Physicians today are working so hard. In the midst of a grueling work schedule, our families can be forgotten. Unfortunately, this leads to doctors and dentists having some of the highest divorce rates in the country.
In my book The Freedom Formula for Physicians, I talk about one of the biggest mistakes that many physicians make is this lack of work-life balance and not making the effort to pour time and energy into their marriage. It can be really hard to put this altogether.
(Note: I outsource transcription efforts, please forgive in advance any grammatical errors. I just simply don’t have time to review it all)
Dave: My name is Dave Denniston, welcome back to the latest episode of the Freedom Formula for Physicians podcast. Well, physicians today they are working so hard, can you agree with that?
And in the mix of a grueling working schedule our families can be forgotten and unfortunately this leads to doctors as well as dentists having some of the highest divorce rates in our country and in my book, The Freedom Formula for Physicians, I talk about one of the biggest mistakes that many physicians make is this lack of work- life balance and not being able to make the effort to pour time, to pour energy into their relationships and their marriages and that can be so hard to put together and that’s why I thought I would bring as a guest Julia Orlando.
Julia serves as the director of clinical services for the Sotile center of resilience and the center for physician resilience in Davidson, North Carolina where she provides counseling and life coaching for diverse client base including children, adults and adolescents and families and actually she lectures nationally on work-life issues for busy medical families and she serves as an invited columnist in the AMA publication, physician family magazine.
She offers counseling tailored to the needs of the busy physicians as well as retreats and time intensive enrichment services for individuals, couples and families. Well, welcome Julia.
Julia: Thanks Dave, thank you for having me.
Dave: I was so glad you’re here; this is going to be great. Well, let’s just kick this off, tell us first a bit about you, I mentioned in the introduction you are the director of clinical services, what I didn’t mention is that you actually work with your parents who are authors and speakers.
Tell us a bit more about your journey and how you’ve gotten to where you are now.
Julia: Yeah, oddly enough I come from a family of therapist which is probably a pretty scary idea for most people [laughter] but I grew up, my parents Wayne and Mary Sotile worked in private in Winston Salem on North Carolina for 30 plus years and they really devoted their practice to promoting resilience for physicians and their families.
So I grew up with an idea that I wanted to go into mental health in some capacity and started my career working primarily with survivors of trauma, physically, sexual abuse and sexual assault and adolescent with sexual behavior problem and knew that eventually I wanted to go into private practice and it just kind of worked out over the past couple of years that we all, my parents and my sister even who is also in the mental health field decided [chuckle] to go into practice together here in Davidson and we established the center for resilience and center for physician resilience. So it’s been a pretty cool journey [laughter].
Dave: I can’t even imagine working with my parents; I think we’d drive each other nuts.
Julia: I know [laughter] the best things is, I’ll say this and I won’t tell them when this is airing so that they won’t hear it but [laughter] they travel a lot, so they are not here a lot [laughter].
Dave: There you go; you’re going to run the place.
Julia: Yeah, exactly. No, it’s actually been really cool working with them, they have so much knowledge and information and we have very different approaches and prospective which can be interesting. We do a lot of intensives with families and work as kind of a team for therapy which is an interesting approach and it’s neat to see how we do things differently.
Dave: So has the practice always focused on physicians or how has that changed over time?
Julia: Way back in the day, my dad Wayne was on the faculty at what was the Vilming grade school of medicine, basically the medical school for Wake Forest University and through that role he started seeing in therapy medical students which kind of grew to he and my mum also seeing for therapy other physicians within the organization and they ultimately became kind of like the EAP for the medical school.
So they worked with lots of physicians and their families and became kind of the primary people in Winston Salem for treating families, medical family and then that has grown now to more physician leadership coaching.
Coaching for issues of professionalism in the medical work place and more consulting around the country that they do with hospital system and then we started working, consulting with hospital systems that they’re having kind of bigger more macro issues. So it’s grown from there but it’s always focus on physician families.
Dave: Let’s share about physician and marriage, so with seeing so many physicians and hospital system what are you guys seeing out there today?
Julia: Yeah, it’s no secret I think that medical families face a tremendous amount of challenges and stress to say the least.
Today, what’s interesting about today cohort of physicians is one of the newer challenges is that more often now there are dual earners in the family.
