The Colleague: Mark Greenawald, MD

Mark Greenawald, MD is Professor and Vice Chair of Family Medicine and Community Medicine at the Virginia Tech Carilion School of Medicine (VTC) and presently serves as the Vice Chair for Academic Affairs, Well-being and Professional Development and as residency program faculty for the Carilion Clinic Department of Family and Community Medicine.  He also serves as the Medical Director for the Carilion Clinic Institute for Leadership Effectiveness (ILE).  He is a former President of the Virginia Academy of Family Physicians and in 2016 was named the Virginia Family Physician of the Year.  

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Mark has served as the conference Chair for the 2018-2022 American Academy of Family Physicians (AAFP) Physician Health and Well-Being Conference and will serve in this role again for 2023.  In addition, he is 1 of 8 national faculty for the AAFP Leading Physician Well-being leadership development program, which is now starting its second year.  He also serves as the Director for the AAFP Chief Resident Leadership Development Program.  More recently, Mark is serving as the Co-chair for both the newly formed Virginia Academy of Family Physicians Well-being Committee, the newly formed Virginia Task Force on Primary Care Clinician Retention and Well-being Sub-Committee and as an advisor for the AMA Practice Transformation process.

In 2019, Mark launched the nationally acclaimed PeerRxMed program (www.PeerRxMed.org) which is intended to help healthcare professionals provide proactive support for each other on their professional journey away from distress and toward thriving.  

Dr. Greenawald’ Prescription for Success:

Number 1: Learn to ask for help, and when help is offered, find a way to accept it.

Number 2: No one is watching out for your wellbeing more than you are.

Number 3: Have at least one mentor throughout your career, and look for opportunities to mentor others.

Number 4: Take a practice that teaches present moment awareness.

Number 5: Set your intentions, so you live your life by design, not by default.

Number 6: Look for opportunities to grow and change.

Connect with Dr. Greenawald

Website: http://www.peerrxmed.org/
Email: mhgreenawald@carilionclinic.org

Notable quotes from Dr. Greenawald’s interview:

I was in awe of those poeple who took time off from school.

There is a teacher gene in me.

We can all be part of something bigger than ourselves.

The things we carry around in healthcare are heavy, long lasting, and open wounds.


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Access the Show Transcript Here

Transcript

[0:00] Inside I did not move on. And I actually spent the next year in constant fear. Constant fear of other bad things happening, constant fear of litigation from this particular incident.
And I literally, there wasn’t a day that went by that I didn’t have a lump in my throat.

[0:20] Music.

[0:25] Paging Dr. Cook. Paging Dr. Cook. Dr. Cook, you’re wanted in the OR. Dr. Cook, you’re.

[0:32] Music.

[0:57] Hello, everyone, and welcome to Prescription for Success. I’m Dr. Randy Cook, your host for the podcast, which is a production of MD Coaches, providing
leadership and executive coaching for physicians by physicians. To overcome burnout, transition your career, develop as a leader or whatever your goal might be, visit MD Coaches on the
web at MyMDCoaches.com because you’re not in this alone. And don’t forget that CME credit is available when you listen with us, just look for CMFI in the show notes to learn how.

[1:35] My guest today is professor and vice chair of family medicine and community medicine at the Virginia Tech Carilion School of Medicine. He also wears lots of other hats that we’ll talk about, so let’s hear my conversation with Dr. Mark Greenewald.

[1:56] I’m very excited today to be speaking with Dr. Mark Greenewald, who is up in Virginia at the Virginia Tech Carilion School of Medicine, Department of Family Medicine. Mark, thank you so much for being with us today. I’m looking forward to the conversation.
Randy, it’s a pleasure to have the opportunity to be here today with you.

[2:17] Well, I am particularly looking forward to this conversation because I’m so interested in the tremendous interest that you’re focusing on physician well-being and can’t wait to hear
about that. But Mark, as we always do, I want to begin at the beginning and talk a little bit about,
how you evolved to where you are. So how about your early life? Are you a Virginia native or where did you grow up? I’m not. I actually was born in Montana, but grew up in Pennsylvania.
I really spent all my formative early years in Pennsylvania until I went to college, which was also in Pennsylvania. So most of that time was spent in South Central Pennsylvania in
the Harrisburg region. And did you grow up in a medical family or did the influence for medical school come some other way? No, I grew up in an immediate medical family. My father is a family
physician. I’m retired now and my mother is an RN. Retired now as well and indeed I have two sisters who were both RNs as well. So we are a full medical family.
So did you have your mind made up really early on? I mean when you matriculated at Bucknell, did you know where you were headed or was there some evolution involved?

