to the University of Florida and then ultimately to Charlotte, where you did your residency, where in that journey did you decide pediatrics was the angle for you?

Janelle White: 03:05 Another thing that I think was formative for me is once I decided I wanted to be a doctor, I wasn't quite sure which specialty that I wanted to focus on. So as a high school student, the church that I attended, one of my church members was an office manager of a pediatric clinic in Miami and Miami Shores, Dr. Gina Morgan-Smith. She actually allowed me as a high school student to come to her office periodically and just shadow her and see what she did day in of a doctor, a physician. I loved it, it was just great to see what she did, interaction that she had with her patients, the care that she took of them and also, you could just tell that the families were very grateful for the care that she provided, the parents and also the children that she interacted with.

Janelle White: 03:52 So, that sparked my interest in pediatrics, but I didn't want to just focus there as all of us as providers in medical school, you have the opportunity to go through all of your different specialties during your clinical rotations and just get a glimpse into what the different specialties entail. So, I tried to keep an open mind as I went through all of those and when I got all my pediatric rotations, it just felt right and it felt like home. I guess, just came full circle to where my initial interest was, was in the field pediatrics.

Shane Tenny: 04:24 Yeah. I'm going to try it all out, but I knew I was going to like this the best.

Janelle White: 04:27 That's right, yeah.

Shane Tenny: 04:30 So you started as a pediatrician, I think, 15 years ago, or so, seeing 30, 40 kids a day and running through that. As you got deeper into just the work of medicine and the work and being a doctor and seeing kids, then you started to get invited to participate in conversations at the planning level or at the administrative level. Talk a little bit about what that was like, and then how, I think your own experience, realizing the other side of medicine, or the other angles that take place.

Janelle White: 05:05 Absolutely. It's one of those things, the first several years, as you alluded to, when I joined my practice, I joined as a full-time pediatrician. So, I was seeing patients four and a half days a week. I just thought that that's what I was going to do, really did not have any other aspirations at that time. Again, I was just happy. To be a pediatrician, it's a field that I love. When I first started my career, recently married, starting a family. So that's where my focus was and just settling into my role, growing my practice, growing my patient panel and just providing an excellent care. So again, that's really, that's what I thought I was going to do and that was my focus.

Janelle White: 05:45 Over the years, you participate on committees, or quality improvement projects, small things like that. That's how I started to get a bit of a glimpse into the other side, physician leadership. As you practice medicine in your patients, you start to see those gaps and, this could probably be better. Or, these sort of initiatives could be put in place to have better outcomes. So again, you just start to see very, just small glimpses of it, and it just piques your attention, but taking on an active leadership role. As you mentioned, I was just tapped and invited to serve as a medical director of my practice and it organically just grew and lead to progressive increasing leadership responsibilities and roles at Atrium.

Shane Tenny: 06:35 Well, you say you were tapped, but in here also is a demeanor that is observed. That's the reason you get tapped. I mean, you have an interest and a proclivity for thinking strategically and thinking fairly, and balancing various interests and things like that. So I know you bring that innate skill to the table. I'm guessing, was there a time though, as you were growing and I'll say more board meetings, and you're surrounded by the executives and the administrators and the policymakers, and you're the doctor and the voice of the providers, but at the same time you feel a little mismatched or a little outgunned and maybe out over your skis?

Janelle White: 07:13 Absolutely. I think that that's something that as physician leaders, one of those things that we have to learn to navigate. So, what I can say, and to back up a little bit, is as you continue to expand your leadership roles, you do realize that it is important to have that voice of the leadership, but as a physician and for myself personally, as I took on these progressive leadership roles, I had to get over the limiting belief that if I'm not performing direct patient care, I'm not using my talents as a clinician to improve the lives of patients. I think that that's something that is easy to get caught up on as a physician. I just had to learn for myself and accept the fact that I can impact patient care without actually touching the patient and transitioning to the physician leadership, it allowed me to be able to do that and to have that wider perspective and also a wider impact on affecting patients, so the lives of patients in a positive manner.

Janelle White: 08:19 So for me, therein lies some of the value proposition, as a direct patient care is that one-on-one, you're affecting the patient whom you have in front of you or the thousand or so that's on your panel. But in a leadership role, you actually have the opportunity to affect the lives of potentially tens of thousands. There were a few just key moments that drilled that home for me.

