A Pediatrician's Marathon Back to Herself | Dr. Michelle Quirk

Sue: [00:00:00] Oh, today I am so excited to have Dr. Michelle Quirk on the podcast. She is a general pediatrician in Pennsylvania, and she's also a run coach. She's the founder of Mindful Marathon, and she helps women physicians find their way back to themselves through running. She does that through her coaching, and she also does these really amazing rest retreats a couple of times a year.

The one in September is full, but she's got another one coming up in March of 2027. Um, we had a wonderful conversation. She considered leaving medicine to work at Starbucks. Uh, nothing wrong with being a barista, but kind of a tough spot to be in to complete a lot of medical education and feel like your best option might [00:01:00] be to abandon ship and do something so divergent.

Um, I also love that she was able to ask for what she needed repeatedly, um, but she had to keep asking, and she had to be willing to make big changes to get what she needed. Uh, and my very favorite part of the interview was talking about Run Disney, and I think we should all get together and go do a 5K or a 10K at Disney with her.

That'd be so fun. Hope you enjoy it Good morning, Dr. Michelle Quirk. It is a total pleasure to have you. Thank you so much for taking the time. 

Michelle: Good morning. Thank you so much for having me. I'm excited to be here. 

Sue: Yeah, I am really excited to hear about your story, um, particularly because I know you hit some bumps really early in your career for a whole variety [00:02:00] of reasons.

And, um, and I think that's a little bit less talked about. I think that happens, uh, fairly commonly. I think training, especially with family life, can be really, uh, arduous, so I'm really excited to hear what that was like for you. But I thought I might first ask you to tell us when you first knew you wanted to be a pediatrician.

Michelle: Oh. I think that I knew I wanted to be a doctor from when I was a kid. Although if you had asked me back then, I probably would not have said that at the time. But my, my parents say that I was always, um, playing with my Fisher-Price doctor kit, and I was checking out all of my stuffed animals and baby dolls.

And my parents were teachers, like public school teachers, um, and elementary level, um, for my mom. So I [00:03:00] don't know, perhaps being with children was sort of a, a comfort to me then, I don't know. But as I went through, I didn't know, you know, what type of medicine I wanted to do when I went to medical school, and I learned very quickly that I was not at home in the operating room at all.

I was a fainter and like, it ju- it, it was not good. Um, and so that I, I thought at the beginning of med school, maybe OBGYN. I thought like, "Oh, delivering babies." Mm-hmm. But I didn't realize how much of a surgical specialty that was. So- 

Sue: Right ... 

Michelle: um, yeah, and then when I found my way to pediatrics, uh, I felt very at home there.

It, it was- Mm ... fun. Um, I, I would say also that like the, the other, you know, the other residents and attendings were, uh, they seemed to be very joyful about the practice- Mm-hmm ... of medicine. Mm-hmm. And I did not find that in a lot of other specialties. So I think I probably knew it from a long [00:04:00] time ago, but it took me a while to come around to it.

But no one is surprised that that is where- Yes ... I ended up. 

Sue: Uh-huh. I love that. Um, I had a, I had a very similar experience where I thought I would do OB. Um, but I remember being a first and, and particularly second-year medical student when we were doing pathophysiology, and we would have lectures by the pediatric cardiologist on congenital heart disease, um, or, uh, the endocrinologist, and very consciously thinking, "That is a guy I wanna work with."

Mm-hmm. "I wanna work with that person." 

Michelle: Yes. 

Sue: And it was funny because it th- didn't make me think at the time, "I'm gonna be a pediatrician." I just, I just was very drawn to those individuals. So yeah- Yeah ... I, I, uh, love that description for sure. Um, tell us, tell us about your experience in medicine before you had [00:05:00] symptoms of burnout creep in.

Michelle: Well, I think I should probably start by saying that I can tell you now when I was burned out, but at the time, we weren't really talking about burnout back then. That was like 2012-ish when I finished my residency. And I, I just, I, I didn't know w- what was happening, and of course, I thought something was wrong with me.

Sue: Right. Right. 

Michelle: And so, you know, before that, I, I, I felt sort of, um... I'm sure a lot of people feel a little bit lost, like when, when you get out of training, you've- Mm-hmm ... put in all this time. Like, I went right from college to medical school into residency, and I kind of came out the other end, uh, newly married, moved to a new place- Mm-hmm

started this new job as a pediatric hospitalist, um, you know, studying for the boards, all the things we do. 

Sue: Mm-hmm. 

Michelle: And, um, [00:06:00] there just wasn't, there was no rest time and no break time. I just went from one thing to the next to the next. 

Sue: Mm-hmm. 

Michelle: Mm-hmm. I describe it now, because I'm a runner, and, and we'll talk about that, but I describe it as being on a treadmill, but not really knowing where I was going or how to step off the treadmill and just keep, keep moving on to the next thing and the next thing.

Only, you know, I got to the next thing, and I really, um, I, I didn't know where I was landing. And all of these things, all of these things were happening at the same time. And so that was 2012 when I finished my residency. And Y- so we had all of those things, and then also my dad was diagnos- diagnosed with cancer and passed away a couple of months after the diagnosis.

Sue: Oh, I'm so 

Michelle: sorry- And so- ... to 

Sue: hear that. 

Michelle: Oh, thank you. Yeah. Mm. And, you know, my dad and I were very close, and he was only 64 when he passed away, so fairly young, and a- an otherwise very [00:07:00] healthy person before that. So all of this happened at the same time. So there, there were l- there was a recipe there, right, for, for burnout for sure.