[3:36] There was likely some evolution or at least I feigned evolution along the way. I think that if I look back, the truth is that I think that was going to be my default pursuit. Did look at,
and entertain some other things along the way, particularly in college, but certainly designed my curriculum to be a pre-medical curriculum and nothing that happened during college did anything but encouraged me even more in that direction in terms of some extracurricular things I did.
I spent some time at Geisinger Medical Center during the time I was in college and just was enamored even more so by what I was exposed to during that time.
So yeah, likely it was going to happen one way or the other.

[4:21] And, you know, it’s interesting, Randy, that when I think about that time, I have very few regrets in life, very few regrets. But one of them was actually under the influence of my father.
When I was finishing up at Bucknell, I was accepted early decision to go to University of Virginia and also had received a scholarship, a health profession scholarship from the Navy.
And my dream at that time was to hike the Appalachian Trail. And so my plan was to actually take a gap year. That was before there was such a thing as a gap year, but to take a year off and do that.

[4:58] And my father greatly discouraged me from doing that. And that’s one that I wish I could get that one back.
Do you have any idea of what made your dad feel that it was important for you to stay in school?
It was interesting that his logic or his reasoning at that time, which at the moment seemed to make sense in retrospect it didn’t was basically you’ve invested this time and you know what you want to do and his concern was if I took that year off that I would change my mind.
Which again in retrospect you think well wait a minute that would make sense if you changed your mind that would perhaps be a good thing.
I don’t regret it now and I don’t aspire to hike the Appalachian Trail now though I have some other things in mind that I would love to do. But it is interesting that that was part of that journey during that time.

[5:51] You know, I can tell you that when I was in medical school, and I did it exactly like you did, you know, it was, you know, you follow the path.
But I had a number of classmates who had done other things, quite a few who had been in the military.
This was back in the Vietnam War era and other things. And my impression was that the people around me who had had other experiences were better students and I think in many ways became better physicians faster than I did.
Did you ever observe anything like that in your own experience? I was in awe of those people who took time off.
We didn’t have many of them during the time that I went through school, as you point out, the tradition at that point in time, unlike now, was really to continue your education during that time.
And you know, I think part of even my father’s reasoning back then was if you delay it, you’re also going to likely move into a time, can hit at least historically or demographically where you would want to be starting a family.
And I think he went through medical school, married and having children.
And I think that was part of what it was echoing in his mind that it would be best to have.

[7:04] To be done with that, to be done with internship and residency prior to starting a family. So I suspect even though he didn’t say it that way, I suspect that was part of what he was thinking at,
the time. When you got into medical school, was the long-term plan for family practice.

[7:20] Already there or did you try to take some time and look around and maybe consider some other choices? What was that decision like? It was absolutely not there. Actually, having
grown up in a medical family, and I spent a lot of time early in my life actually going on rounds with my dad in the hospital, and I constantly heard, you’re going to grow up someday and be just like your father. And of course, that is not my wiring at all. And so I did everything I possibly,
could to convince myself I didn’t want to go into family medicine.
And what I discovered along the way and I think I knew it even inherently at that time was that I’m a generalist.
And when I looked around at a lot of the other options that I entertained and I actually did rotations, I was considered very strongly internal medicine, I was considered very strongly emergency medicine.

[8:15] And when I did rotations during my fourth year, including a rotation, so this is a story about how somebody can influence you who has great wisdom. The chair of family medicine
at the time, subsequently my chair at University of Virginia, Louis Barnett, sat me down one day and we were going through this and he was kind of sharing his perspective and he said, why don’t you go do a rotation with your father?
Wow, and so I said well, I hadn’t considered that but I did and first of all I had a blast Second of all what I discovered is what I think he was thinking was going to happen Which is I realized that my path.

[8:53] Even should I choose family medicine was going to be very different than my father’s He would be practiced for 40 years in the same practice and and had a wonderful career
career, but I think those around me suspected early on I would be taking probably more of an academic route and so the ability to say, yes, I’m also a family physician like my father
and doing something completely different than he did I think was able, that was palatable enough for me to not feel like I was quote following in my father’s footsteps.

