#10: An Interview with an Emergency Medicine Doctor

Well, welcome to another episode of the Zach High show today. I have the pleasure and honor of being with Dr. Zhao Chi Zhang, who is an

emergency

physician here at Thomas Jefferson University, so Dr. Zhang is the assistant professor and assistant courtship director of

emergency

medicine

at Thomas . Jefferson University, he is a three-time graduate of Tufts University and completed his residency at Brown University. Dr. Zhang is a teacher, a loving father, a devoted husband, and a strong advocate for the Asian American and Pacific Islander, or Aapi, communities. He has received multiple teaching awards. Numerous national educational scholarships and he is one of the national leaders in mentoring medical students in emergency

medicine

.

Welcome Dr. Zhang. As we always start, I'll go over a couple of stats and then ask if any of them hold up. I tell you and you want to mention that either sounds a little strange or it makes sense to me, so start by entering the characteristics of the residents, so the first step score of the average person entering the US MD. , so the overall average is 232 for emergency medicine, it is 233. The average step two score is 245 overall, compared to 247 for emergency medicine training, which is typically about three years. In terms of salary, the average general physician salary in the United States of MD is 339,000, the average academic associate full professor salary in emergency medicine is 333,000.

In terms of hours, the average

doctor

works 51 hours a week, the average emergency medicine

doctor

works 46 hours a week. In a 2020 burnout report, it said the overall burnout rate was 48 among all doctors and emergency medicine actually won that competition at the top with 60 percent and its most reported complaint was too many bureaucratic tasks. At the bottom of that list were public health and dermatology with 26 and 33 respectively. Do you have any thoughts on those stats or any surprises or not so surprises? I'm surprised that public health is doing very well in a covid environment, yeah, it's very impressive, it's crazy, right, yeah, you know, I would say I've been in academia for quite a while and as deputy director of internship, I know a lot of the facts. although since step one is pass and fail, I think that number, the previous numbers for step one to join the residency, are going to change a lot from the past for fail or fail and I think the emphasis might be more towards step two, but more data.

To come, yeah, perspective, yeah, um in terms of salary, I think it's always a complicated topic because a lot of it is based on whether you're an academic versus a community city versus suburbs, um and I think there's a big variation with everyone. Those factors are in place, but I will say that I'm not surprised that, unfortunately, we are number one in terms of burnout. I will say that I consider myself the least burned out or one of the least burned out positions, for multiple tutor reasons, but I can see that just with the tolls of it all, with the greed compounded by the fact that we have a hard job, I like it. what I do, but I have to face the facts, the facts are there, yeah, yeah, so what is emergency medicine?

Do you want the definition from Wikipedia? What do I think of her in C medicine? Give me both. Give me Wikipedia. Layman's definition and what you think emergency medicine really is. So I'll give you the hybrid. How about? Well, it sounds perfect. I think it's emergency medicine. It's the art of resuscitation stabilization and a little bit of family medicine all rolled into one um we don't say no to everyone okay sorry we don't say no to anyone um we treat everyone best we can and with every patient visit, whether it's a toe, a heart attack or a stroke, our job is to say do we stabilize them, are they safe to go home or do we need to hold them and make sure everything is good. um you know we are the keepers that we are. the people who do the triage and say if you're sick or not and that job responsibility is very hard to put into words now, of course, if you actually go to dictionary.com or Wikipedia, they'll do a better job, but I think we're , in other words, jacks of all trades and we try to dabble in a little bit of everything, yeah, and that's emergency medicine, yeah, that's interesting and what I think or what I thought as an emergency physician before I came. in medical school is the person in the emergency room is that always what an emergency room doctor is the person in the emergency room or may be in different jobs in other places doing jobs not necessarily just in the emergency room um , I think that's a more complicated question because I think in the context of Kobit Covert has been a game changer.

Well, you know, there are emergency physicians, emergency department physicians who operate urgent care and who do telemedicine, and part of that is doing everything we can to reduce risk. amount of overcrowding in the emergency department and our jobs our training makes us very versatile you know we can do a lot of things and the patient servers and the outpatient service in the digital service we can we can offer a lot um now I'll do it Say that many of We may feel more comfortable in the emergency department working with our nurses, our technicians and all the hospital staff, but you know, I would say we are able to put ourselves anywhere, we will figure something out, have you found it?

You yourself are doing more telemedicine things and things like that since Covid. I found myself pivoting a lot to support our telemedicine department. Okay, I will say that I still do telemedicine from time to time, but most of my time is spent in the emergency department as a physician. and also as a teacher I understood it, I understood it well. Now let's move on to the question of why emergency medicine. Many students know that they think about it, maybe they know when they first come in the first year, but I usually think about it. Most people solidify their decision around the third year of medical school, when did you know you wanted to be an emergency room doctor?