But- Ugh, 

Sue: yeah. Right ... I 

Michelle: certainly didn't- 

Sue: How, how could you avoid it with all that? 

Michelle: Yeah. And I don't think I had, you know, what we have now and what, what is so wonderful about this podcast, well, at least we're talking about burnout now, and at least we have mentors or people who have been through similar experiences.

Mm-hmm. And back then, I really felt like I was alone and I was the only one feeling this way, and like, you know, questioning why, why did I choose this profession? I'm not gonna be able to continue on this way. Like, I would like- Mm-hmm ... to find a different way, but I don't know what that looks like. 

Sue: Right. 

Michelle: And, um, I, I remember, I mean, I was newly married.

My husband is not in medicine, and I think he didn't really know how to support me. Like, he wanted to, but he didn't- Mm-hmm ... he [00:08:00] didn't know what I needed. And, uh, to be fair, I didn't know- 

Sue: Right. 

Michelle: Yeah ... what I, what I needed. I remember, you know, little, little things that I tried to do. Like, I was trying to ask for help, trying to ask my director at the time, like, "Can I, you know, take some time off?"

But I had just started that job, right, in July. In fact, I, I think I finished residency on two weeks of night shift, like night float And then started the new job a couple of days later. So I went right into it. And so, you know, like, the schedule is done, how far out in advance and- 

Sue: Mm-hmm ... 

Michelle: you know, and I remember only taking some very minimal time off to go to, you know, different appointments with my dad, try to get a second and third opinion at different- Mm

um, specialty centers. But I really didn't take a break, and- Yeah ... it felt like failing to ask for a break. 

Sue: Hm. 

Michelle: So that was- Yeah. I 

Sue: mean, you managed- 

Michelle: And 

Sue: [00:09:00] I can talk about 

Michelle: this now, you know? But- 

Sue: You managed to muster- 

Michelle: Uh, yeah ... 

Sue: the strength to ask. Yes. And the answer was, "Mm, that would be really difficult"? 

Michelle: Um, yes.

Yes. Mm. 

Sue: Mm-hmm. 

Michelle: Like, we don't have the staff. We- there were many reasons why. Yeah. But I was not... I think it was one ask. You know, if you- Yeah, yeah ... if this happened now, I, I know how I would deal- Right ... with things differently. But at the time, I just... It, it wasn't the way, right? Like, you just- Right ... your, your personal stuff does not matter when you're here and you're working.

Like, that is- Right ... what matters. 

Sue: Yeah. I think that is such a common part of this experience for people is, one, we can't even imagine ourselves how we can change w- what's going on that's, uh, causing so much suffering. And then if you can figure it out, the system, uh, is [00:10:00] not in a good position to accommodate what we need.

Michelle: No. 

Sue: Yeah. And even more so in 2012. But I don't know how much that has changed. I, I think that's still pretty present. 

Michelle: I think I am different, right? And if we have been through this, then we, we have changed, but I don't know how much the system has. 

Sue: Yeah. At least when we recognize that's what our experience was, we can be a potential mentor to somebody else who is going through a difficult time.

Maybe we will be better able to see it and to offer support. 

Michelle: Yeah. Yeah. 

Sue: Did you have awareness that early in your career of other people who had experienced burnout, or it was not really a concept that was in your head? 

Michelle: I don't think so. I really don't think so. I- Mm-hmm ... but to be fair, I felt very isolated at the time.

Like, I [00:11:00] just didn't have the time to devote to friendships, which is a very sad thing to, to say. Like, I kept in touch with, you know, very few close, close friends, but I very much felt like I was the only person going through this, and I thought a lot of it was because of what happened with my dad. Like, like that was, that was the extra load that I had that- Mm-hmm

other people did not have at the time. So I just thought, "Okay, well, this is, you know," ... And this is a time that we will get through, but that was, I mean, that was also the time that I finally, you know, I started to run, and I started to spend time with myself, and that was really, like, that was the path to awareness.

Sue: Mm-hmm. 

Michelle: Yeah. That, that something was wrong and that the problem was maybe not me. 

Sue: Yeah. Wow, what a gift. 

Michelle: Yeah. 

Sue: And that came through running, you think. That time with yourself was just the little [00:12:00] space- 

Michelle: Yeah ... 

Sue: the little rest, such momentary rest, to figure it out. 

Michelle: Yeah. I think so. I think for others, you know, it's, it's different things, but movement is the key for me.

It doesn't have to be running now, but at the time, and of course, you know, I, I didn't have all of these, you know, aha moments back then. I just thought, "Well, I really need to do something for myself." And I'm, I had this moment one night talking to a patient and his family in the ER, and I remember talking about healthy habits and getting good nutrition and exercise and rest, and I thought, "Boy, like, this is, this is not good.

You're not doing any of these things." 

Sue: Yeah. 

Michelle: And that was really what, that was what did it for me. Like, okay, you need to, you need to do something, and I- Mm ... had some running sneakers in the closet collecting dust, and I thought, "There's a low barrier of entry here, and I- Mm-hmm ... can find five- Yeah ... minutes to do this and walk around the block."

Sue: [00:13:00] Wow. Yeah. I love that your, you know, precipitating moment was, uh, giving this quality advice to another- Yeah ... and realizing you weren't following any of it. 

Michelle: Yeah, yeah. 

Sue: Um, when did you finally come to sort of conceptualize that experience as burnout? Was it a long time after? 