So more traditionally we thought of kind of the physician and his wife, who stayed at home and managed the household which is a tremendous job in on itself but that was kind of a clear division of laborer I guess.
Now, that’s really not the norm anymore, 50% or so of physician spouses’ work outside the home for 30 or 30 plus hours.
The challenges that they’re facing are very different you know the challenges of work- life balance are very different. I think that today there’s much more pressure to achieve that idea of balance, whatever that means and we pressure ourselves to be perfect wherever we are.
You know I have to be the perfect wife, I have to be the perfect father, I have to be the perfect physician and that’s overwhelming. As medicine gets more complicated and more advanced the demands get more complicated and more advanced so with you add in to that that now you have two people working outside the home most of the time, it’s more complicated and even more challenging dynamic that we’re seeing more often is the doctor and her husband or the doctors who both work and that’s just makes things more complicated in a lot of ways.
Dave: I can’t even imagine with trying to figure out shifts and when you have a family and little kids and with me and my wife she works part time and it’s hard enough to try figure out who’s going to pick up who when [laughter].
Julia: Yeah, absolutely. It’s a big stress I think and it’s hard to manage and for women in medicine that’s idea of working towards balance I think is particularly intense and being able to be good in every sphere is sort of ten folds for women in medicine.
Dave: Well and it seems to me that, in my opinion physicians are best and brightest you know they’ve been through so much schooling, they’re often the top of the class over the years and they have this double type A personality where success is embedded in them and I totally relate to that where everything you do you expect to be successful and when you have the vision of that white picket fence and the family and you want everything to be just perfect and to not have that time as a woman, I got to imagine there’s a huge emotional pull you go back and forth between the vision you have as being a mum as well as the vision for your career.
Julia: Yeah absolutely and just sort of stereo typically, society tends to support more the idea of a man doing what he needs to do to get out and make money and support the family and if that means you miss some soccer games then you miss some soccer game, women typically are not supported in that same way.
It’s more of you’re abandoning your role kind of struggle, I think a lot of times whether that’s really what is happening, whether that’s really what people are saying it’s that self inflicted, that’s a struggle that a lot of women in medicine deal with.
Dave: Well plus you imagine all the medical school they had to get there. I ran into one of your articles through that magazine which I thought was really great and it was titled more than married, it was last year that that came out and you had listed three statements and I was just thinking of clients as I read these, here they were, “I will make more time once I’m done with the residency [chuckle], I will take care of my personal health once the kids are older,” another one was, “sure I’d like to pursue my own business but I think it makes more sense to wait until we have more time, we barely see each other as it is.”
So tell us about some of the clients you’ve seen, give us a couple of stories of what physicians are going through today.
Julia: Yeah, you know it’s so fascinating, I feel honored to be able to work with these families and we see some of the same stuff over and over again, this idea of waiting until you know and we’re going to wait until x happens and then we’re going to be happy.
We’re going to wait until we’re done with residency and we’re going to have more time but the reality is that’s just not true, you know training is grueling without questions but the idea of postponing happiness until some phase of life is over really sets you up for unhappiness.
I worked recently with a really young couple who the husband was in his second year of residency and they came to me just sort of to see this you know, how is this hard already?
Residency was supposed to be easier than medical school and now this is harder than anything we’ve done before so surely it’s going to get better once we’re out of residency but I don’t know where we’re going to live and we just had a baby and who’s going to help me with the baby if he’s always out working you know in the mix of all these, they had completely lost their connection.
They had completely lost sight of what brought them together in the first place and there was this idea of we’re going get to that when things are easier and the sad truth is you will not get to that if you don’t take time to get to that now.
So one of the biggest tasks for medical families and couples in situations like this is finding ways to reconnect and to kind of get back in touch with why you’re here in the first place, why did you chose each other? And let’s talk about that and figure out how to really feel that again despite how busy you are.
Dave: So how did they go about that? What was your prescription to help them to get back to that core of their relationship?
Julia: I think so fondly of this couple because they were both very high achieving people and both very sort of black and white thinkers about things, you know they wanted to have a formula for how to fix this and part of what we did was just like they scheduled, I mean these folks were scheduled like I had never seen you know so organized and so [?] about everything, we included time for connection in that schedule.