So I always tell the story. In fact, yesterday I had a meeting with one of my medical students about his career in tumors and seed medicine. or have doubts about whether they want to pursue emergency medicine. I always tell them that my story is that when I started medical school I was one hundred and twenty percent in the primary care boat. I joined all the Family Medicine interest groups. I attended their national conferences and thought that's what I wanted to do, but emergency medicine is weird, it's one of those jobs that chooses you, but not the other way around, and during one of my outings, a second obstetrics rotation , I had an absent Rotator, an audition student that I have Met me maybe once or twice and after seeing me in action for one or two shows, he came up to me totally point blank and said Tony, no, I don't think you're cut out for be a primary care person.

He seems much more active, a little restless, and have you thought about emergency medicine? And at that moment I felt insulted. I thought: what do you mean by emergency medicine? Those Downstream doctors none of that preventive stuff you know about user resources. This is absurd, um, but. I took it seriously because when I was doing family medicine and you know, bless those doctors, they work so hard, they have so many things to do. I wasn't at home when I was doing that rotation and I really tried to do it that way. I said no, this is what I absolutely wanted to do.

I set out on this path. I have to do it, but when I decided to take his words into consideration, I took a week off. emergency department and from that week-long exposure I realized that there was a completely different side to medicine that I didn't know about and I loved it. I love being at the forefront of medicine. I loved providing care to people who didn't know what. type of medical processes that they had well. I was able to learn how to set up Rapport in a quick period of time and to be honest, it was very rewarding.

You know, seeing that someone can come in with a big problem or a small problem and you were able to make a dent in that and that felt very rewarding and we certainly saw a lot of sharpness like different levels of Sharpness during that shadow change or Shadow month process, but I liked it so much that I decided to pivot my career completely. and I haven't regretted it since, so it was a click, it was as soon as you walked into the emergency medicine room and started seeing those patients as a medical student, you're like I know this is for me, yeah, and I think part of this is when I was in Family Medicine.

I felt overwhelmed by your frustration as a doctor told patients suggestions and recommendations and took it personally when each time they simply could not comply with the recommendations due to a crowd. of complex socioeconomic issues of senior sales and support, I learned that they are there for a reason, but when I was a student I got so frustrated that I thought, oh my God, you're going to get back in, your hpa1c is higher, your blood pressure is so high that I feel that if I meet again in a month we will do this again. It felt very challenging once again.

God bless those doctors who are doing such an incredible job and when I was on emergency medicine rotation during that shadow. week I realized that okay, you know these patients, regardless of the hardships they endured, regardless of the challenges they had in getting those medications, when they're with me, you know, we'll start with a cleanse like Blank Slate, I'll take care of you no matter? What happened? You know, whatever difficulties you had, unfortunate circumstances. I'm there, no judgment, it's a judgment-free zone. I'll take care of you and we'll go from there. I felt like that eliminated a lot of those prejudices. burden that some people can have and the non-medical world in the medical world when you are in the emergency department everyone is the same you can be the CEO you can be the custodian you can be a famous athlete I don't care we are all on the same page.

I'm going to be your doctor and I'm going to take care of you and if I can't take care of you, someone else will figure it out and we'll do it. Immediately everything is fine if I work that hard, you know I'm going to make sure something good happens at the end of the day and I and I feel like I don't know, just being in that clinical environment. It gave me a great thrill and it really reminded me that why I wanted to be a doctor in the first place, to be there for someone when they need it and I think that's emergency medicine, yeah, it's interesting, because because you had it. a required emergency medicine rotation in 30 or not, no, emergency medicine as a core requirement really started to become commonplace in the last few years or so, traditional emergency medicine, I mean, as a field, we're still very young, but I think I just started offering don't quote me in terms of the date is incorrect, but since a few years ago we started offering emergency medicine as a core rotation, it's a third year medical student, it's traditionally a elective subject, so most people should know your interest in emergencies. medicine before they even started, so I had to take the opportunity, take a week off and explore this, which ultimately made a big difference in terms of my career choices.

Yeah, it's interesting because you said something that I've heard. A couple of times now someone has told you that you know you should research this and not research this and Mike, I guess I wonder what you do if you're a student and someone hasn't told you that you know them. You're destined to do this or that because I don't know, no one has really done it. I guess someone once told me I should do this, but I wonder if you would have ever discovered emergency medicine if you knew that. The obstetrician didn't say: you know what.

I don't think you should be in primary care. I think you should go to emergency medicine. Do you think you would have figured it out anyway or I don't think so? Yes I think so. I have been very unhappy as a primary care physician. I think it's interesting. I would have done it and I wouldn't be happy about it. Show the power you have as a teacher. Because it is these fortuitous scenarios, these trans interactions that could change the course. of someone's entire career as a student and I don't know, it always makes me wonder if I didn't do it because I've never tried otolaryngology, I've never tried orthopedic surgery, you know this kind of other stuff and I wonder, maybe that's what they wanted to do. , but no one talked to me or talked to me about it.

I don't know, it's just something random to think about. No, I think thanks for mentioning that. I always say let the tank get a message. My story is to keep your options open even for those I specifically advise. At Jefferson we have a very organized faculty student tutoring process. If we know you are interested in emergency medicine, we will match you with one of the internship directors who will read his CVS and help youwriting your personal statements will look at your ranking list as if we will follow you every step of the way and even for those very dedicated students like them I will say by the way to keep your options open because I never know when you just say yes to something and it will change your life completely.

