Episode 15: Combating Burnout And Advocating For Global Access to Healthcare w. Dr. Ana Maria Crawford

May 24, 2019


This Episode

Interview w/ Dr. Ana Maria Crawford

You Will Learn

 – Important considerations to allow medical missions to truly benefit the recipients of care.
– How to balance projects, committees, and clinical time with sanity and personal thriving.
– How Ana managed to take six months to go to New Zealand to practice anesthesia there.
– How taking an intentional period of time to consider your priorities and values can be deeply helpful in combating burnout and in restoring a healthy perspective.
– How cultivating other interests can make you a better and more well-rounded physician.

Resources & Links

Show Notes

This week’s guest is Dr. Ana Maria Crawford. She brings some amazing perspective as a physician who trained and teaches in a top academic center, while she also has a strong global health focus and has built a lot of infrastructure to equip younger physicians to pursue practice in under-resourced areas. She also has made a conscious decision to combat burnout in her own life, taking a six month locums assignment in New Zealand and a six month sabbatical in the midst of her busy schedule to provide for her mental health and personal thriving.

Show Transcript

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Dr. Crawford: [00:02] Basically it started in 2006 in Rwanda, had one anesthesiologist in the entire country. It’s a very densely populated country in one anesthesiologist is not going to cut it. So since then we’ve developed an anesthesia training program and graduated several physician anesthesiologists so much so now that they’re actually running the training program. So we’re starting to focus more on some specialty training.

Justin: [00:26] Hey, this is Justin Harvey, your host of the anesthesia success podcast. My wife is an anesthesia resident and I’m a financial planner and I work with t anesthesia and pain doctors as my clients. This podcast is designed to help the anesthesia community be informed about their careers, the finances, and more by taking important questions straight to the experts. Thanks for tuning in. This week we’re doing the first of a two part series about the practice of anesthesia internationally and I wanted to look at opportunities. We’re currently practicing anesthesiologists who are interested in medical missions or looking for cross cultural impact with their vocation as an anesthesiologist. And so today I’m pleased to introduce to you Dr Ana Maria Crawford animal share with us about her interest in using her skills as an anesthesiologist in places where access to medical care is very limited and how she got involved with the asa and at Stanford to equip many other anesthesiologists who have come in behind her for global medical excursions and make sure to stay tuned to the end where Anna also shares some amazing insights about her own battle with burnout and how she buys us physicians to really take control of their own schedule in life since no one else is going to care about doing that as much as you will.

Justin: [01:35] Hello everyone. Welcome to the anesthesia success podcast. I’m really excited to introduce to you our guest this week, hailing from out in the bay area, Dr. Anna Maria Crawford. Anna is board certified in anesthesia and critical care and is currently a clinical assistant professor of anesthesiology and global health at Stanford University at Stanford. She founded the division of Global Health and anesthesia in 2012 and continues as a co director of that program today. She has experienced in both academic medicine and private practice in addition to her global health endeavors. All of which I’m excited to unpack here today. Anna, thanks so much for joining us. Thank you. It’s good to be here. So I first came across some of your written work on thrive global is website, which we’ll talk about in a few minutes. where your author page has this tagline. And, and this is what made me think I need to talk to Anna. It says position teacher equity defender and global health advocate. So I read this and I knew that this conversation had to happen. So why don’t you just take a minute and unpack what that is and why you encapsulated yourself in that manner.