Michelle: Yes. A very long time. Probably- Five years later, maybe Wow I stayed in that job for three years 

Sue: Mm-hmm 

Michelle: What, much, much longer than I- Wow

you know, thought that I would be able to. I mean, I've talked about this before, probably on my own podcast, but I, I mean, there were times, I had an hour commute. It's a long story, but w- my husband and I lived halfway between our jobs, and we were commuting- Mm-hmm ... an hour in opposite directions. And I remember, like, most of that commute, I was just, like, dreading going in there.

And I would sit- Yeah ... in the parking garage and cry, and [00:14:00] imagine myself- Oh ... really working at Starbucks. Like- Oh, 

Sue: my ... 

Michelle: really, really. And I- Interesting ... and I think I may have told my mom, but she was like, "You know, you, you did all, all of this education and all, like, you can't, you know. And there's nothing wrong with working at Starbucks, but, like"- 

Sue: Right

Michelle: "is that what you really wanna do?" And I just, really, I just 

Sue: did not wanna go in the door. That was your fantasy. Yes. That was the fantasy. Yeah. Oh, I can absolutely relate to that- 

Michelle: Yeah ... 

Sue: so much. Um, yeah, I had a lot of, uh, alternative work fantasies too. Yeah. Um, yeah. But yeah, I did not- Yeah, not that one particularly, but I understand 

Michelle: I did not see all of this until I was out of that situation.

So yes, I, I- That's 

Sue: really difficult, I think, because, um, I think- Being able to name that experience is so helpful in that epiphany that, oh, maybe the problem isn't just me being defective somehow. 

Michelle: Mm-hmm. 

Sue: Um, [00:15:00] so I think that's really, um, interesting that y- you just had to, you had to get out of that job to even have enough settling to sort it out.

Did you figure it out on your own, or did you- 

Michelle: A combination- ... have a therapist? ... combination of, of people and factors, I think. Mm-hmm. Um, I, and it, I think a lot of it has to do with running longer distances. Mm. So I worked my way up from running, you know, like around the block, and then first 5K. And over the course of those five years, I, I ran a half marathon in 2016 with- Mm-hmm

my mom and my mother-in-law. That was, like, our first- Wow ... for all of us, our first half marathon. 

Sue: So cool. 

Michelle: Yeah. And I, I think during marathon training, so after that I decided I wanted to run a marathon, something I thought that I would never, ever do. And I think those long, long runs [00:16:00] on the trail is, like, w- really when I started processing all of this, and really when I started having...

Like, going through a grieving process of losing my dad, because I really, I felt like I just moved to the next thing, to the next thing. Like, I stayed- Mm-hmm ... in that job, and then I, um, moved, my husband and I moved again and, and started a, a different job. Um, and but I was still a hospitalist, and I was still doing, um, shift work, like crazy schedule.

Um, so I was still kind of wrapped up in a lot of motion. Mm-hmm. 

Sue: Mm-hmm. 

Michelle: And I think that, yes, so running longer distances and having that time with myself to really, like, process what happened, and, um, having, uh, a variety of coaches enter my life. I, I knew nothing of, you know, c- the coaching world, life coaching.

At that point I, I knew, uh, I had a running coach, right? So I had met, um, a running [00:17:00] coach along the way, and, uh, the woman I met, I worked with her at the hospital, and she was really the first person in medicine who I met who had a business and was doing something outside of clinical medicine- Hmm ... and still working at the hospital.

And I remember talking to her, and it was really this conversation with her. She was, you know, she said, "You know, it sounds like you are, you're very burned out, and you went through this experience, and I could coach you on burnout. But for the last half hour, you've been talking about running and all that it's brought to your life, and how you've brought along your family and your friends and your husband along for the journey."

Mm-hmm. "And you wanna coach girls on the run. And like, have you-" Yeah. "... thought about becoming a run coach?" And I just, we were having tea, and I remember just sitting back in my chair being like, "What?" Like, "No." No. "That never occurred to me" [00:18:00] "Until now." 

Sue: Oh. Yeah. I mean, yeah, just these serendipitous conversations that d- you know, change the course of your life.

Michelle: Yeah. And really, I mean, she was the example of someone who had done something different. And I, I think I've always, I guess, maybe many people say this, right? I always felt like I was sort of a little bit different. Like in college, I was a philosophy major. I wasn't a, you know, I have a Bachelor of Arts. Oh, nice.

And I remember my parents being like, "What are you gonna do with that?" But, you know- Oh, nice ... I loved, I loved, um, I loved college more than medical school, and I loved, you know, English and all of these different... I, I don't know, like I think I could be a professional student probably, and just keep reading the classics and writing.

But Right ... I loved all of that, and traveling. I studied abroad. Like, that was such a great time. Um, and I, yeah, I, I feel like I've always... I describe it as having like one foot out of the pool. Like, I'm not- Yeah ... all in on [00:19:00] medicine. 

Sue: Right. Yeah. Not straight up. But I think that's 

Michelle: okay. 

Sue: Yeah. Yeah, absolutely.

That's what medicine needs, honestly. We need, we need more of that kind of diversity, for sure, 'cause that's, that's the juiciness of being human. And, uh, to bring that to medicine is a real gift to patients, I think. 

Michelle: Yeah. 

Sue: I love that- I would agree ... that was your major, and that you ran into that coach. How long did it, um, take you to embrace being a running coach?

Michelle: Um, not long. I think, um, we had that conversation. So I ran, I ran the marathon in January of 2018. We had this conversation late spring of 2018. And I, I was a Girls on the Run coach that- Mm ... fall, I think. So I did do that. And then, um, I got my, uh, of course, as a, [00:20:00] as a doctor, right, I feel like I had to get a certification to become- Of course.