So some people that probably sounds really old and formulated but for them it worked because they needed to have it written down, it needed to be a concrete thing, “Okay at 5 O’clock we’re going to have 20 minutes to sit down and at least look at each other and talk to each other, no technology [laughter], no interference,” you know work can wait 20 minutes because this is the time that we are going to reconnect.
Little things like that make a big difference.
Dave: I can so relate to that, I don’t know if I told you the story, now my wife and I part of the reason I started working with physicians was due the birth of our youngest daughter who came out to the world at 23 weeks just stationally with like 12.4 ounces–
Julia: That is amazing.
Dave: And we are in the [?00:13:48] for four or five months and then she ended coming home on oxygen and thank goodness she’s relatively healthy today and doing wonderful, you’ll never know it but the whole time period, that whole first year, we just grew apart and everything just seemed like work and I know a lot of physicians can relate to this that when it just seems like relationship is work it can be so hard so I had to do in my schedule then my wife and I almost got to a breaking point you know I had to put in little things into my schedule, once a week just something to show her I care.
It might be a little note I find on the internet if I spent 10 minutes trying to find something, I send her something and just a little touches like that that I put my calendar to let her know hi, I’m thinking of you has helped so much in our relationship.
Julia: Absolutely, that’s wonderful because I think in a weird way it’s so well intended that the first thing that we lose is the connection to the person we love the most.
It’s almost like you are a sure thing, like I know you’re here and I know I’m here for you, I know we’re not going anywhere but because of that, it can be lower in the priority list, those things that I need to pay attention to today and honoring how important that is in little ways like that mean so much to just let the person know, okay you are thinking about me, you know that’s a wonderful energy to carry with you throughout the day.
There’s no big mystery about it, it’s just finding what works for you to kind of reestablish connection.
Dave: Lets talk about burn out you know burn out in a what a lot of people are calling assembly line medicine working for the big company, what is that look like in the physician patients that you u are treating?
Julia: Yeah, burn out you know we are really dealing with higher rates today than ever across specialties in medicine. From our research we thought that approximately 46% of physicians are burned out and just to add to the complications about 30% of physicians spouses are also burned out, so..
So it’s not just the physicians burn out, its everyone kind of burned out and I want to talk a little bit about what we mean by burn out, I think that it is a phrase that gets tossed around a little bit to day when it’s not always applicable, so for our work when we are identifying someone who’s really dealing with burn out we consider three key components.
The first is emotional exhaustions and this isn’t just I’m tired and I don’t want to get up and go to work, it’s really resent the routine demands that comes with the role that I have to fill out today, whether that’s my role at work or my role at home, you know I can’t seem to get it together to re-energize myself to go and do what I need to do.
The second factor is depersonalization of kind of acting as if I don’t care and this is where we see a lot of physicians get into trouble, you know many physicians who are referred to us or mandated coaching services are sent to us because of complaints related to depersonalization.
So a family who complains that a doctor is cold or this then, he doesn’t take time to talk to them, doesn’t take time to connect with them, a nursing faculty complains that a physicians screams at them too quickly whatever the case is, often times they’re mandated for some kind of coaching and when we get down to what’s really going on, very rarely is there truly a doctor who is just kind of a jerk in that and dealing with people.
More often than not this is someone who is basically traumatized by everything that he or she has been through, everything that he or she has dealt with through from training on and depersonalization is a defense mechanism you know this is a way that I can disconnect from how sad I am or how angry I am or I [?] am by all that’s happened.
The third aspect is a diminished sense of personal accomplishment so I never feel like I’m meeting expectations, my own or others no matter where I am, so if I’m at work I don’t feel good about how good I’m doing and I know that no one else is approving of what I’m doing.
If I’m at home I don’t feel good I am with my family and I sense that other people aren’t happy with that either because my partner is looking at me of the corners of his eyes when I’m distracted by my phone or whatever the case is, its constantly feeling like you’re not accomplishing what you need to accomplish.
So those are kind of main things we consider when we look out whether or not someone is burned out.
Dave: Well, in the same article that I was talking about and I think this kind of addresses that and maybe you agree, you listed 15 different ways on how to get happy, so tell us two or three of your favorites and how you’ve seen physicians overcome this horrible issue that they’re dealing with.