Dr. Crawford: [02:37] Well I think it encompasses the many interests that I have and have developed throughout my career. Definitely stayed in academic medicine for most of my career because I love to teach and love to have that interaction with trainees and love the support and the resources that you get from academic practice. So the teacher part is, is pretty easy and pretty obvious. Global health has been a passion of mine that I’ve developed since I was actually an intern, which was kind of my first exposure to global health. And I’ve really sought to learn as much as I can about how to do global health and how to do it ethically and then in in that have realized that, well, going back to global health, I think the advocacy part is, is fairly obvious but may not be for everyone. I think that advocating for patients globally is really the whole point of global health, which is sometimes confused when people want to just travel or go on these medical mission trips, not really recognizing the impact that they’re having on the local community. So I think advocating for the patients globally is really the whole point of doing global health. And in that is, is defending equity of resources and providing opportunities and facilitating the needs of colleagues that are working in these lower resource settings. So recognizing that you can’t just go and apply the same medicine or principles to each place, you really have to facilitate the individual needs of each location in which you’re working. So I think that really helps to promote our colleagues that may not have the same resources that we have. So that’s the equity part of, I’m trying to make sure that happens.

Justin: [04:18] Awesome. Makes Sense. So you mentioned that intern year was when this sort you awakened to this, this desire to be a global health advocate. What, was there a catalytic event or something that happened where you thought, this is something that I want to commit to?

Dr. Crawford: [04:30] Actually there was, when I was an intern, I did a preliminary medicine year and this was back in Alabama actually. And I had the opportunity to go with my intern colleagues to a very small village and Kenya. And at this point, you know, this is prior to anesthesia training, prior to critical care training. So I really didn’t have too, too much to offer other than physical exams and differential diagnoses. And long story short, that’s kind of what the entire trip had to offer. We didn’t really, you know, even though we saw 2000 patients in like four or five days, and we had patients lined up around that on the streets. You know, we took furniture from local houses, we took sheets from local houses, we used community members, we ate the food from the community, et Cetera. And we saw lots of patients and we gave lots of diagnoses. I think we probably had one time critical intervention on one patient, but when we left that community, we left it in the exact same condition in which we, so I think that to me was very eyeopening in that I realize there’s gotta be a better way to make an impact and to share the resources that we have from the west and the north. So that was very eye opening for me in that I didn’t feel like we had done much at all despite having a really wonderful experience. I think I benefited a lot more than the patient’s dead, which is the opposite of what you’re trying to do.

Justin: [05:54] Right. Did you have any personal at that time that you still remember as you think back upon that trip?

Dr. Crawford: [06:01] Yeah, actually, funny you should ask, there was one woman who, or this is, it’s a little embarrassing, actually 10 met, but she had much more of a profound impact on me than I had on her. She was about the same age, so she was probably late twenties, early thirties, as was I. And she had signs of aids, so she was, you know, not HIV positive. She had aids defining illnesses. And so of course I started to ask about resources or referrals and medications and antiretrovirals and realized there was just absolutely zero resources available to this, this woman that was for all intensive purposes the same as me. And that was just really devastating to me. And I think actually she ended up consoling me. She’s pretty terrible because it was just so upsetting to me to realize that you can have two people living in parallel with such different stories just based on where they were born and the resources available to them. So that was an incredibly, I think it’s an embarrassing story just because I’m admitting my naivete, but it was a very eyeopening experience for me.

Justin: [07:10] Yeah, yeah, that makes perfect sense. It, I went to Uganda when I was a teenager on a part of a, a missions trip to do some construction for a church. And I remember having the exact same experience I was hanging out with these 1618 year old guys knowing that we share a lot chronologically speaking, but there’s this huge cultural divide and then from a resource standpoint like our existences are going to be so different. And that’s so utterly humbling when you kind of process that

Dr. Crawford: [07:40] And absolutely yes, yeah. And it’s just really eye opening. But I think there was another experience, which may sound silly because it’s not related to medicine at all, but I was lucky enough to share this experience with my older sister who is nonmedical and didn’t really have, you know, any medical expertise to offer, but was there really just to help organize. But I think, you know, she saw all the young children in the village and she had handed out, I don’t know if it was candies or pencils or whatever and inadvertently angered some of the village mothers because it ended up causing such a disturbance between the children and they started fighting over these little trinkets. Then my sister just thought would be a lovely gift. And so I think that was the first experience of recognizing that good intentions don’t always have good outcomes and you know, you’ve really have to be conscientious about how you interact with people when there is such a cultural divide and a gap in resources.

