The Educator: Cynthia Jamison, MD

Transcript

[0:00] When I was the medical director for the physician assistant program, that was like one of the things that we talked about, like is a relationship between the physician and physician assistant, that is key. And you never want to undermine that trust.
If you don’t know, it’s okay. I’d rather you say you don’t know than to assume and to make a mistake because we’re not making donuts.
Welcome to the Prescription for Success podcast with your host, Dr. Randy Cook.

[0:33] Music.

[0:56] 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 MDCoaches 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. My guest today is a family practitioner with a range of practice experience, from rural family health center to a more urban setting in Charlotte, North Carolina.
She also has morphed into a health care educator as the medical director of a physician assistant program at Fiverr University. She has an interesting story of how being a patient changed the trajectory of her career. So let’s hear Dr. Cynthia Jamieson tell her story.

[2:06] It’s my pleasure today to be speaking with Dr. Cynthia Jamieson, who is coming to us from Charlotte, North Carolina.
Very interesting story. And Cynthia, I’m really happy to have you here today.
Thanks for being with us on Prescription for Success.
Randy, I appreciate you allowing me to come here and I look forward to getting to know a little bit about you as well.
All righty, well we can make that deal.
But let’s start with you. As is always the case, we like to know a little bit about your beginning.
I know that you are a native of Gainesville, Florida. Am I correct about that?
That is correct. Go Gators. And tell us a little bit about your early life and how you got interested in medicine.
I think that nothing happens by accident, but I actually decided to become a physician the summer before I went to college.
So just a little bit about me, born and raised in Gainesville, Florida, but did spend a few years of my early life in South Georgia before relocating back to Gainesville.
And my mom, who is, I’m proud to say, a single mother who raised all four of us, and all of us have gotten college degrees.
And actually, I’m a physician. My brother’s a doctor of education, and I have a sister who’s a nurse and a brother who’s an educator. So, yeah, so really proud.
Dr. Darrell Bock Wow. Your mom did well. Dr. Kimberlie Kranich She really did.
She really did, and made lots of sacrifices to make sure that we had a better life, and so she has done that.

[3:34] But early on, she had lots of health challenges. She had really severe asthma.
My sister, and I’m the oldest of the four as well, so I like to say I’m the boss of them. Dr. Darrell Bock I bet you do.

[3:47] Yes, they don’t like it when I say that, but I am. So, but you know, just spending a lot of time, you know, in the emergency rooms and the urgent cares and the ERs, just trying to make sure she was well and my sister also had severe asthma and, you know, just because she was a slender mother, a lot of times we all went, and I was the oldest and even though I didn’t have any, you know, any specific interest and medicine, just…
Hearing her interact with the providers at the time, and they would tell her these things, and we would go home, and I realized that she didn’t really, either she didn’t understand or she didn’t remember, and I really feel, looking back, that that affected her ability to take care of us.
And so, early on, I thought I wanted to be a teacher. I was like, I’m gonna be an educator, make sure that people are educated so they can learn how to take care of themselves, they can understand, and that was kind of my initial thoughts when I was younger.
That’s really perceptive of you for such a young age. Are you aware of that?
Well, I mean, at the time, I just, you know, I just knew that we were spending a lot of time in and out of the hospital, and we didn’t really, I don’t think a lot changed from visit to visit.
And so, but I knew it was because she didn’t either feel comfortable, and I mean, my mom has a high school degree, but really no education in healthcare.
And so, I don’t think, I don’t know, she just didn’t feel comfortable asking questions.

[5:07] Didn’t know what questions to ask. probably a combination of all those things.
And so I was like, I wanna make sure that, you know, that people, you know, are educated, they can learn, they can understand and have good conversations with people no matter what their degree or background is. So I decided I wanted to be a teacher at that age.
That’s a great story. So go on from there. Where did you do your undergraduate work?
I actually ended up going to Emory in Atlanta.
So the summer before I decided to go to college, And I decided on Emory really because I just loved Atlanta.
I had visited a few times, I had some family there.
And back then before the days of the internet, got some really nice brochures.
And I was like, I think that’s where I wanna go to school.
And so I applied and got accepted there along with several other schools, in particular, like University of Florida, which is where I grew up and was born and raised.
But I just knew I wanted to do something different than stay in Gainesville.
But the summer before I went to college, I got a preceptorship, like a job basically working at a lab because there’s lots of research labs, lots of things happening in Gainesville because it’s a huge medical center and really just needed money to go to college and got this job working in a lab.
And the lab did research on diabetic rats of all things. Right? Right, right.
And so, you know, I didn’t really, I figured out I did not want to work with rats when I grew up.