Yes, and I've seen that a lot of this will lead to a different conversation. We have seen many people abandon emergency medicine. If you look at the data from this year's game there is a significant drop compared to previous years, whether due to covid, due to exhaustion, due to turnovers, the costs are abundant and there are numerous articles on emergency medicine for animals, as well that talks about the future of emergency medicine as a field that I don't think this podcast can be, yes, it might be too long a podcast to go over that concept, but you know, I think it's important that, from the perspective of the Students, keep things together. open because you never know what this is, maybe let's put it aside for a second here, why is this hat like this?

Because why do they say that people are not applying as much and is it because there are not so many students? apply for emergency medicine residency, it's your turn or I guess this is what you're saying, they're not really sure, so objectively yes, there are fewer medical students applying for emergency medicine, there are an unprecedented number of spots vacancies where in previous years the emergency medicine residencies had that the students who entered had to go through the soap process to find a place because they could not match with emergency medicine and I think the causes of that are multifactorial, yes, and yes, it is interesting. process yeah I guess I hope like all things he likes the ebb and flow and maybe we'll be at one of the lowest points and we'll go back up who knows yeah that's interesting what was um. residency like for you, so I love my residency show because I don't know if listeners can see it, but I'm still wearing my favorite life jacket, talk about your jacket, what's your jacket?

So, my badges, it has this. He looks like a star, what is that man there? No, so this is actually a ppikachu, so it's a pin. I got this at the beginning of Covid. um, you know, there's no product endorsement. I just have it. cheese, I have some other Pokémon pens in my white coat, oh sorry, my blue scrubs here I have some in my white code and that's why I have too many in my Waco, but this jacket is kind of a gift because it I did. A lot of what is called package life is a critical care transportation service that was offered at our institution where we trained and the whole process where sometimes there are patients who are too sick and those patients need a higher level of care and for those transporting patients.

There is often a doctor on board one of those critical care transfer ambulances to provide emergency care and resuscitation as needed. You know it's not uncommon for patients to put chest tubes in there or start chest compressions or pericardiocentesis. It's just that those patients are really sick. and one of the opportunities for my residency program and I gave them a few years notice, so in case this information is inaccurate just because of time, you know we have to get on that ambulance because, for lack of a better word, as an opportunity to obtain more exposures. to Pattern Transfers, so I did a few of those shifts.

I love working with the guys at Life Jack uh Life Pack over there and they gave me this jacket that I wear to this day. Wow, it's also nice and warm and yeah, it's a bit. It's cold here, okay, yeah, I tried. I feel like it's warmer than Philadelphia, warmer than Rhode Island, Boston. I try to mimic hospital environments in this room to make the treating doctors comfortable, but I don't know if it's similar in terms of temperature, okay, there's just never a good temperature in any hospital, whether it's too hot or too cold. No, I think you're right.

I think you're right about the difficulty, as in hours of work per week in residency training. was the Emergency Medicine Residency um just in terms of, I mean, I can only speak from the perspective, yeah, I mean, I thought we were going. Rhode Island Hospital is a very very busy academic reception center there's only a few hospitals in Rhode Island so we had a great capture rate um we were busy so basically like you know there's only one hospital inside from a 100 mile radius and everything within that 100 mile radius comes to you, I see, but if you say one of the 20 hospitals in New York City, I know the volume can be high in general, but that volume It is distributed to every hospital I see, so Rhode Island Hospital had a very high level of critically ill patients.

In fact, in our emergency department there was a section of the emergency department dedicated to critically ill patients, um, who were also joined by trauma patients, so it was like a high acuity place, a high volume place, so I learned a lot and our shifts were reasonable. I think for the future, it will draw listeners to this

interview

, I think eight. hours is a very healthy amount and if you are very, very stoic and have a lot more stamina than me, you can try 12, but as I get older, 12 hour shifts have become much more challenging for me than they would have been a few years ago. ago and in residence, can you choose eight hours or 12 hours or do you do ours were mainly eight eight well and do how many eight do you do a week?

Oh, I have no idea, yeah, so it was It wasn't um, I felt like it was appropriate, I never felt burned out and I got it in residency, okay, cool, so I think as a student in residency, you really want to like it. . I think one of the key things you have to recognize in a program is the more patients you see the more experiences you will learn, you will be part of a team and you will become a better doctor, yes, okay, I think that is very important and if you say That you're a fourth year medical student and applying to programs and things like that, how should you think about ranking your emergency medicine programs and how should you think about choosing the ones you want to attend over others?

It's a very complicated question because it's very personalized and I will do it. Let's say I would leave it up to the student's mentor, but there are some trends, some students actually say I like the west coast, I like the east coast, I like to say I'm close to family, some students may have a preference for a three-year program. versus a four-year program which I can only say I trained in a four-year program, so I'm biased, but I think it's three or four, the graduates are more than capable of becoming excellent or their graduates. are capable of handling emergency medicine, it's just a personal preference as to which one will give you a more unique residency experience, but I think you know one of the most challenging elements is that in a post-pandemic post-greed era, something personal.