[9:27] And I’m interested to know, you said you realized early on that you might want to have a career in academics. How early are we talking and what do you think caused you to take on that interest?
Probably, I think what I suspected is that there’s a teacher gene in me and I knew that even coming into medical school, didn’t know what that was going to look like but envisioned And even at that time, seeing myself teaching and that certainly played out during my time in residency.
I served as chief resident, spent a lot of time really honing some teaching skills. And then once I got out into practice, my first two years of practice were actually overseas on the island of Guam with the Navy and loved it.
And I call that my clinical fellowship because we were doing everything overseas in terms of the scope of practice.
What I even knew then, I came back and I joined a faculty residency program in Charleston, South Carolina with a Navy which is now no longer no longer in existence.
I just knew that that was where my real passion slide was to be a medical educator. And that’s really what has really defined a lot of my career since then.
And a little bit more about your military experience, if you will. Did you make that decision because you owed them an obligation or did you just decide you wanted to do some military service?

[10:52] No, I had applied for a health profession scholarship during college and that was really it was pragmatic.
It was how am I going to pay for medical school?
My parents were incredibly generous actually. It was my grandparents who ended up paying a lot of my college tuition in terms of an inheritance but the expectation was that I would be paying for medical school.
And so I was looking for ways to do that.
Had an uncle who was an admiral in the Navy, a cousin who was in the line in the Navy as well and so the Navy just seemed to be the place to go.
I can’t say that I gave that a lot of thought beyond just that’s what other family members did.
And really had a, my father had done some back when he was finishing his training, there was required service, either military or public health service and he had done Indian health service and that’s where I was actually born.
That’s why I was born in Montana is that he was doing Indian health during that time. And so, I think there was part of me that just felt that that was a one way to give,
back and so there was there was some thought behind that and really
enjoyed those four years, actually turned out to be five years in the Navy was just a wonderful time on many respects, including the opportunity to go overseas, to live overseas.

[12:15] And to really to practice. Part of what I’m really grateful for about that time as well is had I not done that, it would have been very tempting to have stayed at University of Virginia and stayed on faculty right after graduation.

[12:29] And I don’t think that would have been a good thing.
I think it was very helpful for me to get out into practice without having to on the other hand, you know, either at that time often buy into a practice which would have committed me very differently economically.
Yeah, I want to stay with that military experience theme for just a moment if you will. I mentioned to you that I was in medical school when the Vietnam War was underway.
It was common for physicians in residency to actually be drafted into service. There were quite a number of residents appearing both at the University of Alabama where I
was in medical school and at Medical College of Georgia where I did my residency.
There were quite a few people returning from their service in the military.
My impression of those people is that they were all, to a person, somehow I thought a more complete physician than the rest of us who had not had that experience.
I’m wondering if you have an opinion on that. Do you think I just imagined it or is there something about military life that adds another layer of maturity to your character?

[13:49] What do you think? That’s an interesting question and I want to just pause for a moment and give that some thought.

[13:56] My first impression is what the military brings, certainly even within the medical core is structure and you’re part of something.

[14:05] Definitely bigger than yourself and that’s very explicit. You know, we can all be part of something bigger than ourselves in terms of our profession, in terms of our lives, but with the military it’s
very explicit. There is a mission and you are part of that mission. And for me, when I went over to Guam, literally the week as I was going to Guam was when the first Gulf War started.
Wow. So I was immediately given the reality check of, oh yeah, this is part, you know, the mission of military medicine is to support the troops in times of wartime, in time of
wartime at peace and their families as well. And so it was a very quick indoctrination into that process and humbling in many ways, very humbling. We were considered on Guam,
to be already forwardly advanced in terms of our positioning.

[15:00] And so I was already considered in some ways deployed over there rather than thinking that I would go to the golf.
I did have some adventures during that time that I’d be happy to share about that were quite interesting.
But it does, it provides I think a worldview. And for many folks like myself who went straight through training, it provides you some insights,
into the bigger world in terms of even, you know, a lot of the people I took care of were.

[15:28] People who did jobs that I was just not really exposed to much during my upbringing and.

[15:36] The whole military culture, which is a culture of its own, as you know, as well.

[15:41] And one that I really, I found to have deep respect for. And then there’s just the expectations in terms of structure, which I think that can be helpful in terms of growing up a little bit. At least that was the case for me.

[15:56] Being overseas, which was certainly a time of time of great accelerated maturation. I bet it was. any fronts.

[16:04] Have you ever had a moment in your life that altered your future? To see that we have this bottleneck with residency that so many people don’t get that chance to get that so needed training. Have you ever wondered why you chose the direction you went?
When I had left my prior position, I didn’t plan on going back to practicing medicine. Coming this month, it’s Life Changing Moments, hosted by Dr. Dale Waxman.
The parts of your job that are professionally fulfilling, can you say a little bit more about that? In this companion show to Prescription for Success, we will explore those decision points,
with our former guests and provide you with the wisdom and insight to make those choices for yourself.
What can I do for the country other than the psychosocial assistance? Getting the new show is easy.
If you are already subscribed to Rx for Success, you’ll get it automatically.
But if you are not subscribed, now is a great time to do so. You can find the RX4Success podcast on Apple, Spotify, Amazon, or wherever you listen to podcasts.