[6:31] So pest control was out. It was out, but I was definitely intrigued by the medicine part of it, the science of it all.
And I don’t recall, like, I mean, I just love learning. Like I always loved learning, loved all my classes, except for maybe the math classes, but didn’t really have a particular desire to do the sciences.
I enjoyed it, but I was one of those people who would sit in second grade.
I want to be a doctor when I grow up. That just wasn’t me.
But after that summer, I just was like, you know what?
I think I want to be a doctor. And so, starting my freshman year in college, really hooked up with.

[7:08] She’s actually still one of my best friends. She was one of my friends from first day of college who knew since second grade she wanted to be a doctor and had her path all kind of typed up.
She had a list of things that she needed to accomplish and I really just kind of jumped on her bandwagon.
So we got to the same courses that she took and we kind of volunteered in the same organizations and sure enough, I applied to medical school and got in University of Florida, and then kind of the rest is history.
Well, let’s begin to talk about some of that history.
When you got into medical school at the University of Florida, did you feel like you had landed in the right spot?
Or were there some unexpected things that gave you pause? What was your state of mind at that point?
Well, I mean, first of all, I never ever thought I would go back to Gainesville after I left.
But went for interview and just fell in love with the school, fell in love with the school, with the people, the faculty. It was really just a warm and welcoming and inviting environment.
And I interviewed at several other schools and got offers to go to different schools.
And just when I went there, I was like, well, I guess this is where I was supposed to be.
So I really just listened to my gut and went home and really glad that I did, had the best experience, made the best friends that I’m still in contact with now.
And of course, I would say that the first exam, I thought maybe this was not where I was supposed to be. Yeah.

[8:35] I wasn’t working. Those basic science years are rough, aren’t they?
Oh, it was pretty bad.
I remember me and my other friends staying up all night before our first anatomy test, and being there the next morning when our anatomy professor came in to set up the exam.
And he was like, what are y’all doing here? So that was, so I figured there probably was not a best.
Own lighters was probably not the best way to go for the rest of medical school, but still, I mean, I never felt like, I mean, it was challenging, of course, but I always knew that I was doing the right thing. And at what point did you make the decision? Unfortunately, nowadays, we have to kind of make a decision fairly early. But when did you make the decision that it was going to be primary care as opposed to something else? Well, I was one of those people that enjoyed every single rotation. In the beginning, I wanted to be a pediatrician. It was like, well, I love kids and I’m good at it. And so in family medicine, it just seems so hard. It’s very broad. There’s no way I can know all the things that I’m supposed to know as a family practitioner.

[9:42] And so I decided to do Peds. It was really my fourth year of medical school. The AFP had a conference in Kansas City, and I was really sure I was going to do Peds, but they had scholarships for any medical students who are interested in going to the conference.
So I’m not proud to say, but I was like, well, I don’t want to do family medicine, but it’s going to be fun.
So I got on the scholarship and that weekend was life altering.
Like I just met, you know, I felt like I would, I found my tribe.
Like everybody, you know, just was very tuned into just like patient care and just like the family concept. And like I said, I enjoyed every single rotation and really I was talking myself out of family medicine.
And I think this trip just sealed it for me. And I was like, okay, I guess I’m going to be doing family medicine.
Even though I had much angst about all the things that family practitioners did, I knew, that I was a hard worker, that I was committed to patients. I was like, well, I’ll just figure out the rest of it.
Dr. Darrell Bock Well, that’s got to be a really fortunate experience for you because nowadays we really do have to make a decision early.
And for you to have an experience where you actually begin to get a feel for what it’s going to be like, what the people are going to be like, I’m sure had a profound influence on pretty much the rest of your life, so good for you, right?
Yeah, like I said, I think that things happen accidentally and on purpose at the same time, if that’s even possible.

[11:06] And then comes the time to think about postgraduate education, and you make the decision to get into a little bit different region of the country where you still remain. You want to tell us about how you made that decision?
Well it all goes back to that trip to Kansas City. So at the time I really had lots of options in terms of where I wanted to go. I just knew I didn’t want to go anywhere cold.