Julia: I don’t know I like all of them but some of the ones that I’ve seen kind of most profoundly affect people I think, the idea of positive relationships so enhancing positive relationships, making positively social worlds, participating in friendships that are important to you and keeping your relationships positively.
Now, obviously with busy families and busy people, this does not mean I expect that people will go out and join social clubs and meet a bunch of new people and become very active socially but honoring the relationships in your life that are important and doing something to actively participate in them even if its sending someone an email, you know a friend that you haven’t spoken to in a while, something that gives you kind of a positive boost, a positive sense of connection with someone really important.
And another aspect of this is keeping your relationships positive, another physician now who I’m working with and one of the main things that he is working to as the [? 00:20:27] is not surrounding himself by too many negative people but half of the system he works there’s a lot more in laws and there’s a lot of unhappiness and mistrust between physicians and administration and many of his coworkers spend a lot of time commiserating about how terrible it is and he struggled with that, it really really affects him negatively to be around that too much.
So we are working to find ways for him to set boundaries with his co workers so that he’s not just sort of sucked into that cycle of negativity, so working to advocate for yourself that you’re not drawn into other people stuff.
Dave: Give us a way that someone would do that, let’s say you’re in that negative situation how do you handle that? What do you say? What do you do?
Julia: Well, for him it’s been interesting because in his department, they are all in one office and so it’s a challenge because it’s not like he can go and shut himself in his own office because he shares an office with them.
So we have had to find creative ways, you know putting in earphones and listening to music [chuckle] without being seen in too rude to his co workers or finding times of the day when he knows that they are not necessarily going to be in the office when he can go in there and work on the stuff that he needs to work on in the office but also just limiting how much time he’s in there at his desk, participating in it.
Once we kind of really started sorting through it, he realized that he was not just getting drawn into it but leading some of those negative conversations, so him managing how much he allows himself to initiate that kind of what to commiserate about how terrible this is.
I think one of the easiest ways is to just draw your attention to it, once you start being aware of it then you can work on ways to set boundaries on around it, often times we’re not even aware of how much time we spend thinking or speaking negatively, it just become habit you know some simple kind of intention towards not doing it can go a long way.
Dave: Awesome, awesome. Later I personally believe that successful people learn from their mistakes but super successful people learn from others mistakes and making marriages work is well, its work [chuckle] and in the article you list five different ways to strengthen marriages that I thought were really awesome, so what are one or two or three blessings you’d like to pass on to physicians, business owners and physicians in general?
Julia: I think one of the most impactful things that I’ve seen is when people find ways to honor each other’s roles and contributions in the family and this is particularly important for physicians and their families.
It could be very easy to get sucked into feelings of resentment towards medicine because medicine becomes this entity that takes from your family, if you allow it to.
So finding a way to honor the fact that there is a physician in the family and how wonderful and honorable it is that he or she has chosen a life in medicine but then also supporting our other physicians, honoring the challenges that come with that and honoring all the different roles that he or she plays as a partner to a physician and the most important piece of this I think is speaking kindly about one another to and in front of your children so being purposeful in your attempt to honor each other.
We have a family that we worked with years or so ago who could have send us this adorable picture of a mother and their three kids and like the hospital gowns and masks [laughter] that they sent to the physician husband when he was on call and the message was you know when dads on call, we’re on call and we support you [laughter] and we know you can’t be here with us but we love you and we support you and we’re in this with you.
Little things like that are huge, they’re hugely impactful, this I think was probably more prevalence before but I still see this with some of my couples I work with.
Spouse of a physician who don’t work outside of the home to sometimes struggle with the idea of being just a physician spouse and needing some other identity than that, so finding a way for the spouse firs to do something that makes them feel accomplished, whether that’s a career outside the home or it’s just the way you manage your home.
Connecting to a feeling of accomplishment is really important and then that the partner acknowledges that as a real accomplishment is also tremendously important.
Dave: So it could be a passion of some sort like I know my wife is super passionate about music and so it’s not always easy that you don’t get to spend a whole lot of family time but I guess it could be supporting them by letting them spend time on that and have to sacrifice some of that family time maybe so that way they could have that passion.
Julia: Absolutely, right you know it’s worth verbalizing appreciation to and about one another, you know even if you think it all the time, it makes such a big difference if you say it, things like that.