[17:09] Music.

[17:15] Hi, I’m Rhonda Crowe, founder and CEO for MD Coaches. Here on RX4Success, we interview a lot of great medical professionals on how they grew their careers, how they overcame challenges, and how they handle day-to-day work.
I really hope you’re getting a lot of great information.

[17:32] But if you’re looking for an answer to a specific problem, management or administration challenge or if you’re feeling just a bit burnt out like maybe you chose the wrong career, well then there’s a faster way to get the help you need.
No, it’s not counseling. It’s coaching.
Rx for Success is produced by MD Coaches, a team of physicians who have been where you are. I know you’re used to going it alone, but you don’t have to.

[17:59] With the support you need today, visit us at MyMDCoaches.com to schedule your complimentary consultation.

[18:07] Again, that’s MyMDCoaches.com because you’re not in this alone.

[18:16] We’ll get back to our interview in just a moment. But right now I want to tell you a little bit about Physician Outlook.
If you haven’t discovered this remarkable magazine, please do so very soon. It was created by physicians for physicians to showcase the intersection between clinical
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It’s really unique among physician lifestyle magazines. And like the Prescription for Success podcast, Physician Outlook amplifies the voice of any physician who has something to say.
It also engages patients who still believe in physician-led team-based care. And Prescription for Success listeners can get three months free when you enter our promo
code RX for success and select the monthly option at checkout. That’s a really great deal on this stunning publication. And now let’s get back to today’s interview.
So it sounds like that military experience was really significant for you and had a significant effect on your evolution as a physician. But when you finished you.

[19:40] Still had academics on your mind and I’m interested to know was it difficult to.

[19:48] Find your way back to another academic appointment or was that fairly easy? What was the story? So my last two years in the Navy was as part of faculty at a residency program in Charleston and that both sealed the deal for me.
Part of the reason I wanted to do that is to really test drive the position of being faculty and I can remember this vividly.
So once I got to Charleston and started teaching, I just thought, why doesn’t everybody want to do this?
Like this is the best thing in the world. And it was one night I was doing obstetrics as part of my practice at that point in time It was one night that we were up on labor and delivery that…

[20:32] It hit me why everybody didn’t want to do this. We had a woman in labor and she was having a prolonged labor and very prolonged push, a pushing stage. And I was with the resident and just,
wanting to dive in and do everything that I could to make sure that the perineum was preserved.

[20:49] And she ended up having a third degree tear during her delivery, which likely would have happened anyhow. But I realized in that moment that the reason that being on a faculty is likely not suited for most people is the giving up of control.
And you know people are practicing in your name and really under your license and you have some control but not as much as you would if you were in there doing it yourself.
And that’s the case, you know, we know that, right?
You know when I’m rounding in the hospital, I don’t, I gave up inpatient two years ago but when I was rounding in the hospital knowing that, you know, residents are rounding in in the morning on numerous patients on the service, I’m going to take their word for.

[21:32] A lot of what happened during that time.
That takes a lot of trust and a lot of suppression of ego control. Having said that, I also realized that I was cut out to be able to do that.
It was just so exciting for me to watch the developmental process of a physician and to be part of that. So I got my test drive and said this is exactly what I want to do. So
when I came out, I had already had two years of faculty experience, wanted to do inpatient and OB, which at that point in time was in huge demand. And so it was like a little bit,
like being in the candy store when I started looking for faculty positions. And we struggled because we didn’t really know what was going to be. My wife was coming out of a child psychiatry
fellowship at that point in time, and we just didn’t really know where we would likely want land it turned out that her father was very ill during that time. He subsequently died of.

[22:31] Metastatic colon cancer. They lived in Danville, Virginia, which is about an hour and 15 minutes from Roanoke. Roanoke happened to also be where we had done rotations from University of Virginia
as residents. So we had a memory of it, but the memory was very limited because it was mostly spent at the hospital. And so there was something about Roanoke though that was very attractive on on many levels, just being in the mid-Atlantic, being in the mountains, which is something we wanted.
And so came back here and this was the one place that didn’t have a job where we really wanted to come.

[23:05] And so I talked to the program director at that time. I said, look, I know you don’t have a position right now, but we’re going to be coming up to visit anyway. And we just do an interview just in case something were to open up.