[11:33] Which is interesting because I came to Charlotte, North Carolina, which is not necessarily a cold state, but we definitely have seen our share of ice and snow since I’ve been here.
Chillier than Gainesville, isn’t it?
Absolutely, absolutely. And while I was at that trip in Kansas City, I met a young lady. She’s a resident at Carolina’s Medical Center in Charlotte, North Carolina, and really just I knew I didn’t want to go north. I was like, okay, that’s far. And you know, just going through the tables in the exhibit hall and just seeing different people talking about their residency programs. And so, you know, I’m looking at the different ones and walking by, and so she says to me, I know you’re not about to just walk by my table without stopping.

[12:10] Needless to say that that interaction would change the trajectory of my life.
So not only did I go by her table and she told me about her program, which is an excellent program, but not only that, but it’s a program where even though it’s not an unopposed, like family medicine also has surgery, he’s all in the same hospital.
But the things that she impressed upon me was that as a family practitioner resident, pretty much on the same rotations with the same expectations as the other specialists and you’re respected as a profession in the hospital. And you know just listening to some of the other medical school students and residents and people that I met while interviewing like that wasn’t the same bill for every single residency program. And so I know that residency program was gonna be hard but I wanted to be challenged but also prepared knowing that family medicine is one of those things where you really need to know a little bit about everything. So that weekend, I decided I was going to interview at that part, which I had not even thought about, Charlotte, North Carolina, but hearing about the program, meeting this young lady who is still a friend of mine today, and we just kind of hung out that weekend and just got a really good feel for her and the program. And I was like, okay, I’m gonna interview. So that’s what.

[13:26] Happened. Today’s episode is brought to you by Doc-to-Doc Lending. Doc-to-Doc provides match day loans of up to $25,000 to fourth-year medical students and current residents. These loans are designed to help students cover personal expenses such as moving costs, housing down payments, and living expenses before and during residency. With fixed interest rates, flexible repayment terms, and no prepayment penalties, Doc-to-Doc match day loans provide financial flexibility, and allow students to focus on their exciting journey towards becoming a physician.
Doc2Doc was founded for doctors by doctors. They understand the challenges and hard work involved in becoming a doctor, and they support doctors throughout their careers.
Using their in-house lending platform, Doc2Doc considers the unique financial considerations of doctors that are not typically considered by traditional financial institutions.
So don’t let financial stress hold you back from achieving your goals.
Doc-to-Doc Lending has you covered. Visit www.doctodoclending.com MD coaches to learn more.

[14:44] Hi, I’m Rhonda Crowe, founder and CEO for MD Coaches. Here on Rx for Success, 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, 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. Get the support you need today. Visit Visit us at MyMDCoaches.com to schedule your complimentary consultation.
Again that’s MyMDCoaches.com because you’re not in this alone.

[15:46] 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 and non-clinical interests.
Whether it’s writing, painting, cooking, politics, and dozens of other topics, Physician Outlook gives a physician perspective.
It’s available online and in print.
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 RX4Success 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.

[16:54] Well, that’s a pretty good way to start. And clearly you were very happy with your choice.
And when it came time to make a decision about where you were going to practice, kind of decided to hang out in the reasonably nearby territory. First practice was in Rock Hill, South Carolina. Is that right? Correct. Which is almost in North Carolina. How’d you make that decision?
Well, so just going back to why I decided to do medicine in the first place was just making sure there was a voice for people who didn’t have a voice, for people who were underserved, you know, people who needed, in my mind, who needed providers to be their advocate.
So the job was actually working at a community health center, FQHC, right over the border in Rock Hill.
So I knew I wanted to stay in the city.
I liked Charlotte and I found my people, that physician who actually stayed in the area.
And the one who recruited me to Charlotte was actually had worked at that practice before.

[17:55] She left and started her own practice. And so I knew a little bit about the community health center. It was close and it was the group of people that I wanted to take care of. So that’s how I ended up in Rock Hill. Dr. Darrell Bock And once you got there, I’m gathering from looking at your bio that it really was where where you wanted to be, and undoubtedly, you had a very satisfying experience there.
But as we do when you’re young, you decided to continue to do a little moving around.
So tell me about the next step over to Lancaster.
Yeah, so I was in Rock Hill for the first, maybe like two years I practiced there, and it was a challenging job.
I mean, I’m pretty sure they don’t do it like this anymore, but I did everything.
I did the hospital, I did a newborn nursery, and I still saw patients in the practice.
And so, you know, it was a good experience because you.
When you leave residency, you’re like, I don’t know if I can do it, especially family medicine.