Shane Tenny: 08:42 What's one of the moments that are coming to your mind?

Janelle White: 08:45 Yeah, and I can actually share one. I was involved in ... I remember the day, it was a Mecklenburg County, healthy weight, healthy child initiative [inaudible 00:08:56]. Through that, that was their annual big meeting where they highlighted and shared some of the initiatives that a lot of our multi-sector organizations in the county and surrounding area were doing to combat pediatric obesity, childhood obesity. At that time, when it was time to highlight the work that Atrium Health was leading around childhood obesity, they highlighted some of the work that a committee that I was leading at that time did. I just remember there was a PowerPoint presentation and the slide that was presented showed that the work that our small committee did actually touch the lives of over 80,000 patients that year. To me that was just mind-blowing, and that's honestly when that light bulb moment ... that's when it went off from me. That's when I said, "This is it. And this is where I have an opportunity again, to position myself and to have that sort of perspective and the opportunity to influence systemic change and change on a greater level to improve care of patients."

Shane Tenny: 10:03 It's an interesting paradigm shift that you're describing. I hadn't thought about before, but if I'm tracking with you, it's almost that inflection point where you go from ... and you have to be willing, to go from having your constituency and primary focus be your thousand patients on your panel, to your constituency being the thousand doctors in the system-

Janelle White: 10:25 That's right.

Shane Tenny: 10:26 ... whose processes and systems and protocols are going to be impacted by your work, which is going to affect their thousand patient panels. Am I tracking with you?

Janelle White: 10:35 You are. That's the thing as a physician leader, another thing that I had to get over personally, and I think that being a physician involved in direct patient care, it allows me to maintain that perspective, that physicians in particular are feeling a loss of control and autonomy in the systems within which we work. There are many reasons for this. It feels like there's more oversight, there's that electronic medical record, as you mentioned, where we, a lot of times spend more time charting than we do actually interacting with the patient. Declining reimbursement, so the purse strings are tightened in, and that causes us to have to be more efficient with our resources and resources include our time. Resources include our support staff and things like that.

Janelle White: 11:23 So, as a physician with over 15 years of direct patient care, when I'm in those board meetings and in those rooms with our administrative leaders, I can speak up on behalf of practicing physicians. I think that that is an honor and a privilege. It certainly does put you in an uncomfortable position at times, because you're walking that fine line and you're there in the middle.

Shane Tenny: 11:47 But I know from your story, this administrative role that you've embraced, I mean, it isn't just one that you've grown and evolved into. There was a decision point where you decided, "Yeah, this is where I feel called to make change." You were accepted to Harvard Master's of Health Administration program and doubled down on your education.

Janelle White: 12:10 Where that came from again is, I felt as a physician leader prior to getting the degree, I could speak up on behalf of the practicing physicians based on my experience, but it's one of those things, as I continued to grow in my leadership roles and responsibilities, you take a look at your CV and you look and, where are the gaps? What's missing and where can I make myself stronger? And how can I make sure that I'm speaking the language, of the individuals with whom I'm in this room and making these decisions? So that is what led me to pursuing the master's degree. I've always been a lifelong learner, and I'm not one to shy away from opportunities to grow and opportunities to learn.

Janelle White: 13:01 So again, it is one of those things as I reflect back, it's funny how at the beginning of my career physician leadership was just not on my radar, but as I reflect back, I've always been in a leadership role in some capacity. So in high school, president of my class, senior class, involved in several activities, extracurricular activities and college, I was college of our minority association of pre-health students, several other committees and organizations in medical school. President of the Student National Medical Association. So again, but those were all just more narrow focus interests healthcare, so again, making that paradigm shift from a only clinical perspective, to actually more of an administrative strategy, operations management, finance, that's where that paradigm shift occurs. Again, it's one of those things as a physician leader, you want to make sure that you are speaking the language and then also able to translate that back to your physician.

Shane Tenny: 14:05 And so the continuum of when you make a big change in life, I'm just thinking with you through the experience you're describing, there's a continuum, I think, or maybe it's an X, Y axis of exciting and scary.