Another kind of tip that I think is really effective is honoring the rituals that exist in your family, not eliminating rituals because someone is working. I think when schedule gets crazy and busy some of the first things to go are more ritual like behaviors that we have, the other is that we sit down every Tuesday nights and play checkers or you know we order pizza every Friday night and have pizza night, things that even seem simple.
It’s important to honor them as rituals and kind of raise them to level of this is something that our family intentionally does together, honoring that really promotes positivity in a cool way and boosts the overall moral of a family knowing that no matter what we are going at least to come together and do this and honor this is something we enjoy doing together.
Dave: And what if you end up missing that ritual because you’re on call or you know they end getting pulled another direction and that spouse has that sense of disappointment and maybe even anger that you missed that ritual how do you handle that?
Julia: Absolutely and inevitably that will happen right just whether in medicine or not, inevitably things come up that will take away those moments if but what you’ve done is consistently work to let each other know this is important to me, you’re important to me, I enjoy it when we can do this.
When it doesn’t happen, it’s a little bit less insulting I guess [chuckle], you know it’s all week long you go without connecting to each other, without looking at each other, without speaking to each other because things are so busy and you’re banking on this one 30 minutes time we have to sit down and have pizza together and then that doesn’t happen.
It’s much more difficult to say okay, that didn’t happen but if you’ve found ways to connect to one another, to appreciate one another throughout the week, even if it is a little sticky note that says I love you and I miss you. It’s easier to tolerate the disappointments when they happen.
Dave: It’s kind of like that analogy I use sometimes that you want to make little deposits in the bank so that way you can withdraw from it [laughter].
Julia: Absolutely, perfect analogy.
Dave: Well, what are some good resources as we’re starting to run out of time here, what are some good resources Julia regarding strengthening ourselves as well as our marriages that you would recommend whether it’s to residents or fellows or practicing physicians? Maybe some good books, some good videos online that they could check out.
Julia: Well, not to make a shameless family [? 00:29:14] but my parents have written some great books specifically about managing resilience and happiness through medicine.
My dad and one of his colleagues who’s just written a book, Building Resilience in Nerve Surgery Residence and then my parents wrote a book called the Medical Marriage and Marriage Built for Busy Couples.
So most of those books are specifically targeted towards medical couples and how to manage and promote resilience and happiness through a life in medicine but in general I think Sue Johnson is a clinician who has written several books and she’s created sort of a therapeutically approach for couples counseling, anything by her is amazing and very acceptable, very easy to apply I think and the same is true for John Gottman, John and Julie Gottman are kind of gurus of couple counseling and they have a tone of great advice.
Dave: Awesome, awesome. Well, there’s so much that we could cover here though we just don’t have time, we don’t have all day.
Julia: I know.
Dave: What are some closing thoughts that you want to make physicians and folks that are listening to this aware of?
Julia: I am so happy that podcast like this exists because it saddens me how much physicians and their families are not taken care of today in our society and so on behalf of those of us who are working to do that, I hope that this can be helpful to some people.
I apologize that [chuckle] that we are not more proactive in taking care of the people who take care of us because physicians and their spouses and their families are such an important part of all of our lives and I don’t think we acknowledge that enough, so I’m grateful to folks like you who take the time to do that and I’m glad to be able to try to help in some way.
Dave: Well, thank you so much for being with us Julia, this is just great. If people have more questions how can they reach out? How can they get in contact with you?
Julia: Sure, so the easiest way is probably to go to our website which is sotile, S-O-T-I-L-E dot com and all of the ways to contact us are linked on that website.
Dave: Okay, awesome so it’s kind of like sotile is what I often want to say is how you spell it but its sotile S-O-T-I-L-E dot com.
Julia: That’s right; it looks like so tile [laughter].
Dave: Okay, awesome. Well if you’re a physician you’re listening to this or you’re someone else servicing physicians and you want to tell your story, grappling with task issues like this one, you want to get up on the soap box for a few minutes, I’d love to share it too in the next Freedom Formula for Physician podcast, make sure to contact me at David Denniston dot com or on my website doctor freedom podcast dot com.
For the Freedom Formula for Physicians podcast, this is Dave Denniston, thanks so much for joining us, make sure to subscribe and check in again soon, have a good