[18:52] Yeah, you do do it. And like I said, my training was very strong. I felt like, Carolinas Medical Center, now known as Atrium Health, was a very strong residency program.
And I felt really prepared from day one to not only, I want to say I knew everything, but I knew what I didn’t know, and I knew how to find it. And so that was to me like the biggest things. So that was, yeah, yeah. And it was, and it was taking care of the sickest of the sick.
And you’re not only dealing with diabetes and high blood pressure, you’re also dealing with, I can’t afford my medicines. So you have to know like what medicines are affordable. Like it just, it just really challenges you in a different way, but it’s very rewarding. And so I enjoyed working there. And I make the joke often that I got promoted to the medical director. I think I was late for a meeting. And so when I walked in there, like, congratulations. And so all of a of a sudden I had an administrative role after a couple of years of being in practice.
I was like, wait a minute, I didn’t run for this position.

[19:52] But anyway, I think that was really what kind of caused me to what I say my first episode of burnout because I feel like there’s been times in my career where I was like, okay, this was a bit much. But having the role of doing all those things.
And then I was also one of the saw the most patients in the practice.
And then all of a sudden, I was responsible for trying to change processes within the system and it just got to be a bit much.
And that was around the same time that I had my health challenge, which really put things into perspective for me.
Can you enlarge on that a little bit? I mean, I don’t want you to be more personal than you want to be, but these turning points in careers are very interesting to me.
It sounds like you had reached a point where you felt like you needed to do something different.
Had to make some kind of a change. So I’d like to know if you can tell us how you came to that decision and how you picked what the next place would be. Right, so I had been practicing in Rock Hill for probably close to three, three, four years. And like I said, I got promoted to the medical director and it was just a time of high stress. We had just decided to go from paper charts to the electronic medical records. Oh boy.
And like I said, I was the medical director. So I was responsible for that. And then also still seeing patients still doing hospital work. It was a lot. It was a lot. And really, you know.

[21:14] Not that I wasn’t, I was enjoying it, but I just realized that I probably wasn’t in as well balanced as I should have been in terms of, you know, I wasn’t really, I’d exercised throughout my whole, you know, life really. And when my first job, which was in Rock Hill, was the first time that I found it hard to fit it into my life because I was commuting 40 minutes because I still lived in Charlotte, but I didn’t want to live in Rock Hill, but I wanted to work there.

[21:37] And just the challenges of being a new provider. And probably it was that the beginning of the year, one of my aunts who was 39 at the time had just gotten diagnosed with breast cancer.
And I was like, wow, that’s really young. And I was 32 at the time. I was like, you know what, you really need to do a better job of taking care of yourself. And I had really gone to the doctor consistently, but I would still go and get checked out, went to the dentist, but, you know, it just wasn’t like very regimented in taking care of myself. And so I was like, you know, you need to start doing your breast exams. And so when I decided to do that, I felt the nodule.
And I was like, oh, well, I don’t remember that because, you know, I’d done my breast exams before but had never really, like, it just was different for me. And so I called the doctor that I refer patients to, the surgeon who I sent all my patients to at the time, I was like, you know, I think I need to come see you. And so, of course, she got me in within like the next week or whatever. She did my exam and she was like, well, have you noticed that this breast is a little bit larger than the other? Have you noticed this? I’m just like looking at her like, no, I’m not. Just because I was doing so many other things. So within a few weeks, she actually got me to the local radiologist and got me set up to have a diagnostic mammogram.
And so I just was like, OK, well, let me move my schedule around.
Because remember, I’m seeing patients in the hospital. I’m doing clinic.
I’m doing my medical director responsibilities.
And so, you know, to me, I was like, OK, it’s really going to be hard to move my schedule around.
But, you know, she made this appointment for me, so I’m going to make it happen.
So I just push my patients back.