Janelle White: 14:19 That's right.

Shane Tenny: 14:20 Things ebb and flow with each other. So as you began to, I guess, mentally think, "I think my impact is going to be essentially in the boardroom and the conference room and not in the exam room." I know that in some ways it's swimming upstream and there may be some folks they'll say that's like, "You sold out. You gave me the bureaucrats." Was that decision one that felt just ... on my little mental graph of exciting and scary. Was it exciting, and you just felt called and drawn to it because that's how you're wired? Or did it feel scary and a little bit of a leap of faith, or that sort of thing?

Janelle White: 14:54 I really think that it's a combination of both. So again, as I mentioned, I'm not one to shy away from growth opportunity, but again, there is a part, I think as a physician, where you may initially feel like you're selling out and you're moving over to the other side. Again, that is something I think, as a physician, we can sometimes maybe broaden our perspective and understand that we can have a positive impact with actually touching the patient. As a leader, I've learned that I value transparency, integrity, and ownership, and I try to bring all of those traits with me in all of my interactions, especially when you are working with physicians and administrators. And especially when you, as you mentioned, could potentially be weighing in and also communicating certain initiatives that may not be popular and that could potentially totally change the workflow of a physician's day, of their OR schedule, how they manage patients on the floor. That's a big burden to bear.

Janelle White: 15:57 So again, it's one of those things over time, you just develop those skills and I've always found that communication is key. Again, just in this role, you have to be able to translate and speak the language on both sides.

Shane Tenny: 16:14 Yeah. Well, you're in a unique position to do this. I want to take a quick break and then we come back, I want to talk about what you referenced earlier about your awareness and affinity for community health. Then I know you've got your own story that you want to share as well. So we'll be right back after this.

Shane Tenny: 16:35 Summertime comes with a lot of change for those of you who are finishing your residency or fellowship programs and heading into private practice, whether you're going to be joining a hospital system or a medical group, or becoming an associate with a dental practice, you know that there are a ton of financial decisions facing you. Ranging from things like disability insurance, the right type, how much, questions about a home mortgage, or how to finance that and what size house to purchase. Often there's questions around budgeting and taxes, and definitely student loans, whether to go public service loan forgiveness, or refinance them. All of these questions are addressed and more in the free Residents and Fellows Survival Guide that you can download in the show notes below or directly from sdtplanning.com under the Free Guides section.

Shane Tenny: 17:25 With this free guide, written specifically for residents and fellows as they go through the transition phase, you'll be able to answer really important questions that will help you lay a solid foundation as you start this next journey of your career. If it's helpful for you, download it today. If you know someone who's finishing training, make sure to pass along this tip to them. You can click in the show notes below and download it or navigate directly to sdtplanning.com and navigate to Free Guides. Best of all, you'll have a resource in case you need future advice that would be helpful for you or your family.

Shane Tenny: 18:04 So, we're here with Dr. Janelle White talking about her journey from clinical medicine into administrative medicine. Dr. White, I know that that role and just the longer you're in medicine, you've become more and more aware of just community health issues and high-risk populations and those sorts of things. [inaudible 00:18:22] level set for me at least, what is community health? How should we think about that?

Janelle White: 18:26 So community health for me, it's just the definition of caring for the population more from a population health standpoint and not necessarily the individual patient level. Community health also involves caring for the health and wellbeing of the community as a whole. With community health, we tend to focus more on our vulnerable and marginalized populations. Also, the third leg of that is, with community health, you pay attention to the factors that are outside of the walls of the hospital setting or the four walls of your clinics. So that's what's called our social determinants of health.

Shane Tenny: 19:11 In our society right now, where in many ways, there's so much individualized rights and individualized focus. I'm even thinking we're recording this, hopefully in the third quarter of the COVID pandemic, or fourth quarter of the COVID pandemic, when the vaccine topic is so big and I guess, help elucidate a little bit, what is the value of community health on society as a whole? And what would you say to folks who are like, "Look, that's somebody else's problem. My job is to take care of me."