[23:19] It literally turned out that something ended up opening up that they didn’t anticipate. And so I had a position offered to me and it was just total grace because that was not the way it was likely going to happen.
And the other piece of that for us, having come from the military where you basically are going to move every two to three years, we wanted to come to a place where we could see ourselves staying beyond two or three years, which is what a lot of the other places I looked, it felt like a stepping stone to something else.
Whereas this was the one place that felt like this could be where we could be for the long haul and indeed, you know, over a quarter century later, here we are.
So that turned out to be quite prescient on our part.

[24:03] Well, nothing like being in the right place at the right time. And you have certainly made the best of it.
I don’t know if this is a fast forward for you or not, but what I would really like to get into is the thing that I found most fascinating, most compelling about your story, which I have done a lot of poking around in.
And certainly you have been an effective teacher of the art and science of medicine, but you have really taken a tremendous interest in physician well-being.
And I’m curious, is that something that you brought with you when you first showed up or did it evolve because of what you were seeing before your eyes?
So there were two parallel tracks that happened there, Randy, that I think probably led to that.
The first is actually my initial passion for leader development and coaching, interestingly enough.
So when I came out of the military, one of the things that I was, because of some experiences that I’d had in the military, both I would say quite positive and quite negative around leadership, I realized the importance of leadership.

[25:23] In general, and the importance of leadership for me in terms of I wanted to make sure I worked in an environment where I had the kind of leaders that I was going to be able to grow and thrive with and really got into that conversation around leadership at a time when,
healthcare we were really just starting to talk about physicians as leaders.
There were some, but they were, that was really the first generation of physician leaders.
And so that was a thread that was happening during that time. So I came with that passion.

[25:53] That passion then led to some things that I did within my own health system as soon as I got here to start looking at ways to develop physician leaders more, which led
to an opportunity to join the faculty of the American Academy of Family Physicians Chief Resident Leadership Development Program, which was just in its infancy at that point in time.
Fast forward a little bit, I was through, again, many circumstances that were just total synchronicity.
I was asked to be part of that faculty, got to that program and had already had some interest because of my leadership development work with coaching, which was also in its infancy at that point in time and certainly within healthcare.
So I went and did some additional coach training as part of my preparation to be part of that program.
So I was already having that developmental mindset through both my educators mind and mindset, now with a coaching mindset leader development mindset as well. And then in 2001, I had a very tragic.

[26:55] Occurrence that happened in my own patient care, which is that I had an OB patient who died during labor and in the process the baby was neurologically,
devastated. This was a woman who ended up having an amniotic fluid embolism which are almost uniformly or at least at that point were almost uniformly fatal. I,
didn’t know it at the time of course, but that changed the course of a lot of things in my life as you might imagine. And I know that we all have, we all of, we physicians,
we clinicians have our stories about tragic outcomes, some of which were unavoidable and some of which we may carry blame into our lives from there forward. This was one that was kind of a mixed one for me. The first time I’d had other tragic things happen, but,
This was the first one that really, really hit close to home.

[27:50] What was interesting, and I’ve spent a lot of time writing about this since, what was interesting is watching a few things happen in terms of both my own mindset, I think my innate nature as well as the culture of medicine.
That within one week of that happening, I was already designing a resident education intervention to talk about this.
Talk about kind of how I was processing it and how I was handling it and talk about being way premature. You know, emotionally there’s no way I was ready to do that and yet there was part of me that was just like, okay that happened,
we’re gonna learn what we need to learn from it and move on. But the fact is that inside I did not move on and I actually spent the next year in constant,
fear. Constant fear of other bad things happening, constant fear of litigation from this particular incident and I literally there wasn’t a day that went,
by that I didn’t have a lump in my throat most of the day. Now you know in retrospect some of that was just repressed grief that was happening but.

[28:59] It took me a year and during that time I think on the outside folks would have looked at me and said Mark seems to be doing pretty well. Seems like you know,
he’s recovered from that and you know I had a few folks reach out just to check in on me and I did the old I’m fine I got this you know everything’s
going fine thanks for asking but it wasn’t true at all and and so after a year a series of circumstances happened that finally just broke me and it was my
wife of all people who said look you need to get some help you’re not doing well right now and so I sometimes it’s a good good thing to be married to a shrink right well I fooled her for a year but yes she she just said you know it’s time to get some help and I was fortunate to have you again during that time.