Justin: [08:39] Yeah, that makes perfect sense. Maybe you could take a minute and give us a brief overview of all of the different roles and responsibilities that you currently fulfill.

Dr. Crawford: [08:46] You know, well I’m kind of all over the map, but have done some really, really amazing things and they’ve been really lucky in my career. So I, as you probably read, I was full time anesthesia ICU at Stanford University for about seven or eight years and then decided to leave briefly for a private practice job, which I ended up having a bad experience in deciding to leave and subsequently kind of reshuffled the deck a little bit on what I’m doing career wise and personally, you know, kind of trying to find a better balance. So currently I’m coming back from taking some time off and exploring some other things. I had moved to New Zealand and did ICU there for six months and then came back again. Yeah. So back in that, in the bay area, just because my, I have a lot of family here, but currently now, clinically I am still at Stanford working probably per diem hours, part time hours, not, not as full time as I used to be. And then also working clinically at some of the other bay area hospitals, which has been really interesting. It really has afforded me a lot of, flexibility in my schedule and autonomy over my schedule. But at Stanford in particular, I doing some clinical work as I mentioned, but also continue to be actively involved in the global anesthesia division, which we formalized in 2012 2013 we also have a global health fellowship at Stanford and we have our second fellow with us now, which has been really fun and exciting. We have also a resident pathway for anesthesia residents and interested in global health. So we have a lecture series with them and they are also afforded opportunities to do projects collaboratively with some of our partners abroad. So that’s been really fun and interesting as well. So those are really the projects at Stanford. But a lot of these projects kind of dovetail on to other areas. I also have recently started a new endeavor volunteering as an anesthesiologist for an organization called operation access, which is in the bay area. And that organization basically provides free surgical services for patients that don’t have access to health insurance. And that’s been really lovely. And then I also sit on the American Society of anesthesiologists. We have a global humanitarian outreach committee and I sit on that committee for a few years now as the program lead for our overseas training program in Rwanda. So I do a lot of coordination and organization with that. Awesome. Yeah. Awesome. I’m busy.

Justin: [11:26] That’s great. I’m curious, so there’s a bunch of things that I want to sort of revisit, but the one that caught my attention with operation access in San Francisco. I’m curious, you know, you have a very, a lot of different experiences all over the globe and you’ve got this thing in your backyard. Has there been anything that you’ve seen elsewhere? Where are you found that in trying to meet a need locally that there’s been some translatable principles where something you learned in Kenya or New Zealand or you’ve been able to sort of enact some of those principles in your backyard or, or maybe even just share a little bit about what that program is like in San Francisco.

Dr. Crawford: [12:01] Yeah. So I think, some of those principles, I think specifically about the ethical approach to global health to do kind of find their way into why I’ve started doing operation access. In fact, I got privileges at a local hospital simply for the opportunity to volunteer with this organization. And a lot of this comes from, you know, that experience that I had and Kenya and I’ve had several other experiences subsequent to that in Rwanda, in Zimbabwe and other places where you’re coordinating these programs and you really have to question not only your motivations about doing this work, but also the motivations of others that you’re trying to facilitate. So I started to really question why I personally and why the colleagues that I facilitate and, and my colleagues that I work with in the global health division or global anesthesia division, why we’re having to fly to Africa to do the work that we do when we have lots of people that need health care just down the street. And I kind of started a search looking for ways to become more involved. And there’s a lot of opportunity for the primary care specialties to work in local free clinic and things such as that, but it’s a little bit more difficult to actually coordinate and volunteer in perioperative services. So surgery and anesthesia, etc. Simply because those resources are so incredibly expensive that there’s just not a lot of it that that happens. So I’m new to this organization, but still really excited to learn about one, how the organized organization is run currently, but also how I can help push that a little bit further so we can impact more people in the bay area. But I think that the principal you’re asking about is probably that you really want to make sure that the patient is the one benefiting from their own the project. And so I think that’s really why we need to start looking at where we’re doing things on why we’re doing things since I’m constantly evaluating that for myself and others.