Janelle White: 19:41 That's right and that's understandable. I can see from a certain vantage point, but the pandemic has just laid bare the urgency to pay more attention to health equity. Again, just the disparities in the morbidity and mortality from the pandemic, we've always known that there are disparities there, but the pandemic just laid bare that reality. It's real and it's something that, that has to be addressed. Again, as clinicians, we tend to focus more on clinical care, but I think one of several things that the pandemic has shown for us is that social determinants of health can have a greater effect on health outcomes, more than the clinical care that we provide.

Janelle White: 20:22 So I can give you an example, as physicians, providers, I think we are all very familiar with quality metrics. We're monitored on how are we providing quality care? Are we seeing measurable improvement in the patients that we're taking care of? And there are sometimes certain patients where despite what we do clinically, the medication that we prescribe, the procedure that we perform, they're readmitted, or their hemoglobin A1C is continuing to climb despite the time and the care that you took with them. So, that is the missing piece, that's the missing piece and that is where the realization comes. Studies have shown that only 20% of a person's health and wellbeing is impacted by clinical care. So that means there's a huge other piece of that pie that is beyond our control as clinicians, that's about 80% of that.

Janelle White: 21:14 So other factors include, studies have shown that about 40% of an individual's health and wellbeing is impacted by socioeconomic factors. 30% is impacted by health behaviors, and 10% is physical environment. So again, when the question becomes, what does that have to do with me? If you are looking at this solely as a physician and provider, I think that that may help explain, some of the, what does that have to do with me is when you are seeing that despite what you're doing, clinically your patient is not getting better and your quality metrics are not improving.

Janelle White: 21:52 So again, I think that that's just another paradigm shift, is that we sometimes have to broaden our focus and look beyond the walls of our hospitals and clinics to understand the multiple other factors that impact health and wellbeing, and not necessarily, I think, label someone as a noncompliant patient.

Shane Tenny: 22:12 And so as you have moved into leadership and been able to think broader than just the patient in front of you in the clinic, what are some of the things that you and the healthcare system are seeing and are beginning to put energy into, to really impact the community health outside of just the clinic?

Janelle White: 22:35 So happy to share that our community and social impact division strategy includes several different initiatives. I'll share a few. For example, we are devising a strategy to screen all of our patients for social determinants of health and also implementing support systems and resources to actually connect the patients to the community resources who have identified needs. I think that that's important because again, as providers and physicians, we may not feel empowered to do anything about it. There's a hesitancy, I'm sure you may know that there are factors there, but as a physician, what can I do about that?

Janelle White: 23:11 So again, that is recognized and understood, so that's part of our division's work in our strategy. So again, as a clinician, I can lend that voice and clinical thought leadership to that, "Hey, this is what we're seeing. I'm in the trenches too and I'm in direct patient care. This is what we're seeing, but this is the bandwidth that we as providers have, so we need some help and we need support." So that's something that our division is working on.

Shane Tenny: 23:38 You have, in that example, specific, additional screening questions that either the nurse or the physician are asking, and though not just asking ... and then not knowing what to do with it, asking and helping to provide them with the social network, or the other services, or departments, or organizations that maybe we can connect that patient with, or their family where there things like that. Is that what you're describing?

Janelle White: 24:01 That is absolutely correct and we wanted to make sure that we're doing this in the correct order. Sometimes when we push through initiatives, we identify the gap in the need. So we go to screening, but then where's the support system? So yes, that's what we're doing, is we have actually built the support system and onboarded community health workers, referral navigators, so that when the clinical team screens the patients for the social determinants of health, there is a warm handoff, and someone that can connect the patient with those wraparound services.

Shane Tenny: 24:33 What's an example of the sort of question, or the social determinant that would show up in that sort of screening and where the handoff would be?

Janelle White: 24:40 A very common one that we have identified, especially through the pandemic, is food insecurity. So there are questions around, do you have enough food to last the next 48 hours. Over the past 30 days, have you actually run out of food, or do you think that you're going to actually run out of food? So food insecurity is a big one that we've been able to have a collaboration with entities here in Charlotte, community-based organizations, where we identify someone as food insecure, and we can immediately connect them to a resource where they may receive the help that they need.

Shane Tenny: 25:14 Right, that's a great example, that again, just doesn't occur to those of us who aren't in that risk population, but it's so much more profound having a belly that's full, is way more impactful than, "Oh, by the way, I need you to make sure I'm taking vitamins."