In-person

interview

s are out of the picture, and I think there's a lot to learn and experience when you go into the facilities, when you meet the people, when you visit the cities, now, of course, as someone who's on the court committee . I also recognize that asking everyone to travel to a new city, especially during interview season, is expensive and time-consuming, and there are pros and cons after everything moves to the virtual element. As an old school person, I miss visiting people, but I think, going back to the question, what recommendations would I have is to spend as much time as possible with the residents because I think you'll read a lot of things on paper, but it's really about to talk to students. asking them about the questions that I think really distinguish which program is up or down, I got it, so definitely reach out to your Mentor when you're figuring out, definitely reach out to your Mentor because I think this is a very personal decision, um and as far as I know.

I know, there is no list that decides which is the best emergency medicine program. There may be some lists floating around out there, as far as I know, and within my circle of emergency medicine leaders in the country, I don't think I give that list much credence. I see that it is possible. I understood. I see I don't have access to a secret success list here. The best emergency medicine residency programs. I don't have that here. He really has it and he's not giving it away. For me, no, no, I don't think, as far as I know, as far as I know, I don't have that access, okay, I have it, I have it, but now you're an assistant.

Yeah, how's that? It's a lot, it's a lot of work. Yes, okay, it's a lot of work, more work than residency. I would say if you do hours by hours. Yeah, I think MRI definitely puts in a lot of hours. I think, as you mentioned at the beginning of this interview, assistants generally work in their late 40s. 46 yeah, 46 compared to the average for regular MD attendance or other specialties, the average is 51 and then emergency medicine attendance is 46. So I would say we probably work a little less hours in residency, yeah, but I will say that it is an emergency.

Attending is a stressful job because you are taking care of all the patients in your area and all the patients have different backgrounds, different levels of acuity, different things that can happen acutely during your shift, it's a constant war zone and I just don't do it. You know. when someone who came in with a benign accident or ended up having something more catastrophic and now all their attention is focused on that area while their other patients go unnoticed, then I think the level of responsibility at a stress level increases significantly as a assistant, but you are trained to do it well, as the purpose of a residency is to train you to know how to handle chaos and in a way that incorporates all players within the department to work in sync to best expedite the patient.

Take care of yourself, so you're trained to do it, but that doesn't make it any easier, yeah, yeah, what's that what everyday life is like for you? So let's say, I know weeks can differ, so let's start with a week. So what would an average week look like? Do you have a couple of days where you're in the emergency room? I know you are also a teacher. Do you spend a couple of days teaching how it works for you right now? so I will say that I'm probably not your traditional emergency doctor and I try to do everything and that can be a little exhausting, so on a day to day basis I will say that I spend a lot of my time as an internship, I spend a lot of my time to teaching.

I teach about five or six classes. Wow, a lot of my time is spent on tutoring and a lot of my time is spent on research and some of the time, which should be more of the I should spend time with my family and I will say that work-life balance. It's something I'm struggling with, but from an academic clinical perspective at least that part is easier, but my day to day life I generally don't know. At 8 am. is when I teach, I start my first class followed by mid-afternoon meetings, followed by clinical shifts in the afternoon and I rinse and repeat, so normally I want to show you what my schedule is here, but then it's like this, it's like you're teaching for this eight and then, yeah, let's break it down if you don't mind, yeah, yeah, just walk me through a day or a particular on average, the most average day that you can find. so let's see what happened in ah so let's say today's last one was today today is the 27th 27th so let's say on an average day it's like last Wednesday so last Wednesday I taught from eight to twelve I had a meeting of 12 at 1 I had a teaching session from one to two thirty and then I think I had five meetings after that, five meetings after that, yeah, I think my meetings went until 11 at night, oh my goodness. , this is a lot and these are these. are these, no, it's not time to be in the emergency room, it's just meetings, meetings, teaching, teaching, teaching, teaching, meetings, meetings, wow, um, I might have a decent amount of academic discount, so for most doctors, or you work clinically, yes.

You do research or you do administration and that's how it is, the work of teaching is like the work of teaching administration and research. I think those are like the four ways you can prove yourself in the hospital. Obviously you can't do everything. them all the time, yes, so anything you can do in one of the sectors will slowly eat up your clinical time, so I don't spend as much clinical time as the traditional ER doctor, but then that extra time I spend on my other interests. And I just want to bring you into the topic of burnout, which I'm sure we'll inevitably talk about, but I think there's been some literature on the process, as one of the solutions to burnout is to diversify your interest and do something you love other than emergency medicine, so I love teaching.

I love thetutorships. I think that's something I value a lot as a resident. I had tremendous and helpful mentors who shaped who I am as a person, not just a doctor, and I and I love it. doing that for students in kind, so I dedicate the extra hours of my day to helping student mentors become an even stronger version of who they were, so you know, with my position on the SI minute, personally I mentor some of the students you even know. as a first or second year medical student, they are already applying for grants to present at conferences, and I love doing that.