Mm-hmm ... a run coach, even though I was writing training plans, and I had read all of these books about run physiology and how to write training plans. But I took the course in 2019, and I officially, like, launched Mindful Marathon in the summer of 2019. So maybe- Yeah ... a year after I had that conversation with her.

Very 

Sue: cool. Mm-hmm. Yeah. Awesome. And did that, uh, first of all, I'm interested in the name Mindful Marathon a little bit. Yeah. I want you to tell me about that choice. 

Michelle: Yeah. Um- I think, so that, that has also evolved as I have looked back on this. W- when I started it, it had to do with the journey on the trail by myself and- 

Sue: Mm-hmm

Michelle: I used to run with music or podcasts all the time and- Mm-hmm ... one time I forgot my headphones, and so I ran without anything. And I had- Mm ... this wonderful experience of, [00:21:00] like, connecting with the nature and the animals on the trail- Mm ... and just this, I felt like I could go on forever. It was like a very blissful, maybe I had a runner's high.

I don't know. 

Sue: Right. 

Michelle: But it was lovely. Sounds great. It was great. Yeah. And so f- from then on, I just started running without any headphones, and I found it very helpful, especially to take the advice of my run coach at the time, because he was really trying to help me tap into, like, the level of effort scale, and how did that feel?

Was it really an easy run? Were, were you running- Hmm ... you know, were you huffing and puffing? And I couldn't tell you when I was running with the, the music. Like, I would think it was easy, but then I would look at the data and look at the heart rate and say like, "Well-" Mm. "... n- that really wasn't. I was, I was-" Yeah.

racing that 5K," you know? Mm-hmm. And so running without the, the input of, uh, anything else really helped me to tap into, like, how does this feel? And it was a much more enjoyable experience. Yeah. So I was trying to get at that with [00:22:00] the name Mindful Marathon, but- 

Sue: Mm-hmm ... 

Michelle: now I, I feel like I have evolved, and the runners who I coach have evolved over the last seven years.

And, um, I feel like I'm helping a lot of people and myself to reconnect somehow with, like, who we are or maybe to unlock- 

Sue: Mm ... 

Michelle: other interests and other things about yourself that you may not realize is under the surface because we are on the treadmill so much. Right. And it's just- Right ... moving, moving. And I, I've, I realize, you know, we're moving with running, but when you take away the, the music and the podcasts and all of the information that's coming in and you are with yourself, like, amazing things happen.

Sue: Yeah. I love that. That's, uh, a great, uh, telling of the origin of the name and then the evolution of it. I, um, am not much of a runner, but I'm a [00:23:00] swimmer, and- Yes ... um, definitely feel that- Yes ... meditative pace in the pool, and really all I'm doing is counting lengths of the pool. Me too. Yeah. And that is just a really lovely kind of meditation.

They now make, you know, these underwater- Yes ... earphones that- Yeah ... work through, um, bone conduction, and I've thought about getting a pair, and just listening to you say that, I just know that I will never need that product because- 

Michelle: Yeah ... 

Sue: that's, uh, probably gonna sap some of my benefit when I'm just, just counting lengths and, uh- Yeah

it's, it's the best. I love it. 

Michelle: I love swimming, too. Yeah. 

Sue: Do you? Oh, that's- I do. 

Michelle: Yeah ... good to 

Sue: know. Yeah. I wonder what, back in those first five years of your practice- Mm-hmm ... what felt really impossible then that you ultimately were able to [00:24:00] achieve in career and life? 

Michelle: Oh, I, I think the biggest one was a regular schedule, and that sounds so simple.

Right. 

Sue: Right. 

Michelle: A regular schedule. Um, as a hospitalist, w- the schedule was done, you know, a couple of months out, so y- you could plan a little bit- Mm-hmm ... at least so that you would have that, but having the same day off a week w- would have been huge, um, at the time. Yeah. I didn't realize that. 

Sue: Yeah. Mm-hmm. 

Michelle: I remember, so, so I work in primary care now- Mm-hmm

and I switched over to that about six years ago. Mm-hmm. But at the... So I have had sort of like three major, like, jobs since I've been out of my residency. 

Sue: Yeah. 

Michelle: And in the second one, when the coaching business was starting, I remember going [00:25:00] to my director at the time- Who was a lovely man, and he was very supportive of Mindful Marathon.

And I remember asking him, like, "Hey, could I have the same day a week off? It doesn't matter what day, but whatever weekday that would work," because I'm tr- I was trying to coach Girls on the Run, and, you know, the practices are, you know, once or twice a week. Uh, it has to be a regular schedule for the kids and everyone.

Sue: Mm-hmm. 

Michelle: And I remember him being like, "I really want to help you to do this, but we just don't have the staff to do it." And I think I knew like in that moment, like I need, I, I need to switch out of this. Even though I love my colleagues, I liked what I was doing. Mm-hmm. Um, but I knew where I was going, and I needed this regular schedule.

Like, that was what, what I knew would be helpful. Yeah. And no longer [00:26:00] working night shifts and switching back and forth, like having a regular sleep schedule. Yeah. I had no idea, no idea how much that would help everything. Yeah. Including my, my running, my relationships, um, friendships, family, like all of these things.

I, I I think I took that for granted and because we didn't have it for so long in training- Right ... the schedule was just- 

Sue: Exactly ... 

Michelle: willy-nilly. But- 

Sue: Mm-hmm ... 