Janelle White: 25:31 That's right. Yeah, the Maslow hierarchy of needs is one of those things. If I need to pay my rent or if I need food, my money's going to go there and not the prescription that you prescribed for me because I just ... I can't. So again, as you mentioned, it's just keeping those factors on our radar as clinicians.

Shane Tenny: 25:54 Now, I know from just our past conversations and things, there was a time in the last couple of years, where in your story, you had a rude awakening, the phrase that comes to mind, in some ways not even the right phrase, of just your own vulnerability and things. Could you share a little bit about that?

Janelle White: 26:12 I'm very happy to. Again, as I mentioned in my of committee and leadership roles, I've always, for the most part chosen to lend my voice and talents to initiatives that focus on vulnerable populations and also historically marginalized. It was just a professional interest for me, and also it was somewhat personal from stories that my father shared with me. He grew up in Middle Georgia. He was born in 1939, so that might provide a little bit of context, but he would share the story with me of how he could not attend the quote unquote good school in his small town, because he was poor and because of his race. So, that always stuck with me. Again, it's always been an interest of me as something that I cared about, but it became more real, I think for me personally in 2018, when I became a widow, single mother. Lost my husband suddenly and unexpectedly, and it is one of those things where it hit home for me that how someone can potentially be placed into a vulnerable situation that they never anticipated, never expected, and certainly did not ask for.

Shane Tenny: 27:27 You're absolutely right. It makes you grateful for your own level of preparedness, but also I think you're describing a freshly empathetic for those that don't have the connections, let alone the financial connections, but just the relational connections to be able to provide stability and support in times like that.

Janelle White: 27:46 Absolutely.

Shane Tenny: 27:48 Maybe to bring us across the finish line here, what do you see as the biggest opportunity in medicine right now, over the next couple of years? Particularly maybe based on what we've learned and seen coming out of COVID?

Janelle White: 28:01 I would say a few biggest opportunities, so I would like to touch on the two that we are focusing on for this particular conversation. So the one is physician leadership and then second, health equity and community health. So, to first touch on physician leaderships. For us as physicians, whether you are in a formal leadership position or not, we all have the opportunity to lead from where we are. We all have that opportunity to lend our voice to ensuring the wellbeing of our patients and also Lynn our voice to just making sure that we understand that even administrators, they have a patient's wellbeing in mind, and understanding that we can assume positive intent and understand that strategy and finance and operations management, that's very important for us to remain competitive and to remain viable as a healthcare system. So I think that as physicians, there's ample opportunity for us to lead from where we are, and to take on leadership, wherever it's in a formal role, or again, just in your day-to-day interactions as patient care.

Janelle White: 29:14 Regarding community health, a lot of people have asked, "What do you want to do with this degree?" Or, "What is your goal?" That has obviously changed. Initially, it was just to provide excellent and quality care to the patients that I care for. But for me, really my goal and where I think our greatest opportunity as healthcare in general, is to provide the same quality of healthcare to all. I think that that is especially something that the pandemic has shown, is that if the least of us are not receiving quality health care, then again, the playing field is not level and it can have ramifications, obviously from a healthcare standpoint, from a moral standpoint, to see a particular population of people just disproportionately impacted by a pandemic. So again, I think that that's something where we have the biggest opportunity, is to apply a health equity lens to all of the work that we're doing.

Shane Tenny: 30:13 Dr. White, as you've spent the last decade growing in the number of meetings you attend, board meetings, conference meetings, planning meetings. What's one of the biggest tips that you've learned, or aha moments you've had as you've sat in meetings with executives and MBAs and planners?

Janelle White: 30:29 What I would say, is one of the many lessons that I've learned, is that as a clinical and a physician leader with over 50 years of clinical experience, it is important for me to speak up on behalf of practicing physicians and to sometimes level set when we're having these conversations and explain why there's sometimes pushback from physicians when new initiatives are rolled out, because sometimes it's not out of, "I don't want to do it," but sometimes it's just self preservation. There are times when initiatives may look nice and clean on a spreadsheet, but they're difficult to execute in a busy clinic or in the OR, on the unit. It's just sometimes not possible to do that because patients are human. Patients are complex. Everything that we do is not transactional.