I think I love working with medical students, it's funny because they always consider themselves a lower totem in the hospital chain. I think it's just untapped resources, everyone has so much talent, everyone has so many skills. Look at you, you do these interview sessions, you have your YouTube channel, it's crazy, it's crazy, but everyone has incredible talents. and unfortunately the only thing we see in assistants is just their medical abilities, but I see them for so much more and I love giving them opportunities and finding them mentors who hopefully have something else I can offer them so they can be the best they can be. be and they have more options to choose from, so I love that and when I do things that I love outside of my job, it gives me life, you know, work can be hard, actually, work is not that bad. it's okay, I love the job, but whatever stressors I have at work, I get to Mentor, you know, I get to Mentor, I get to teach these students, I get to be someone who can push them to do what they want to do, right, um and I? and I love that and that takes time out of my day, but it is something that gives me joy and reduces my exhaustion.

Did you have an experience with a specific Mentor or something like that that you were so passionate about or was it really like when? you started mentoring students and hanging out with students, you're like, wow, this is almost like the click you had when you were in the emergency room during that junior year. Okay, this is what I want to do? More than what students teach students. go ahead, yeah, you know, so I was going to say I've been a terrible mentor coach for the last four out of five years because I didn't know what it meant to be a good mentor, now, and it was necessary. some you know, figuring out the right things in the wrong things that I've done to say, "Okay, I shouldn't have the same expectations that I have for myself and all my trainees and it took me some time to get over it, but I also think." that you should never have just one Mentor, there should never be one person who is in charge of changing who you are or making you better, you may have a public speaking mentor, you may have a mentor on how to be a better husband, Yes You're spending a lot of time at work as someone who you see as, oh, how is it possible to balance six kids, work, and a happy lifestyle?

Please teach me your methods, right? I'm a big fan of having multiple mentors at All Elements of. Life and I got it because I had multiple mentors and all the elements of life and I learned a little bit from each and every one of them, as well as emergency medicine. I learned a little bit from all the consultants I talk about and then I became just a little bit smarter day by day, like students or people should? I guess they find their mentors because then this is a key question. I think at Jefferson we have an incredible connection with the teachers, professors and aides.

It's one of the reasons I love him so much. It's one of the reasons I only talk to people in Jefferson is because you guys are amazing, you're there for us and you really take the steps to communicate with us, which I think is different than other places, so, what? How can other students be? or maybe people that even you don't know on the same path how they should find mentors you need to find a good Gateway mentor, you got it, you need a Gateway mentor because you need a mentor who says you know a mentor who is able to look inside themselves and say they need something I can't provide, but let me reach out to someone else by word of mouth and say, "Hey, look, Zach needs someone who's really good at IT and social media, and I use a paper encyclopedia, so I don't think I'm the right person.

Do you really use an encyclopedia? I have an encyclopedia, but the point is that I'm going to reach out to someone I know who might have a little more knowledge about this and he or she may know someone else, so you know it's standing up for yourself and knowing someone who is willing to stand up for you. I think not networking is key. In fact, I'm really terrible at networking even though I don't. I like speaking in public, yes. As crazy as it may seem, I end up doing a lot of this, but you know I find that networking is really the best way and finding a mentor who works hard to recognize what they're good at and what they're good at.

You're not good at the key to like finding multiple mentors and you said the first four years of your five years of mentoring you were doing it wrong, yeah, why were you doing it wrong? You know, if you think about a pendulum in terms of the tutoring styles that I used from the initial elements. You know I'm an immigrant. I was born in China. I came here and I think my parents had the successful American dream. I think I continued that successful American dream and I have As an immigrant, I have a high expectation of what it takes to be successful, so I do a lot of things inside of work, I do a lot of things outside of work and initially, as a mentor, I put all those expectations on my students, which requires a lot of sacrifice that I think not many of my mentees who didn't share my future goals really appreciated and I think I probably burned some bridges as a result like I was a bad mentor and then the pendulum swung toward laissez faire. like what if me?

I just tell you one or two things and you figure it out and then I realized that with that kind of hands-free tutoring there was no guidance and as a result nothing happened, like I didn't think I had given them good direction . They didn't know what they wanted to do and after a year or two we ended up being friends, but that's not what a mentor does. We can be friends without being mentors, so I think I'm moving more toward the middle ground now. where you know I have to accept what elements I can bring to the table as a mentor and now I'm very transparent about this is who I am as a mentor these are my expectations if you want me to be your mentor these are my expectations for you but I don't think you need to have them so you should tell me what it is that you want and I want to meet your expectations and anything that happens beyond that you have to give me permission because, as adult students, they are not going to do something that they don't want to do well, so if there is no um, there is no reward in the end, whether intrinsic or extrinsic, they are not going to do it.

I don't want, I don't want. I personally would be disappointed if they didn't do what I asked them to do, realizing that we are just adults with different sets of expectations and goals, so I would say that for the last four of my five years attending, it just wasn't a good mentor and I think I'm finally getting a little better. That's interesting, that's really interesting. I always think about it because I always come from the other side. Anyway, I'm not advising. I mean, maybe I talk. to the occasional people who are interested in medical school, but I'm always looking up to see what is a good mentor, what is a bad mentor, and what should I look for.