Michelle: having a regular schedule has been just fantastic. 

Sue: Right. And coming out of training, which is so disorienting to a schedule, even a hospitalist schedule is an improvement over that.

It 

Michelle: is. It is. Yes. 

Sue: But- 

Michelle: It is ... 

Sue: it's not that great. I know. Uh, I'm impressed that again you asked for what you needed and- Ooh, it took a long time ... the system couldn't provide it. 

Michelle: It took a long time for me- Good for you that you could change ... me to ask for 

Sue: change, 

Michelle: you know? 

Sue: Mm-hmm. 

Michelle: I, I, I feel like, again, like if I had realized this sooner or if I had a mentor or someone to say [00:27:00] like, "Oh, hey, may- you know, just to try something different.

Like, it doesn't have to be this way." Like, the system- Yeah ... just says it has to be, but it doesn't really- Right ... have to be. Yeah. Yeah. 

Sue: Yeah. I'm hoping generationally that younger trainees are gonna, uh, find more receptivity when they wanna remodel how things work. I'm not sure they will. I know, you know, they, th- there's been, you know, some improvements in things like work rules over the last 20 years.

Michelle: Yeah. 

Sue: Um, but I, you know, big systems especially have a lot- I know ... of inertia, and so I'm sure that's a common experience. But, um, gosh, makes me, makes me sad that you could articulate what you needed in two different systems, and- Yes ... it just wasn't possible. But then you were able to see, "Ooh, I need to make another change."

Michelle: Yeah. And I think- Yeah ... the, the other big thing that made a difference was cutting [00:28:00] back from full-time. So I was, like, a full 1.0 this- Yep ... this whole time, and I think I made that decision when, when I knew I couldn't have the, the regular schedule. I think- 

Sue: Mm-hmm ... 

Michelle: I had another conversation with the same director that I wanted to go to .9, and I remember him saying, again, like, very lovely and- Mm

not in a, a, a mean or, or a bad way, but he said, "I don't think that's really gonna make that much of a difference for you, but if you want to." And I thought to myself, like, I'm the one who is asking for the pay cut, essentially. Mm-hmm. And I know it seems like only one less night shift a month, but to me- Mm-hmm

that feels huge right now. Yeah. 

Sue: Yeah. 

Michelle: So let me be the judge of whether it's helpful or not. I didn't- Yeah ... say that. I didn't, I didn't- Of course not ... have the, the courage to say that at the time- Mm-hmm ... but, but that's what I thought. And it did 

Sue: help. Yeah. 

Michelle: Yeah. 

Sue: I bet it [00:29:00] did. I bet it did. Um, we're gonna take a quick break, and we'll be right back with the rest of the episode.

And we're back with Dr. Michelle Quirk. Do you remember, uh, when you were certain that you needed to make significant changes, uh, and that you just couldn't keep pushing through? That might have been that moment you were just describing when you were like, "I'm gonna go to point nine And there was still more resistance.

Did you think then, "I'm going to leave hospitalist medicine"? 

Michelle: Yeah. I, I think it, it does take me a long time to, um, to sit with the decision. Like, I think I- Mm-hmm ... know where I'm going, but it takes me a little while to get there. Maybe that is- Mm-hmm ... you know, that's the, the endurance athlete in me. I, I like- Mm-hmm

a long, a very long, um, journey. [00:30:00] A long journey. But, um, I think I, after I started Mindful Marathon and I was so excited about it, and I, I realized, though, that to build this other thing, I really did need some protected time to do it. Mm-hmm. And I, you know, it, it started as wanting the same day a week off to be able to coach Girls on the Run.

But then as- Mm-hmm ... I started to get some clients, it was, it was hard to have a very willy-nilly, like open my calendar sort of haphazardly when I was not at the hospital for the coaching clients. So a- again, I could like see where it was going, and I needed to make some tweaks, and I started just talking to other friends who I knew in the, the s- the academic system that I was in who were in primary care.

Because I thought, "Well, that is, you know, a regular schedule. And, um, you know, it might, it might just be [00:31:00] time for a change of pace that way." 

Sue: Yeah. 

Michelle: When I was a resident, I, I can't say that I loved my, um, primary care experience, unfortunately. Um, I think there were a lot of reasons why that was. Like, we, we would go to our continuity clinic post call sometimes, so I was probably half asleep for, for a lot of it.

Sue: Oh, right. 

Michelle: Um, and so, yeah, I felt when I came out of residency, I, I wanted to do hospitalist medicine be- because I, I thought, "Well, I didn't really care for my primary care experience, so I'll do this." Um- Yeah ... so I had a lot-- I think that's why it took me so long to, to get over there because I was holding onto my experience from- Right

residency that as I talked to friends and colleagues in the system, it just became apparent, like, "Hey, this really might be a very nice change." And I also thought, "You know what? They always need pediatric hospitalists." Like, I really felt that if I left this job on good terms, I [00:32:00] could go back- Mm-hmm ... if I didn't like it.

Yeah. 

Sue: Right. Yeah. Awesome. 

Michelle: And so that's, yeah. So I, I moved within the system, um, to one of the primary care sites, and I actually, I signed the contract Right before COVID started. Like, I think- Mm-hmm ... that was the end of February or early March of 2020, and I thought after- Boy ... this was all in motion, I thought, "Oh dear," like, "I might have to stay here in the hospital- Mm-hmm, mm-hmm

longer." It was, like, a lot of uncertainty- Right ... but I did end up- For sure ... you know, starting in primary care that summer. And I've been there- 

Sue: Yeah ... 