[23:05] But the plan of going to get my mammogram that morning and coming back in later that morning.
And so I go to have my mammogram done.
And the radiologist was like, I think we need to do a biopsy. And I’m like, OK.
So when let me look at my schedule. He was like, today, I was like, today, this, this was, this was not in my plans.
And so I was like, well, is there any way I can just, you know, I have patients scheduled, like, you know, in the next hour or so, is there any way I can just come back? And he just looked me in the eye and I’ll never forget.
He was like, if you were my wife, I would want you to have this done today.
So I was like, oh, wait, wait, he’s not kidding. This is serious.
So I had the biopsy done.
You know, first of all, I had to call my clinic and be like, look, I need, you know, I need the day off. And, you know, I took time off to come have this done.
I knew how inconvenient it was going to be to reschedule my 50,000 patients that are on the schedule.
And I just remember feeling so, like, just guilty about doing that.
Like, I just was like, oh, my gosh, I miss people take time off from work.
And, you know, I get to see Ms. Jones today. I know she’s super sick.

[24:05] And I want to leave my partners hanging today. And, you know, and the next day as well, because I wasn’t planning on going back the next day because I was, you know, getting the biopsy. And so, I just remember that. And then I just went home and I just was like, what are you thinking? Like, what are you doing? Like, they can see somebody else. They’ll be okay. And just over, you know, the next few hours, few days getting the results back, she called me, my doctor called me and was like, it’s positive.
So that was just like, wow, this was not in my plans. I mean, I’m 32. I’m single at the time.
You know, I’m the medical director. I have all these patients, these responsibilities.
And then I just was like, you know, at a loss, like, what do I do now?
And I want to ask you to reflect on that a little bit more, if you’re willing, and talk to me a little bit more about that state of mind that you were in at that point.
Now, you are a very well-trained medical professional. You understand what palpable breast masses can mean. And yet you found yourself doing what so many patients do, and that is bargaining with the person who is trying to help you.
It sounds like that must have been a moment of really profound personal realization for you, and if you can talk about that, I would really like to hear it.

[25:20] I wouldn’t say that the revelations or the insight came right away. I think it came over time because, you know, knowing that I had a positive biopsy and knowing that there was a lot of of unknowns. Like I was going to have to have doctor’s appointments, big surgery versus little surgery, time off from work, and like I said I was single at the time and as you call them the oldest of four siblings and so financially like I was it. And so just all those things. And I also just remembering like what’s going to happen to my patients. You know, I know that there’s already everybody’s already overworked and all those things. And I will say that over the course of like a few weeks to, you know, a few months until I figured out my treatment plan was I really had to to kind of just have some some really big, deep conversation with myself like self. I know that you are that you are worried about these things, but ultimately you can’t do anything about these things if you are not in a good place physically.
So that was kind of the first revelation of the things that I had to, once I had time to sit down and think about it, the other thing I had to think about was your patients.
If you don’t come back tomorrow, they will have to find another doctor.
I mean, that can happen. There are other doctors that will take care of them, but your mom cannot find another.

[26:38] Daughter. Like your siblings cannot find another sister. You know, your friends will not find another you. They’re gonna miss you if you’re not there, but your family are the ones that are gonna grieve you. And so I just think that that put it in perspective for me. Yeah, and I’m gathering, I know you did make some changes shortly thereafter, and it sounds like that experience had a great deal to do with your decision to get professionally relocated back into Charlotte, is that correct? That is correct. Part of me felt like when I decided to leave the Community Health Center that I was disappointing kind of.

[27:13] My mission for becoming a doctor. I was like I always wanted to work with patients who were quote-unquote underserved, who just needed someone that was going to give them their all. And so, but I knew that going back into that environment, because I did after I ended up, you know, thankfully it was stage one, ended up having a lumpectomy and had to do chemo for a year radiation. And so I was basically out of work for almost a year. And during that time, I just had to do some really deep soul searching about what it is. Because when you hear the C word, cancer, it’s like, is this it for me? Was there something else I was supposed to do? Should I have done this? And you’re relieved when you hear it’s a stage one, but all those thoughts go through your And I knew I don’t feel like I ever put my life on hold when you know going to Medical school going to medicine because I always you know spent time with family. I always I traveled I loved You know just doing things that made me happy I never felt like I gave up on those things, but I also felt like like Monday through Friday, I was I was living for the weekend. I was living for vacation Yeah, And so I was like I don’t think that’s the way that you’re supposed to live your life like I have to find a different way to…
To balance out like my career and having a life outside of medicine where I don’t feel like I’m always like zero to a hundred money through Friday and then on the weekends I’m like.