That's really interesting. I want to talk about burnout because I believe. We mentioned it a couple of times, you have an interesting work schedule now, not what I would think of as the classic doctor attending, right, it's different and you attribute that to helping your burnout and things like that, is there anything else you think ? that people can do, that thing that medical students or residents or physicians should consider when they're trying to combat burnout because it's almost, I mean, what's the overall 46, it's like 46 across all doctors averaged out, which is almost half, it's crazy, it's hard, I don't know, I think it's one of the emergency medications, it can be very frustrating when you want to do something and whether it's because of the electronic medical records, whether it's because of the boarding school or for inserting any complaints that some of the doctors You may just not be able to provide optimal care and then when you have burnout that spreads to yourself, your patients, and your family, one of the things that helps me with burnout from a clinical perspective is that I remember I always try to remember why I went into emergency medicine, you know I love people, you know I like to think about the good things about people and not the bad elements, because sometimes, When you're feeling particularly tired and salty, you may start to think that it's not the best of those people. and that can lead you into a very, very dark hole, especially if you are the champion of healthcare, if you have sworn the duty to protect all patients and you start to feel irritated by your patients and you can't.

I know you're biased against them, so one of the things I do is I always and every person I've worked with in the ER knows that I love my patients, which is important. I don't necessarily have to like everyone, but I love them all and I have to take care of them all and I can take care of them all uh and I think that prevents me from any burnout that results in poor patient care because it's like a lesson, this is just who I am, my identity is: I'm a doctor who loves his patients and I think that's a smart distinction too, even the words and you were saying this before when you were talking about mentoring students.

I can be with the patients, you know? I can teach these students instead of what I have to do or this is my job or this is what I need to do is interesting, it's a small distinction, but I think it's a key, it's an important key and this is one of the things that I know when I was studying, I was like I was staring at these books for like three six hours, like this is crazy. I think back to when I was applying to medical school and I thought, God, I want to be here so badly. and now I'm there and now I'm thinking, oh, I have to do this, so I think it's a really interesting different feature to do.

I mean, I have to say that I know it's going to sound very cheesy as is your interview. I'm going to go on, but I really think we feel honored and privileged to be in a position where we're like the number one doctor. Doctors are considered publicly as before Covid. I guess you know, we're like a noble field like us, we really try to advocate for health and everything that's involved and you know, in what case in the social world can you walk into a room and have someone get naked for complete and share everything that is most intimate?

Psychiatric personal health story without the blink of an eye, I mean, it's a privilege to be involved with the most intimate elements of a patient's life, a person's life, because that's our job, like our job is to take information because we go through hours and days, months and years in the library watching videos learning about anatomy, it's like we're finally in a position to put it to good use and I think we have the privilege of getting a glimpse into people's lives that are confidential and not they know. They don't even tell their loved ones properly.

I think if you think about it from that perspective, we have a special power, our power is knowing people and I think as doctors we tend to forget about that, we just tend to see. people according to their lab results according to their x-rays and we tend to forget that they are here because they are emotionally in trouble they need someone they need a hand to hold them they need someone a shoulder to cry on we think we have that opportunity and we have to cut the line most people will have to spend years to meet them, that we get there right away and say my job is to take care of you, how can I help you? and I think That's what I find romantic, that's why you know, I rarely feel exhausted, but they are situational, but I don't feel exhausted like an ER doctor or a doctor in general would.

So this is pretty awesome, has there ever been a particularly memorable super or patient encounter that you've had where you've felt this kind of connection with a person or something like that? um, I'll say it's an emergency, the Emergency. Doctors tend to be like a thankless field, um, and this could ruffle a few feathers, so I, this is like my end of such a subjective feeling, these are not objective feelings or statements. I feel like we're a little less loved by a lot of patients and colleagues because, as colleagues, we employ a lot of people like us, who we consult with, we admit, as you know, doctors were like we don't see people when they're happiest.

We are not life. Saving cardiologists, people tend to forget about us or tend to get angry with us when we don't find a solution to their problem. and I will sayone of the things that attributes a lot of exhaustion to my colleagues. and all the elements of the workforce is that there's just not a lot of positive feedback, there's not a lot of positive reinforcement and I try to change that so that every time someone hands me an EKG as an assistant, we get a lot of On EKGs, we get each EKG from every patient that comes in and instead of looking at it as just another thing that I have to read and review, I take the time and thank the person who takes the time and does this really well done EKG. for doing your job, I think you did a great job and I think it's not often that we get thanked, you know, you know, it's hard work, but a little thing goes a long way and I try to thank people as much as possible when I'm in the department and um and the reason I mention this is I recently had a patient send me a letter to my work address and I will say that when I first saw the letter in my mailbox I thought about it.

It was going to be like a demand letter. I was like, oh my gosh, what did I think HR was supposed to tell me these things and that they were supposed to read my letters before I opened them, but it was from a patient, I should say an undisclosed amount of time um a patient who wrote about their care when I was in the emergency department and they thanked me because I usually try to call a patient um I try to like once after every shift I pick a patient that I think you know what I'll call this person and see how they're doing. and I called this patient because one of his images was updated slightly and I called this patient specifically because I said to look even though the reading might be a little different.