Justin: [14:01] Yeah. Great. So you had this experience as an intern in Kenya and then he came back and you’re back to the residency grind and I know that you’ve had a few what I would call career epiphany’s as you matured as a clinician, why don’t you kind of take us through a little bit of that timeline. What was your residency like and how did this global health interest continue to marinate and then sure. How does that manifest in conjunction with being a very busy doctor the way that you were expected to be?

Dr. Crawford: [14:29] Well I think you are pretty spot on and although there are two very big questions and that one is how was my residency, which would be a whole another interview I think. And then a second is how did this global health interest marinate residency was? As you know, because you’re living through it now is very challenging, very demanding. I was right at the cusp of the 80 hour work week enforcement, etc. So we’ve really just weren’t super exhausted and I had went to a very hands on type training program, which is great, but the didactics and et Cetera, this is years ago, so I’m sure the program has changed dramatically since then. But you know the didactics and the learning was, you know, you really had to be self motivated, which is good for some not so good for others. So I, I considered it good training a bit challenging in that. So I wasn’t really thinking about global health very much because my bandwidth was pretty consumed by it.

Justin: [15:23] Makes perfect sense.

Dr. Crawford: [15:25] There wasn’t a lot of room for it, especially when you, you know, you didn’t have the 80 hour work week restrictions.

Justin: [15:31] Just try to laundry and go grocery shopping occasionally.

Dr. Crawford: [15:34] Yeah. If I got a shower in and I was probably doing pretty good if I ate. Yeah. So then I went to Stanford for my ICU fellowship, which was a really lovely transition. I really, I’m originally from southern California, so it was happy to be back in California. I’m happy to be closer to some of my family. But again, I see fellowship was pretty demanding, not quite as demanding as my residency. And I really enjoyed that. So it wasn’t long after that that I, you know, once my bandwidth kind of opened back up, I started to think about global health once again. And I was looking for a Master’s program, actually. I was going to do a master’s in public health and I was looking for programs that had an international slant, etc. And then I found this master’s in global health sciences, which was just up the street at UCF. Since Fellowship, I’ve lived in San Francisco and commuted to Stanford. So it really was, geographically convenient. So I am lucky enough to have a very supportive, really incredible chairperson who really facilitates faculty and lets them, you know, execute their vision. So Ron Pearl was really open to discussing with me about going back to get this master’s program while continuing to work. So we rearranged my schedule ever so slightly. but I did a full time masters and was working full time for a year. So that was all pretty challenging. Yeah, right. But he understood that I wanted to go get this master’s in global health and like really set aside the time. And that’s really what the program allowed me to do, is to set us out a time to formally study, you know, all these different components of global health and all these different stakeholders and partnerships and just different methods of how you can impact global health outcomes. And that was awesome. I was really so glad to be supported through that. And so then I finished that and with the intention of starting global health programs for residents and fellows, etc. So I started this global health division.

Justin: [17:37] So how far removed from residency where you or fellowship at the time that you concluded the global health?

Dr. Crawford: [17:42] I finished as of, let’s see, fellowship was 2008 2009 and I finished that in 2011 so I maybe worked for a year and then did another year in that master’s program.

Justin: [17:54] Okay.

Dr. Crawford: [17:54] So I’m never going back to school again. But, so anyway, yeah. So then really started to investigate ways to start global programs for our trainees. and was also lucky enough, another mentor of mine, Drew Patterson, who’s now the chair at Emory, was gracious enough to allow me to accompany him and his group to a small village and Rwanda where we also did kind of service provision type mission trip, which was also a good learning experience. But we did, adult thyroid resections for goiters, which was on and, and very interesting. But again, kind of learned a lot about what I liked and probably thought could be improved about the service space missions and how our interventions are good and how our interventions could be, you know, maybe not so good. So another learning experience.