[28:36] I’m recovering from the, you know, running the marathon. And that was when I decided to go into the private practice world to see if it was different, if it was better. It was all that I knew was working at the community health center. And so it was different.
Yeah, I bet. So you made your way to Charlotte and do you think you conscientiously made some substantive changes about the way you were doing things or was it simply the new environment, bigger city, maybe fewer patients that made it easier for you to manage your life or what was that like? Tell us what that stage of your development was like.
So in the beginning it was nice because I went from working for a community health center where I felt like I had little to minimal control over things like my schedule, the types of patients that would show up, those types of things, to working for a big hospital system where I was new to the system and I also was given the opportunity to start a practice from scratch. And so it was pretty exciting. It was pretty exciting. I was able to kind of set the culture, you know, with the staff and with my patients. And the other thing I was pleasantly surprised to say, like I said, I was like, I don’t want to leave community health center.
I want to work with patients who really need me. Was that just because you have insurance doesn’t mean that you don’t need a good doctor.

[29:57] And so I went from working, right, because I went from working with patients who, you know, they needed not only my medical expertise, but they also needed my social work skills and my, you know, sometimes my, you know, my counseling skills and just the, it’s not I think the social determinants of health, they are real.
Like they really do affect your ability to take care of patients.
And so I felt like going into the private world, it would be different, but it wasn’t.
Like there was still the same level of need in patients from all backgrounds, whether they’re CEOs of organizations or professors, or they still need somebody who’s gonna take care of them and help, you know, and help.
So that part was still rewarding in terms of the patients I was taking care of, but I was less stressed out about the administrative things in terms of doing policies and making sure they’re reinforced.
It was things that were happening on a bigger level. And so that was refreshing.
And I really enjoyed the first few years of my practice. And being the only physician in the office, you do have a lot of administrative, I guess, responsibilities.
But it was different than being the head over at Community Health Center.
Well, it sounds like you made another good decision at that point, and that you were happy with your choice.
But yet, you continued. You decided to…

[31:14] To continue to expand your horizons and to turn yourself into a medical educator, particularly with the so-called physician extenders. So can you tell us about that transition?
Yes, so like I said when I first decided what career I wanted to do, it was an educator. And so, really being a physician educator is an extension of that. And then really, I mean, even just talking to patients every day, you’re an educator, you tell them about their medicines, about their health. And so really, for me, it was like, I wanted to make sure that the next generation of providers know the difference they can make by the relationships they have with their patients, as well as how they treat their patients, and also how they talk to their patients. I mean, it’s kind of me going back to that experience when I was younger, like I wanted to make sure that as a provider, you know that if your patients don’t understand that you’re doing the best you can to make sure they understand what’s going on about their health when they walk out of the room.

[32:15] So I really wanted to model that behavior and teach that behavior.
And so I really just enjoyed working with students and letting them see kind of the joys of medicine, of working with patients and getting to know your patients and having that relationship with their families.
So that’s where the education bug kind of bit me.

[32:32] So it sounds like you get a lot of really profound personal reward from participating in somebody else’s education. Am I right about that?
I do. I do. I enjoy it.
So, in the particular educational role that you’re involved in involves education of so-called physician extenders, physician assistants. And I’m going to ask you to talk a little bit about some of the controversial things that we face when we talk about people that practice in those roles, the PAs and the nurse practitioners and so forth. People have raised concerns about people straying outside their level of expertise and the impact that it can have, potential dangers and so forth. Would you like to offer some opinions on that?
Well, I think that whether you’re a physician, a physician assistant, nurse practitioner, surgeon, pediatrician, at the end of the day, it comes with knowing your level of expertise.
I’m never going to know everything, and I’m okay with that, but I also know when to say when and when to ask for help, when to ask for resources, for referrals, and that’s part of the education piece of it.
And the reality is, is that there’s never going to be enough providers to take care of all the needs of all the patients that we have.
You know, there will always be underserved areas in rural medicine.

[33:52] Some inner cities, like there’s always a need to take care of patients and we can only take care of a certain number of patients.
And so if we train the next generation of physicians, physician assistants, nurse practitioners to be good health care providers, then we can all work together as a team.
But I think that it’s really unrealistic to say, well, I don’t think that physician assistants can do that.
I was actually, I worked in a physician assistant program as a medical director.
The program director has over 30 years experience of training future PAs as well as of clinical education. Like I’m never going to catch up to her, you know. So I think that we have to be realistic and realize we can’t do everything all the time. And maybe that’s where some of the burnout is coming in because people don’t realize you can’t be everywhere at the same time. It’s impossible. But we should at least train people to be able to take care of patients in places that we can.
Have we been not as careful as we should have about clearly defining the roles of these physician extenders?
You know, we have heard horror stories. I’ve actually interviewed a few people on this podcast who have had some very bad experiences with physician assistants and nurse practitioners.