I think this is a reading you should talk to your doctor about, maybe get an additional consultation and look at. Check it out because I think this might be what brought you to me in the first place, and that patient responded to me and told me. He said, "You know, that person was also in the healthcare industry, but I didn't know until later." As you know, as someone who works in the healthcare industry, I can see that my initial main complaint might have been overlooked, but you spent the time sitting next to me, brought a pillow to my spouse who was sitting next to me and they were falling.

In my sleep, you called me about this reading that I was initially going to ignore, maybe I would have read it, but that phone call changed the whole course and now I had this major operation that I would never have found and it has completely changed. my life thank you so much for taking me seriously and it moved me to tears I don't get many thank you letters I can count on one hand the number of thank you letters I have received um less than five less than five one hand probably more or less more or minus two, but it's rare that you know it and it's because in emergency medicine you have the task of looking for emergencies correctly and I have learned even throughout my short career that diseases do not follow The general pattern is very complicated and can be passed by high, even the most thorough examinations can miss the most devastating diagnosis and you never know when it will be your luck that you will be faced with that situation and all of us.

What we hear in our own circles is that patient for whom we miss a diagnosis. In fact, one of the worst things you can hear as a doctor is the phrase Do you remember that patient? I think there are probably no scarier words to say to a doctor. Do you remember that guy he saw? Because nothing good happens after that. It's like, oh my god, what disease did I miss? What a horrible thing happened. I could like every day, so to receive something that was so positive and unprovoked really made me feel special, I guess I'm a good doctor, you know, I guess I found something and it's like that little thing that I'm sure they would have found. at some point, but it was that extra effort that I think really made the difference from that patient's perspective. um, yeah, I think it's just some little things in life, yeah, that prevent burnout.

That is incredible. any significant impact on the way you practice medicine or the way you teach anything or just thanking more people like you're doing with EKGs and things like that, you know, I think it really reinforced some of the teaching. elements that I have for any student is someone smarter than me once told me that it's not what you do to a patient that matters, but what you can do for a patient um and just like you mentioned, it's just a small change of words, but what you do to a patient could include IVs, painkillers, antibiotics, clamps, chest tubes, you know, electrocution, like anything, there can be a lot of things you can't do to a patient to make them better, but what can do for a patient is bring him. a chair to your spouse who has been standing for 12 hours waiting for a bed.

Well, what you can do for a patient is hear that his quality of life has really decreased and that he doesn't want extensive training, he just wants something to help him. feel better, what you can do for a patient is realize that their phone is tinted and all they really want is to charge it so they can tell their parents that they are in the hospital and I think it's that element that makes Yo every day I try to figure out how I can be a better version of myself than I was yesterday and I think the inner drive prevents burnout because I think you know, I think burnout happens when you do the same thing day after day after day after day and that's just wears out it's like, well, what am I doing different today?

I think with that element of what can I do to make a patient feel more comfortable so that they feel heard. I think that's the art of medicine and I and I think it keeps me you know, it keeps me happy to come to work no, that's amazing and I was reading this on Medscape and I may have taken the numbers out a little bit, but the report from Medscape questions and it looks like in 2019 or before covid burnout in ER doctors was I think 47 around average and then jumped to 13 or so a year later, I guess this was midway through the start of Covet.

I guess we were eight months into Covid at that point, what was it like practicing the emergency? medicine during greed I guess it's still going on, but I mean, during the initial beginnings, the first year of greed, I'll try to be as apolitical as possible with these answers, um, you can do whatever you want, you can say whatever right, um. I will say that from politics, cultures, racism, apart from being a doctor during covid, it was quite difficult. I think it is a new disease, we don't know what is happening. Everyone should stay home and, except for me, yes, and not a newborn.

Wow, so me. It was like I don't know I could bring something that's going to kill my daughter every day. I don't know, I have to go to work and it's painful because there was so much uncertainty and you know, one of the scariest things and this is not Burn like you guys it was like being in a doctor. I think at some point we were looking at what the worst case scenario is. What happens when there are not enough fans? How do you say no to a dying patient and tell them? Sorry, we don't have the resources to save you, we have to choose someone else, you know, it was a lucky start.

Parts at the beginning of covid, except New York, people just didn't want to come to the hospital. and because they were afraid and what ended up happening is that people who had serious, uncontrolled chronic illnesses just got worse and they just showed up and died. Wow, that was the other half, either people came with really sick greed or people were really scared. from the hospital who showed up with decompensated sepsis or Cardiac Arrest because they just said you know I have this chest pain but you know I don't want to go to the hospital because I don't want to risk that so The heart attack just got worse so medically it was challenging and at some point the overcrowding and inability to discharge patients from the floor above became so rampant that you know overcrowding is an emergency and just not being able to provide care because there are no rooms available to see a The patient was depressing, I would say that was probably when I felt a little exhausted because you see the waiting room, you know what their chief complaint is, you see their vital signs and you look at your own emergency room and you say there's not a single open room that I can take them to and we did a lot of creative things and then I have to thank the operations team within Jefferson who did an incredible job of expediting patient care. creating rooms where none existed, many emergency protocols had to be put in place, but even then it's like putting a bandage on a big open wound.