[29:46] A little bit different than perhaps now but not as much as I would like. You know, going and seeking out a therapist or something was just not what you did. That was a sign of weakness as much as
anything. And so I finally did and had some good guidance from one of my mentors here at Krillin Clinic who was a psychiatrist as well who guided me towards somebody in the community who was doing
a lot of work with physicians. And you’d think, wow, really? Which means of course there was a a lot going on, you know, kind of underground if you will. And as I like to say, she, so
I sought her out and I won’t say she saved my life because I never thought about hurting myself during that time, at least consciously. But what she did is she gave me my life back.
You know what’s really fascinating to me about this Mark, it’s not so unusual for me that she noticed that you were in trouble but it sounds like she really behaved much more like a spouse rather than trying to treat you herself. Am I hearing that correctly?
Oh yeah. Yes. Yeah, she wasn’t going to touch this one. Not at all. No, even to the point of perhaps being a little blind to a lot of what was going on because I was able to put,
up an incredible front.

[31:07] We’re good at that, aren’t we? We are well practiced. We are really well practiced. It’s a performance art.
And so it was the performance art competing against.

[31:16] What was going on inside of me which was just corroding me emotionally. So finally again asked for help and she really gave me my life back and what I realized in retrospect was that year,
I was just a shell of a human being and that was a year when I had a young family and I missed it.
It’s a year that I can never get back because it took all my emotional energy just to put up that front every day. And so I had nothing for those around me at all. So it was an incredible,
gift. And that, so back to your question then of how did I get involved in the whole well-being,
work? It was really, I had done some presentations even prior to that time. That was kind of before.

[32:00] Kind of burnout and well-being were really a thing, but that was through my coaching work.
But all of a sudden it became very real.
And one of the things that came out of that for me was I had resolved, I said, you know, that was just a terrible year.
I would not want anybody else to ever go through a year like that, at least without knowing that there were other options available to them.
And knowing that, you know, once, as you know, once you start telling your story and it almost in many ways feels like it gives people permission to tell their story, the things that we’re,
we carry around in healthcare are heavy, and in many cases long lasting, and not even scars but still open wounds.

[32:42] That people carry around with them, that really alters the course of their careers.
And so it was my way to begin to say what could that look like, to begin to open that conversation in a different way. And that led to a lot of what has happened since then.
Well, that was incredibly insightful on your part. And the other question that it brings up for me is that, you know, it’s easy to spot the person who has been through an especially traumatic event such as the death of a mother in childbirth.
You know, everybody can spot that as potentially traumatic.
But I can’t imagine that there is anybody who is dealing with sick people from day to day to day that has not experienced things that are not as obvious as that. they suffer from it.

[33:34] So what’s the method for getting to that? What’s the method of helping people understand that they’re suffering when they don’t even know it?
So now we’re fast forwarding a little bit because part of what came out of that time is, and we can talk about this an hour later, is the PureRxMed program that I started.

[33:54] Really started unofficially in 2018 and started more officially in 2020. I realized and this really is based on a lot of experience so…
Backtrack a little bit. What was happening early 2010s, one of the things that was starting to happen was of course the whole well-being and burnout concerns were becoming more so,
particularly around 2012 when some national articles were published. One of the things that came out of that was the second victim programs. And so the second victim programs for your
listeners are programs that say that basically the first victim in any kind of traumatic event is the patient and their family. The second victim then are those caretakers who were part of that, starting with the EMS and the hospital personnel, etc. I’m not keen on the,
term victim, so I’ll be very upfront about that. But the concept is a very important one. In our own hospital, we started something called our trust team. The trust team was,
the second victim equivalent and it was a peer support process for those who had been,
part of traumatic events. What I observed during that time, I love the idea and as you and I both know because of the culture of medicine, most clinicians then.

[35:08] And still for the most part don’t really access those resources. So it’s there when an event happens the team will reach out, offer peer support and my,
experience has been and this is the experience of many others is that most say thank you, I’m good, I’m doing fine just like I did. So you know some things don’t change in the culture of medicine. And so what I realized, and this is what I realized for me moving forward because it wasn’t the last traumatic event that.

[35:35] I’ve had in my career, was what I really wanted is not somebody who I didn’t know to share that journey with me but what I wanted was somebody who got it.
Like who could really say, I don’t know what your experience is exactly but I know what you’re talking about. And that wasn’t even my wife because as we pointed out earlier, that was.

[35:55] Early on in our medical marriage, I realized that I didn’t want every day to be a rehash of all the tough things that had happened. I didn’t want that to define our marriage and our relationship from early on. And so, while we talked about some of those things, I really needed another outlet.

[36:10] To make sure that I was processing those things and those became my peers.
And I was really blessed early on by one of my mentors who pointed out to me that even though we talked about patients and the primacy of our patients and those relationships in terms of our professional work, the fact was that we were going to spend more time with.