[35:12] Who were clearly going way outside their level of expertise. And it occurred to me that maybe we haven’t done a very good job of making the boundaries clear. And I’d really like for you to just react to that and tell me what you think. I think part of the issue is that every state is a little bit different in terms of what they allow the advanced practitioners to do. And then also experience is real. If you come out of school, whether you’re a first year physician or first year PA, like you’re not going to be as experienced and as able to do things as someone who has five or 10 years of training. And so really we should be training these new clinicians to know your boundaries. Because I’ve heard horror stories about PAs, about nurse practitioners, but I’ve I’ve also heard horror stories about new physicians, or even not even new physicians, just physicians who.

[36:06] And so I think it has a lot to do with the person, the personality, and I know that we do, we definitely need the skills to take care of patients, but there’s also that whole, you know, the things that come, like the ethical piece of it, and also just, like I said, knowing yourself and knowing your boundaries, and that piece I don’t think is as well explored in school, at least, well, it’s been a long time since I’ve been to school, And when I was the medical director for the Physician Assistant Program, that was like one of the things that we talked about, like is a relationship between the physician and physician assistant that is key.
And you never want to undermine that trust.
If you don’t know, it’s okay. I’d rather you say you don’t know than to assume and to make a mistake because we’re not making donuts. Like we’re taking care of patients’ lives and that’s important.
Well, you make a very good point. And one of the things that concerns me and I’d be interested in getting your reaction on this as well. And you sort of alluded to it, And that is the truth.

[37:04] Training for physician assistants and nurse practitioners is not exactly the same from, institution to institution to institution.
Whereas I think if you’re in one medical school and somebody picks you up and takes you and drops you in another medical school, you know, you can pick up immediately and proceed just as if you had never made the change.

[37:29] But this state-to-state variation, to my mind anyway, seems to be a significant impediment to getting everybody on exactly the same page.

[37:38] Am I dreaming this, or is there some reality to that? No, I do believe that there is a reality to that, especially the way that the governing board for the physician assistants, they give them a very loose guideline in terms of what they want, but then they have all these different requirements that are very strict.
And so it’s confusing versus, you know, with medical education, you know, like, you know what your charge is and there’s no miscommunication.
The other thing is that part of the training of physician assistants, just like in medical school, is doing rotations.
They have a month of rotations with all the different specialties, but now the challenge is getting physicians or physician assistants who actually want to train these students because everybody’s, well, I have other things I need to do.
I’m burnt out, I really wanna go home, I gotta do my charts, my end basket.

[38:32] And so that is a huge challenge to making sure that these future clinicians are trained correctly and for physician assistants and nurse practitioners even, I think it’s even more important because a lot of their training before they’re certified to go out and work is right there during their school.
Like after they’re done, they’re able to go and get a job and you hope that they get with a physician that is able to spend time training them, but there’s lots of barriers that could affect that.
That’s a very good point. I think we sometimes forget that it’s only been just a little over 100 years that we formalized medical education into what we see today.

[39:13] And even with over a century of experience, we’re still trying to figure out how to get that exactly right.
The PAs and nurse practitioners, on the other hand, have had official training for not nearly that long.
And I hope that we’re still gaining experience in how to make it right for them, because they certainly are a necessary component of our healthcare delivery force.
I think, and I want to take over the program there, I want to get back to you.
One final thing before we get into your prescriptions for success, I’m kind of fascinated that you clearly have decided that you’re never going to be well-educated enough to stop learning.
You’re about to receive another degree, are you not? Tell us about that.
So one of the things that I decided when I went into education, and I definitely have enjoyed my time with the physician assistant program that I worked with at the time, but I really want to get more back into the training of physicians primarily. But part of that was just making sure I understood the science of education. So I’m working on-

[40:20] Dr. Michael Smith What a great idea.
Dr. Nunez-Smith Yeah, yeah. Just like, right. I mean, you know, I know how I do it, but like, how, like, why do we do it this way? Like, how, what are the best outcomes? How do we make sure that we’re training students to be prepared when when they go not only into the real world, but also when they go to the rotations.
Like if you’re only gonna have a certain amount of time with an attending physician, like we wanna make sure that you’re prepared to get the most that you can out of that situation.
So I decided to go back and get my master’s of health professions education, which I’ll be finishing up in May, which I’m excited about. And it’s really just changed.