I mean, it's only going to last so long and that's probably the most challenging element because as you can probably guess I want to take care of patients. I want to see them get better and be physically chained and not be able to see them. It's just difficult. You know, it's like you watch his vital signs get worse and then you just say. Well, I want to do something for you, but what can I do? Yes, there is not enough equipment, there is not enough staff and with the staff calls it was also a challenge because people get sick, yes, with greed, yes, it's not even that people have done it.

I don't want to come to work, I got sick, and then we're short-staffed, so there's a shortage of staff, too many patients, not enough room to see them, and patients get upset because we're trying to be creative in caring for patients. and now privacy becomes an issue when people are in the hallways just to be seen and it's hard, it's hard to be a teacher, it's hard to be a learner, um and I think that was very stressful back then and it's still going on now. , yes, but I mean. I think there's recent news right now that I think the children's hospitals in Philadelphia are being overwhelmed by diseases like the flu and RSV, and yes, it's difficult, yes, yes, and we're also busy, I think a lot. of our neighboring hospitals are also busy and we are trying to do the best we can and each hospital, their administrator said their operations team is trying to make the system more efficient, better, stronger, but it is difficult, yes, That's what makes a system more efficient. um, getting people through the check-in process quickly and then the discharge process quicker, assuming they're healthy, of course, uh, but the time from discharge to leaving the room and the rooms being ready for another patient. is that.

Tilting a system is or is, so I would just say that because I'm not on the operations team, I want to say something that is incorrect, but only from a global sense, so reduce the time for a doctor to physically lay his hands and eyes and do an exam for a patient, allowing for more flexible boarding situations like an inpatient floor, so creating rooms now, of course, this is under the emergency concept, we wouldn't do this under normal circumstances, but we have to reduce it, perhaps elective. Imaging, for example, instead of going to the ER for a non-emergency X-ray or CT scan, maybe try to arrange a smoother outpatient process and sometimes it might just look like you might be admitted, but in an environment without hospital space. outpatient providers to create a more robust follow-up process with these patients so that instead of being admitted to the hospital, they can get expedited outpatient testing and follow-up, so the list goes on and on and I think what we're doing our best now that it's been so many years after Covid is to try to make the system even more efficient, but it's an ongoing process, yes, and we tried things that worked, we tried things that didn't work and every day we just have to return. and as emergency room doctors I just say keep trying, yeah, yeah, and I apologize.

I know we're not technically supposed to say emergency medicine, it's always like one of those slap-on-the-wrist situations, so it's emergency medicine. The doctors or the doctors or the emergency department understood it technically. Emergency is just an emergency room, which is a single room. Oh, technically it's like one of those little nuances like spelling Ophthalmology correctly, it's like you know it's just that little H over there, um. OB GYN a dash or a dash or it's a ribbon, you know what I mean like one of those, what's it called a slash? I don't know iPhone, no, the slash, especially yes, so given these happy stories, I say I was going to give you a hundred. million dollars today tax-free in your account you will never have to do anything, you could do whatever you want with it, right?

Let's keep working, you could still keep working, yes, yes, I'm one of those people who will do it despite the disagreement from my wife. I'll probably work until I evaporate in a cloud of smoke. Yes, would you change anything? Would you do more? Would you spend more time doing different things or would you continue working in exactly the same way? You would probably work less hard. Thisemergency, get a mentor now, get a mentor now, yeah, yeah, I think because my job as a mentor is not to push them into emergency medicine, but to give them every opportunity to be successful if they apply to emergency medicine.

And it never hurts to have a mentor from an early stage in life. The way emergency medicine looks right now, historically we've never been a field that cares much about research, so it's not a field where you need to publish six papers before you get started. I'll be considering a field in emergency medicine, which I know is true for some of the other more competitive specialties, but you know the whole concept of talking to talk to a mentor, see if we're the right field for you, see if you want to consider it . whether this lifestyle is right for you and your family and you know you have the necessary qualifications to do what we do.

I think having a mentor is probably the best thing. Find a mentor. Do you have any final words? anything you want to mention, anything you want to mention, any final message or anything like that you want to say. I think one of my last words is: remember that you are there for your patients, you are like an ER doctor, like an ER doctor. I'm like the first and last person the patient can see for a while and you only have a few minutes to make an impression and that can be true for many specialties as well, but sometimes it makes a good impression. when they've been waiting for you for 10, 8, 12 hours, they don't want to see someone who's exhausted, you know, they don't want to see someone who's in labor, who, you know, loaded down with baggage, they want to see a supportive face.

You know, be positive, be happy, actively listen, listen and I think that would make a difference. It's fantastic, great. Thank you very much, Dr. Zhang. I really appreciate you showing up and I think this was really very helpful. Thank you so much. Okay, great, perfect. awesome that was fantastic