[36:32] Our colleagues with whom we worked than we would ever spend even with the sickest patient we ever cared for.
However, most of those relationships were parallel.
They were basically like parallel private corporations happening within a practice.
And yet here you had your partners who were these incredible gifts, also incredibly accomplished people right there as a resource.
And so from early on I made it a point, and the Navy really encouraged this in many ways to connect regularly with my colleagues, with my peers.
What I realized with PRX was that that was the relationship that was going to be the most important. You didn’t want to be looking for that, what I call your two o’clock buddy.
You didn’t want that to be happening in the moment of crisis when you’re searching for that person.
You wanted that relationship to already be established so there would be no question in your mind if you had a crisis at 2 a.m., you knew who to call right away.

[37:25] And so that became the premise for PRX, which is no one should care alone in good times or bad.
And that by having those relationships develop when there’s not a crisis, they would be built 10 crisis management when it happens.
And that’s indeed been both my experience and those who have participated in the program was they know who they’re going to call at 2 a.m. because they’ve been calling them or contacting them every week and sharing the journey together.
And then so what we do is we start to normalize those things that initially were really put to the edge or to the fringe of the conversation about our journey in healthcare.

[38:04] My recollection of life during the time that I was practicing was that it was fairly easy to talk to physicians around me and kind of be a sounding board for each other.
Because we were all in business for ourselves. And by that I mean, you know, the business side of medicine. We were in private practice. We were in charge of our show.
The majority of physicians nowadays, as you know, are employees. I wonder if you think that it is more difficult now that most physicians are employed for physicians to take a personal interest in one another,
as opposed to when I was practicing, when that was kind of built in for us because we were business partners on our own rather than somebody else’s employee. What do you think?
When I started practice, I was employed, but I was employed as a faculty member here at Krillin Clinic. So when I started my practice here, I was doing inpatient during that time. So a lot of exchange, as you point out, was happening during that time.
A lot of that happened in the physician’s lounge.
That was the gathering spot. And that was the time when you started to get to know people.

[39:16] You talk about your families, you know, talk about hobbies, whatever that was. Exactly. That I’m not sure if that was as much because of employment or not, but,
because of proximity. So a few things changed during that during the next two decades. One was of course the employment phenomenon, which does change
some things. In some ways you could say back in the time when most people were in private practice, you had a common mission because you were all really in business together.
I remember this more from my own father, but there was a symbiotic relationship in terms of those various business entities. As a family doctor, I helped to support your gastroenterology business,
if you will, by referring patients to you. So there was a lot more of that give and take, some very pragmatic. So now as an employee, you know, I have a different incentive in terms of building the business because as my health system thrives, so do I financially in many ways. It is different because it’s a little,
bit less personal, it’s a little bit more removed. I wonder though, Randy, if one of the bigger issues that happened during that time in terms of disconnection was,
less about employment and more about the electronic health record. And you talk about the way because all of a sudden I didn’t, there was no need for the doctor’s lounge.

[40:43] Right? Because the main reason I went to the doctor’s lounge is to make sure I didn’t get into trouble with the medical staff because I didn’t finish my charts. And because the charts… because the other reason was of course bills couldn’t be… billing couldn’t submit bills until those charts were complete.
So once I was able to complete my chart from anywhere, then the reason for gathering became less. And you know, it’s interesting during that time what employment impacted more, at least here in our region,
was people getting involved with local and state medical societies.

[41:15] Which were the other gathering spaces. So all of a sudden, and then even that was a dynamic, some of which I’m not particularly proud of,
but a lot of those gathering times happened because they were also a pharma sponsored, right? So the dinner, you know, it was a very nice dinner, but it was pharma that was paying for it.
And when we started backing away from supporting that, that part of pharma and the different federal acts went into effect in terms of disclosing,
where money was coming from. That was another gathering spot that went away, some of which had to do with employment because you almost didn’t identify as much with that with your local medical
society. But it was also I think because of pharma support and you know again that’s the part I’m not proud of is a free dinner was what gathered us which is we certainly all have the means to,
able to not need that free dinner. So a lot of things happening during that time and the bottom line has been that there’s more disconnection than ever.

[42:17] In terms of a lot of physicians, even those who are still in the hospital together, just not gathering in the same way that we used to naturally gather in the past.