Michelle: since. 

Sue: When you- Yeah ... made that change, was there anything you felt like you were leaving behind in your sort of concept of self, your successful old self? Did it feel like a loss in any way?

Michelle: Um, that's a great question. I mostly felt like I, I was going to miss my friends, like my- Mm-hmm ... my colleagues- Mm-hmm. Yep ... and the nurses [00:33:00] and other staff members. Um, you know, people I had made friends with over the last five years. Right. And I was sad to let that go. But- Mm-hmm ... the medicine, not really, no.

Sue: Mm-hmm. Well, 

Michelle: excellent. Yeah I, I was ready to not have the stress of being in the emergency department. Yeah. I didn't realize, again, how much, uh, I, I think I'm perhaps not suited for, for working in the ER either. Although I loved- Mm-hmm ... you know, procedures and- Mm-hmm ... you know, lots of, like, injuries and lac repairs and, like, I liked that, but I did not, I, like, when that pager would go off and it was, you know, a code or s- something, like, I could feel, like, internally, like, I don't really like being here.

Like, on the outside you would never know that. But on the inside, like, over the years I've learned, like, I don't ... This is not good for my system- Yeah ... my nervous system. Right. So I d- I do not miss that [00:34:00] at all. 

Sue: I bet. I bet. That's awesome. Awesome self-insight, for sure. I wonder if you, um, walk around with any sense now that that burnout is lurking in the corners, or if it's really in the past for you, or how you relate to it now.

Michelle: Yeah. Um, I have, I would say I have awareness of when things are creeping in. Whereas before, it, we would be- running so fast and so far on the treadmill, we were huffing and puffing and out of breath and needed to lay down. And now I can feel like, okay, like this, this was a hefty week for a variety- Yeah

of reasons. Mm-hmm. If I, uh, did an extra day in the office to help a colleague out or, uh, extra time, you know, that I picked up around the holidays to help someone [00:35:00] out. Mm-hmm. Mm-hmm. And I can, I can recognize like, okay, like that was more than what I usually do. I feel extra tired. Uh, I f- I'm not sleeping as well.

I am, uh, snapping a little bit at my husband. Like, he probably- Mm-hmm ... gets the, the brunt of it. 

Sue: Yeah. Yeah. Um- That's a good barometer. 

Michelle: Yes, for sure. It's- Because that's not, that's not where I, where I live anymore. 

Sue: Yeah, yeah. That's so 

Michelle: great. So I can, I can recognize it now and I, um, I, I can at least, um, kind of correct course a little bit better.

And I, I left out... I l- I cut down my hours again, like a couple of years ago, so I've, I've like slowly, slowly, I'm, you know, like going down from 1.0 to .9 to .8. So I'm in the office roughly three days a week, sometimes four. But having like those two days of the week that, you know, yes, I'm, I'm doing things with my [00:36:00] coaching clients, but I'm trying to build in some blank space and time for other things that I haven't had time for.

Sue: Yeah. 

Michelle: So that is 

Sue: helpful. Yeah. Um, yeah, that's, uh- Uh, really makes a lot of sense to me, and actually reminds me of a conversation I had with the immediate past president of the AAP, Sue Cressey. Um, she was on the podcast, and you'll have to listen to her episode because she talks about her calendar being her main, um, notice- Mm

that things are creeping- Yeah ... out of balance, just the, just the appearance of her calendar. 

Michelle: Yeah. 

Sue: Um, which I think is, uh, nice to have, you know, some external triggers for us to go, "Wait a minute, wait a minute. Have I said yes to too much?" 

Michelle: Yeah. 

Sue: Um- 

Michelle: That is- Which, you know, we do- That's the default setting, you know, I think, to say yes to all of the things.

I guess I should also say I, [00:37:00] I've gotten very good at saying no to things over the years. Yeah. 

Sue: Mm-hmm. 

Michelle: Um, mostly m- mostly work-related things that maybe, like, if it doesn't light me on fire, like I'm excited to do it, if it is... I'll, I'll give an example. Like, um, the, the office often needs extra help, l- like, volunteer work for, like, sports physicals.

Like, this time- Mm-hmm ... of year, all the teams- Mm-hmm ... need sports physicals. 

Sue: Right. 

Michelle: And, like, I d- I don't wanna give up a Saturday to do that. Like, if it counted toward my, you know, toward my work, but it is... Like, it's, it's v- volunteer work. It's community service. Mm-hmm. It's a great- Yes ... thing that we do. Mm-hmm.

Um, but I, like, don't have the bandwidth- Yeah ... to add that. At least not- Yeah ... right now. Um, things that- 

Sue: I, I think that's, uh, a, a key thing that we don't develop early in our career. Everyone, it feels like, that I talk to or know comes out of [00:38:00] training saying yes to everything. Yeah. Um, because we feel like we're supposed to, or we should be inspired by a day of giving back to the community.

And, and we are, but we're also, you know, not infinite in our capacity. No. And it takes, I think, most of us a while to figure that out or understand that, so. 

Michelle: Yeah. Very good thing. I feel like I'm much more, you know, present with my patients- Mm-hmm ... and families when I am in the office- Mm-hmm ... because I have the time to recharge when I'm- Yeah

not in the office. Yeah. And I don't think I realized that, you know, certainly not at the beginning of my career, and even five years ago when I started in primary care. Again, it, it, it's just the treadmill analogy. Like, just move from, you know, patient to patient- Mm-hmm ... and but my- Yeah, keep going

relationships and my experience of the work, and hopefully my patients and families have that experience as well, that- It, it's just I'm [00:39:00] showing up in, in a much better place for them now. 