Janelle White: 31:19 As physicians, there is an art to what we do. I think that sometimes that may get lost and I wouldn't say that intentionally that's what happens, but sometimes the perspective is not there. So, through my past 10 ish or so years of serving as a physician leader, that's one of the most important lessons that I've learned and something that I continue to stick to.

Shane Tenny: 31:41 I'm thinking of those hypothetical meetings, where there was a report showing that the EHR system is going to significantly save you time and you can keep seeing 40 patients-

Janelle White: 31:51 That's right.

Shane Tenny: 31:51 ... and it takes somebody with guts to say, "Excuse me, I don't think it's going to work that way."

Janelle White: 31:55 Absolutely.

Shane Tenny: 31:58 Yeah, one final question, we'll wrap it up here, you listen to a story and for all of us, we come so far in life and you can look now at the last 15 years and you can see that you've climbed a mountain. From the outside folks can listen and say, "Wow, you've grown from seeing little kids all day, to sitting in boardrooms, to setting policy, to looking on the wall at that Harvard degree that you've worked so hard for. But I know in the midst of that journey, the days aren't always bright and sunny. Was there a time when you have just felt overwhelmed, or scared, or that sort of thing?

Janelle White: 32:34 Absolutely. There have been many times, and again, it is as we mentioned, just when you're having those difficult conversations, when you are explaining to individuals who may not have that clinical background or knowledge, again not unintentionally, but when you're explaining that what's on the spreadsheet is just not going to be able ... it's just not possible to execute that. So, those are those uncomfortable moments, but a time for me that particularly sticks out, is in 2018 when I suddenly became a widowed single mother. That was the time when I had been enrolled in my master's program for about a month. That was a point and the decision-making is what am I going to do? Do I continue to move forward? Can I do this as I'm grieving, as I'm caring for my son, as I'm still working full time and fulfilling my clinical duties?

Janelle White: 33:29 There are times when you're learning finance and you're looking at spreadsheets and putting in formulas into ledgers and you get to the point to why am I doing this? Why am I doing this? What am I accomplishing here? If you share with colleagues that you're getting a master's degree, sometimes [inaudible 00:33:47], "Well, what are you going to do with that?" Or, "You're moving over to the other side."

Janelle White: 33:50 So again, there are sometimes external and internal battles that we deal with when we're along this journey. And again, limiting beliefs that may pop up in our minds. So again, I always center myself and I am reminded of why I became a physician and that's to care for patients and improve their health and wellbeing. I can do that through direct patient care, and I can also do that through this degree. And again, just keeping that perspective on my radar, that this will give me the opportunity to impact the health and wellbeing in patients on a larger scale is one of the guiding principles and the North Star that was able to allow me to continue down this path.

Shane Tenny: 34:40 It's great. You're in a great role, and it's a pleasure to hear your passion and your vision, and to know that there are folks with your skillset taking the wheel of our healthcare system. I'm excited for what is taking place. I'm excited for what our country is learning as a result of COVID, and as a result of the renewed awareness around health equity and community health issues. Dr. White, thanks so much for being with us today.

Janelle White: 35:08 Thank you for the opportunity.

Shane Tenny: 35:10 Thank you for joining us for another riveting episode of The Prosperous Doc podcast. We greatly appreciate the time you give us, whether you're working out, or driving, or wherever you are listening to us. Welcome your feedback on iTunes or Google Play. Welcome your reviews. Definitely subscribe, you'll find out about our episodes coming out every other Monday. And as always, this doesn't have to be a distant conversation. You're welcome to email me directly, shane@whitecoatwell, and I welcome your comments or suggestions. If you have guests or topics that you think we ought to put on the show, I'd love to hear about them. Thanks for being with us, we'll see you back here next time.

Outro: 35:49 This episode of The Prosperous Doc podcast is over, but you're not alone on your journey. Spaugh Dameron Tenny has been helping physicians and dentists prosper through financial planning for over 60 years to connect with us, visit sdtplanning.com today and take your financial wellness to new levels. Join us on the next episode of The Prosperous Doc podcast.