[42:28] Dr. Craig Pagel, M.D. Yeah. Dr. Craig Pagel, M.D. And so gathering has to become much more intentional if it’s going to happen. Dr. Craig Pagel, M.D. That’s a very astute observation and points to what is almost always the case,
and that is in most instances when you have trouble, the source of it is frequently multifactorial,
as you have so eloquently pointed out.
Mark, I think I could take this conversation on for hours and hours, but what I’d like to do is what we came here for, and that is get out of your way, and I’m gonna close my mic for a moment, and Dr. Mark Greenewald is gonna give us,
his personal prescriptions for success.
So when I think about success, I think well beyond just professional success, and I’ve written down just a few so that I wouldn’t forget the ones that I think are most essential.
And I’ll just go through these and hopefully some of them will speak to you as well.
The first is one of the best pieces of advice I ever received and it was recent.

[43:29] It was recently from a colleague and we were just talking about help seeking, which is something that we in medicine tend not to do very well. We tend to identify as the helpers, not the helped.
And what she said was, whenever anybody offers to help me, I always find a way to say yes.
So I find a way to practice allowing others to help me. So the lesson for that for me is first of all, to learn to ask for help, but when help is offered, always look for a way to accept it.

[44:01] One of the things that gets back to the wellbeing conversation that we’ve had, and I certainly believe this is the case, which is that no one is watching out for your wellbeing more than you are.

[44:11] So, as we look outside of ourselves to think that somebody is going to come along to help advance our well-being, don’t be surprised if that’s not the case and take that onto yourself and own that.

[44:24] No one should care alone, which is the tagline, no one cares alone of PRX. And I believe that each of us should have a mentor, at least one mentor throughout our career, somebody who we’re looking to not just in our professional lives, but also in our personal lives.
We should always have a buddy or buddies traveling the journey with us and we should always be looking out for opportunities to mentor others, those who are coming behind us and give to them perhaps sometimes things that we didn’t receive ourselves in terms of support and help and encouragement.
Take up a regular practice that teaches present moment awareness. One of my wisest things I ever did with my wife was when she said, would you like to come to yoga with me?
I thought, no, but I did it anyway and it actually turned out to change my life and I’ve become a regular practitioner since because it taught me something that I had never learned,
really during my formative years which was present moment awareness.
That can come through meditation, through mindfulness, through yoga, through contemplation, through prayer, lots of different ways that that can happen, but there are many forces that are taking us away from that.

[45:30] One of the things that yoga taught me was about setting intentions. intentions regularly so that we live our lives by design, not by default. Entropy will take us into default very easily. And so making sure that regularly we’re asking ourselves,
am I living the life that I intend to be living? Am I showing up who and how I want to show up? And if I’m not, what do I need to do to regulate that? Part of that for me has become learning to recognize the sound of my own inner voice and my own inner guidance system.

[46:02] Really understanding that that is a very important part of allowing me to have a rich life, but it only comes through having some kind of practice where I’m able to quiet myself. Look for opportunities to grow and change. Always.
We should always be stretching ourselves and just trying new things. We’ll learn a lot about ourselves just in the process of doing that and as part of,
that taking on a beginner’s mind and not being afraid to fail. Those, Randy, are my prescriptions for success. I hope that they’ll perhaps help others as well.
And those prescriptions are loaded with a great deal of wisdom, which I appreciate you sharing with us. I’m not at all surprised having done a lot of poking around in your life in,
preparation for this interview. And I thank you for being here to have the conversation and for sharing your wisdom with us. Before we get away, I want to give you an opportunity to,
tell our audience where they can find you and contact you if they so desire.

[47:01] Sure, absolutely. So you can certainly access the work, peerrxmed.org, P-E-E-R-R-X-M-E-D.org, which is the PRXMed website. I’m happy to have folks contact me through my personal email,
which is mhgreenawald.or. That’s either way I would love to engage in conversation and.

[47:36] Pick up where we left off with this interview if anything is peaked by listening to some of this.
Well, I am confident that there’s going to be a lot of interest in many of the things that you’ve had to say. And Dr. Mark Greenewald, I really appreciate you taking the time to be with us today and for sharing your wisdom.

[47:56] It’s been an honor and privilege, Randy. Thank you. Thank you so much for joining us today. You can really help give our podcast much more visibility if you could kindly take the time to leave us a five-star rating. We would be most grateful for the gesture. Also, please look for exclusive content on our Patreon,
page, including membership-only material like personal rapid-fire Q&A sessions with our guests.
To be sure you never miss an episode, visit our website at rxforsuccesspodcast.com to subscribe. And while you’re there, learn how to get CME credit from CMFI just by listening. Special thanks to
Ryan Jones, who created and performs our theme music, also Craig Claussen of the Claussen Solutions Group who edits the show. And remember, be sure to fill your prescription for success,
with my next episode.

[48:49] Music.

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