Sue: Yeah. Yeah. I feel, I feel that way, too. And maybe I'm just convincing myself that, um, there's a really good justification for making changes that are looking out for me.

But I, I really do feel that, that the quality of those interactions is warmer- Mm-hmm ... more attentive, um, and ultimately more helpful than- Yeah ... when you're just grinding away all the time. 

Michelle: Yes. Yes. 

Sue: Um, I'm curious what things besides running felt supportive when you were struggling back in the day, or when struggle creeps in now 

Michelle: Um, definitely movement- Mm-hmm

of probably any kind, but running, swimming, walking, hiking. Um, I do a lot of that. Yoga, like all of the, all of the movement things. Other things I like, I mean, I like to read. I, I should say [00:40:00] like not heavy books, like a novel. Mm-hmm. Mm-hmm. 

Sue: Right. 

Michelle: Um, writing. I love to write. I've always been a writer, I think even, you know, when I was younger and in high school and college, and like rediscovering that part of myself because I just didn't write for so long, and now I have journals, you know, filled in the bookshelf.

Nice. And I don't know what that will become. Maybe it'll be a book, who knows? Or maybe not. 

Sue: Yeah. Oh, that's exciting to contemplate too. But 

Michelle: yeah. Um- I love being in nature. I love traveling. Uh-huh. Yeah. Resting, sleeping, like just- Mm ... I love to get good- ... sleep. 

Sue: Yeah. Yeah. Critical. Critical- 

Michelle: Yeah ... 

Sue: to get, for sure, and not something that is, uh, built into the expectations of a career in medicine, for sure.

For sure. Do you have creative outlets that you pursue other than the coaching, which I would say sounds- Mm ... like a very creative process? 

Michelle: I think, you know, I talked to, um, a [00:41:00] lovely colleague, Dr. uh, Sonal Kamlia, who is an artist, and she-- We had a conversation about this 'cause I told her I don't really draw or paint or anything like that.

Mm-hmm. But she suggested that perhaps my podcast is an art form. Oh. And I was like, "You know, that's a really great-" 

Sue: Yes. 

Michelle: W- I, I didn't ever think of it like that. Yeah. But I think my writing maybe, like creative writing, and maybe the podcast and in- 

Sue: Yeah, 

Michelle: for sure ... in the coaching space. But I, yeah, I don't, um...

I'd like to try pottery at some point. Ooh. But I've never really been, um, an artist. 

Sue: Ah. Well, I think in those ways it sounds like you are. Um, yeah, I love the idea of pottery too. I'm going to take a class called, um, oh, shoot, I can't-- It's a very punny- ... name, which of course I can't remember, but it's basically, you know, making your pet out of pottery.

Oh, that's cool. So seems like a- Yeah ... good place to start anyway. Yeah. 

Michelle: Yeah. 

Sue: If you could talk to yourself [00:42:00] back before the burnout hit, especially knowing that somebody listening right now might be in a very similar place, what would you want to say? 

Michelle: I think that nothing is wrong with you. Like, you are in a system that is failing you.

Like, this is a, an inhuman expectation that's being placed upon you right now, and it's okay to ask for what you need. And it's okay to take rest. I think, you know, uh, if I could go back, I would-- things like FMLA, I- 

Sue: Mm-hmm ... 

Michelle: that- that's something that I share with residents now that- 

Sue: Yeah ... 

Michelle: um, at the time, I had no idea.

I thought you needed to have a baby to take FMLA, like at that- Right ... back then. And I didn't realize that, like, a [00:43:00] sick family member, like I could have... You know, it's unpaid time, but it's- Right ... you know, it'll save your job. It will and you- Right ... you could have that time and, like, having that time to just to attend all of the appointments with my dad and- Mm-hmm

um, you know, to have some time off after he passed away, like that would've been- Right ... huge, um, back then. So just throwing that out there if you haven't thought of that. But I think that just be kind to yourself. Mm-hmm. It's not you. It's okay to- Yeah ... ask for what you need, and if you don't get what you need, it's okay to talk to someone else and, like, to leave that situation if that is the best thing for you.

Like, you don't have to stay. I, I stayed a lot longer than maybe I wanted to, and, um, you know, it all works out the way that it's supposed to, and hopefully- Mm-hmm ... this will help someone else, you know, by sharing- Yeah ... the story. 

Sue: Well, I am sure that it [00:44:00] will, and I really appreciate you coming on and sharing so openly about a vulnerable period.

I think that is hard for most of us to do, and I, I do think it has the potential to be very helpful. And even, even for me, um, just to hear you say those words, I mean, I feel that as you're speaking it to me, and, um, it's really potent, and I, I thank you for that. And I wanna say that I never have thought of myself much as a runner, but, um, getting to know your work made me aware of these Disney run situations And this is the first time I have wanted to be a runner.

Will you tell us just a little bit about that, and if you've completed the Goofy Challenge, which is a 5K, 10K, half-marathon, [00:45:00] and marathon four consecutive days. Totally goofy. 

Michelle: I love runDisney. I am not an ambassador for them or anything like that, but- Wow ... if you're watching the video here, you can see all of my Disney paraphernalia back there.

That, those ears are from a Disney marathon. Um, it's a beautiful, wonderful race experience. I have not done the Goofy or the Dopey Challenge, so. 

Sue: Oh, yes. 