[40:53] I mean, it’s been a while since I was in school and really the way school is done now is very different.
First of all, it’s an all online degree, which was not, which was very different.
And I feel like it’s probably harder because you’re pretty much teaching yourself a lot of the concepts and then just kind of interacting with others virtually.

[41:11] To make sure you understand them.
And then just learning in general, using my brain a different way.
So that was definitely, it’s been a good experience and it just makes me have a better appreciation for people who are doing any type of schooling, especially during the pandemic when all the schools got converted to online.
That was definitely, I was like, wow.
Like for kids that are in elementary and middle school have to do this type of learning are really…
It really made me have a level of appreciation for not only for teachers, but also the students who had to do that.
Dr. Darrell Bock Well, hopefully there’ll be more people like you who recognize that if you’re going to be a teacher, you’ve probably got some things to learn about teaching, and I think that would make us all better.
Cynthia Lee I think so. Well, any type of education. Dr. Darrell Bock Yeah.
Cynthia, this has been so much fun, and I’ve really enjoyed the conversation.
I appreciate you being so open with us, particularly about your illness.
It’s been a really enlightening conversation to me.
However, we are at the point where I wanna get out of your way and let you have an opportunity to speak to our audience on our own.
So I’m going to close my mic and Dr. Cynthia Jamieson is going to give us her personal prescriptions for success.
Thank you for the opportunity to speak with you. I really appreciate it, Randy.

[42:31] So my prescription for success, there are several and it depends on the day, but the top three today, just stop and smell the roses.
I feel like we are so busy as physicians, saving the world, saving our families, saving ourselves, that sometimes it’s really hard to just stop and be quiet.
And in those times of quietness, just listen to what your spirit is saying, listen to what your gut is saying, whether it’s regarding something regarding a patient, something regarding your family, your health, but if we don’t stop, then we’ll miss those opportunities to hear what the universe is saying to us.
My other prescription is just to remember that every day you wake up is another day to do whatever, dot, dot, dot, to get it right. Start over. You’ve never.

[43:18] Had the opportunity to do something that you wanted to do, today is the day to start.
So that’s what I tell my patients. I also tell myself, which is why I feel like I’m always learning more and trying to do better. Every day is an opportunity to do something different, right, or better. The last thing to remember is that you are the boss of you. We as physicians, I think, have gotten away from knowing our own power. We’re the, I would say, one of the hardest working, the most educated, skilled, trained, empathetic, just nurturing group of people in the world. And we forget our own spirit of creativity. Healthcare is kind of a mess right now. But we’re probably not going to fix it overnight, but we have the power to do it.
But it really starts with fixing ourselves, taking the opportunity to make sure that we’re good.
And also knowing that we are the boss of us, like we can always make a different decision.
As long as we remember that, then I think that we’re going to be okay, and we’re going to be the revolution to change medicine. So thank you for letting me share my insight.
Dr. Darrell Bock Outstanding, Cynthia. I love that.
Stop and smell the roses. Remember, each day is a new opportunity. And best of all, you are your own boss. I really like that one.
Cynthia Miller Thank you, Randy.
Dr. Darrell Bock Before we go, I want to give you an opportunity to tell our audience where they can find you if you want to share email addresses, websites, and that sort of thing. People might want to get in touch with you.

[44:46] The easiest way to reach me is probably just by email, cynthiajamsjms at gmail.com.
Well, that’s easy enough. And once again, I want to thank you very much for being with us, Dr.
Cynthia Jamison. We really appreciate you being here for Prescriptions for Success.
Thank you for the opportunity.

[45:09] Thank you so much for listening with us today. If you enjoyed the show, you can help us reach more listeners by leaving a rating and a review, especially on Spotify or Apple Podcasts.
And if your app doesn’t have that option, just leave us an email or a voicemail through, speakpipe at www.rx4successpodcast.com.
You can also help by becoming a Patreon member.
That link is in the show notes. And we hope you’ll also follow our companion podcast, Life-Changing Moments with Dr. Dale Waxman.
Special thanks to our producer, Craig Clausen, our promotions manager, Marianna Rotabaugh, and to Ryan Jones, who created and performs our theme music.
And remember, be sure to fill your prescription for success with my next episode.

[45:58] Music.