Michelle: Yeah. They have- Dopey 

Sue: is 

Michelle: what I'm thinking ... multiple. You're thinking of Dopey, yes, yes. I have coached a variety of amazing ladies to that goal, and- 

Sue: Yeah

Michelle: the Goofy and the Dopey, they're really ultra-marathons. That's the way I think of it, because you are running on tired legs, um, on successive days. But if, it's a great entry point if you are, if you're a beginner, or even if you're an experienced runner. It is a great time, and they put on a wonderful race experience.

You have to wake up at, like, 2:00 in the morning, um, because [00:46:00] the race starts at 5:00. So you- Wow ... you know, it's a little bit of sleep deprivation- Because of heat maybe. Uh-huh ... but yes. Heat, and to get everybody clear of, um, the parks as much as possible when the parks open. But they have characters on course.

The running community is really supportive. The cast members come out and cheer. There's- 

Sue: I mean- 

Michelle: There's lots of things to take your mind off of the running, honestly. There's- Mm-hmm ... just so much to see, and it, it's, it's very fun. And I have a variety of runDisney friends I have made over the years. Uh-huh.

So the first race was 10 years ago, the, the half-marathon. Really? And I've done a variety of other race weekends. But yeah, not- 

Sue: Yeah ... 

Michelle: not taken on the, um, the Goofy or the Dopey yet. I won't say I never will. I've, I've- Uh-huh ... learned better than to say that. But- 

Sue: Yeah ... 

Michelle: I've done some personal challenges, like I did the, the 10K and the marathon.

Uh-huh. So I had a day off in between when- Mm-hmm ... people were running the half-marathon, so. 

Sue: Wow. 

Michelle: But yeah, but it's, it's great. I can't say enough good things about runDisney, so. Well, 

Sue: [00:47:00] I think that we should make a plan to do some of that together, 'cause like I said, this is the first time I'm like, "I might be a runner."

It's possible. 

Michelle: Oh, absolutely. Oh, yes. And you can, I should also say the, the pace requirements are very generous. Yeah. So the, um, you have to keep a pace of a 16-minute mile. Yeah. But it doesn't start until the very last person crosses the start line. Uh-huh, oh. So you have, you have some buffer there. So I truly think that most people could do the race at a brisk walk.

Like, if you just- 

Sue: Yeah. 

Michelle: Yeah, if you can keep- If- ... that pace between- Mm-hmm ... 16, 16-and-a-half-minute mile, you, you can- Hmm ... definitely do it. So you don't even have to run- Awesome ... that much. 

Sue: I love it. I love it. I, uh, you will see me again. We will, we will, uh, definitely make that happen. 

Michelle: Sounds fabulous. 

Sue: Thank you again so much.

It's really been just a real treat to talk to you. 

Michelle: Thank you so much for having me. I really appreciate it. [00:48:00] 

Sue: Uh, this next story comes from a family member of a retired ER doctor sharing their thoughts on what burnout actually is. Let's read what they wrote. "I have a now-retired Ontario ER doc in my family.

I remember being stunned at the stories of absolute stupidity that hospitals are forced to operate under. At any given time, somewhere between half and two-thirds of the beds in the ER are filled with overflow plate-- patients from other areas of the hospital. I was shocked at this, since I figured that if anything, you'd want the ER to have as many open beds as possible, since it's literally the only place in the entire hospital where you could suddenly find yourself in a situation where a dozen or more patients all show up at once in critical condition.

I really think the system was only allowed to get to this point because ER docs kind of self-select for a certain personality type that will just [00:49:00] say, 'Okay, well, this is what we have to work with, so let's just buckle down and get it done.' It's allowed shitty administrators to pile more and more bullshit on ERs with less and less support.

Now we're at the point where even the high levels of grit, determination, and a frankly unhealthy work ethic is not enough to bridge the gap anymore." The story points to the broken systems that we're working within, and I think a lot of that is due to rapidly shifting medical economics that systems are not capable of adapting to fast enough, and the casualties of that become medical professionals of all sorts and patients.

And I think it's the big sort of problems like these that are not gonna be fixed piecemeal. We probably are going to need government coordination, if not direct intervention, [00:50:00] and I don't know that there's political will for that at this time. But hopefully we can all be looking for how we can help facilitate those kinds of system changes, because we will at some point be the ER patient, uh, and it would benefit us all if we could pull together and, and try to fix some of what's broken.

Do you have a burnout story? I would love to feature it on the show. Share it with us for a chance to have it read on an upcoming episode. You can email us, hello@stillpracticingpod.com or visit our website, stillpracticingpod.com. You can also check out sudaniels.md on TikTok and Instagram or Facebook to keep up with me and the pod.

Check out our Human Content Podcast family on Instagram and TikTok @humancontentpods. Thanks to everyone who listened to the episode. Please come back and listen again. Send us a message or leave a review on your [00:51:00] favorite podcasting app or on YouTube. Speaking of YouTube, check out our full episode videos on YouTube that will be posted every other week at Still Practicing Podcast.

Thanks again for listening. I'm your host, Sue Daniels. Our executive producers are me, Aron Korney, Rob Goldman, and Shahnti Brooke. Our associate producer is Sundus Hassan Nooli. Our editor and engineer is Andrew Sims, and our music is by Omer Ben-Zvi. To learn more about Still Practicing's program disclaimer and ethics policy, submission verification and licensing terms, and HIPAA release terms, you can go to stillpracticingpod.com and reach out to us at hello@stillpracticingpod.com with any questions, comments, or smart remarks.

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