Dr. Crawford: [18:50] Sure. It could be good and could be improved.

Dr. Crawford: [18:53] Yeah, definitely. Yeah.

Justin: [18:55] And so you’re very busy fellowship another degree and then trying to launch these global initiatives. I know that you, from your, the writing that I’ve read, that this was a time of continuing to evaluate or maybe getting to the point where you’re thinking, what do I want out of life out of my career with balanced between these professional pursuits and other pursuits. Talk a little bit about how that was evolving during this time and how that played out?

Dr. Crawford: [19:20] Yeah. I think it was only a couple years later that I decided to actually cease being a full time clinical position at Stanford. So this was definitely a time of hyper productivity, I guess you could say. And for all intensive purposes, my career was amazing and I was doing a lot of really amazing things and had all these great resources available to me. But there were a couple of elements of the situation that just tended to weigh heavily in a negative way. And I think a lot of that were involved timing commitments, commuting long clinical days where you may or you may not get out of the operating room and any sort of decent hour, or are you just, and I think a lot of it had to do with just not on that waiting, not being able to make plans with friends or family, not being able to consistently work out and so that not knowing when your day is done, plus a commute was just really exhausting. Yeah. You know, I had all the resources that I needed. I had amazing mentors, I had amazing opportunities. I definitely had, you know, the drive to get a lot of this stuff done, but I think I needed to really reevaluate and kind of obviously narrowed down what I wanted to focus, which I don’t know if I’ve actually narrowed down the hall. I’m still quite manic.

Justin: [20:41] But it’s an ongoing process.

Dr. Crawford: [20:43] Yeah, it is. It’s definitely a learning experience. You know, there was statement while there was a couple of things. One thing that one of my mentors through Patterson said to me, which was a huge compliment, but I think very eyeopening for me. When I was coming out of fellowships, I still very young, still pretty green. He told me when at one point that I had what it takes to be the chair of a department one day and I thought, Oh God. And I just thought, you know, I guess that’s what I’m doing. I’m doing all of these things and I’m being hyper productive and I’m getting involved. But is that the path on which I want to be? Is that where I’m headed? Is that what I meant to be doing? And additionally, you know, which I love the fact that I had that kind of mentorship and people that gave me that confidence. You know, that’s just a huge gift. But for me it was a little more eye opening on what I was doing and where I was going and whether or not that was the right path for me. Right. I think another thing that kind of fed into that was the more I did with my projects in that, you know, I’m on the ICU fellowship education or anesthesia, ENT, difficult airway teaching or all my global health stuff. The more projects that I took on, the less clinical time I had, which is just how it works. You need that time to do all these projects. But I got to the point where I’m like thinking is that, do I love these projects more than I love my patients? And I don’t think that that’s who I am. I don’t think that the, you know, I do enjoy, you know, the administrative, the teaching. I enjoy all of it. But you know, I am first and foremost a health care provider and I really, really cherish that interaction with the patient. So, you know, it’s, it’s not that I don’t want to do those other things, it’s just that I need a better balance on, on that.

Justin: [22:48] Yeah. So I know that you had written this article, leaving my dream job was better than finding it. And that was this describing this experience of it sounds like, is this that segment in time, which you’re describing with that?

Dr. Crawford: [23:00] Yeah, definitely. I think it’s easy and I think it, I mean arguably when you have a really exceptional work environment in that you’re highly supported, you have lots of resources, you know, and you’re surrounded by these brilliant colleagues and everybody sprinting, everybody’s just doing amazing work and it’s super inspiring. It’s easy to get swept up into that rapidly running river and just get sucked away. And I had a really hard time slowing myself down. I think because I’m naturally driven. I mean we all are naturally Griffin, otherwise we wouldn’t be in this field for some, that’s not an issue. But for me it was, I had a hard time slowing myself down. I really felt like I had to step away to refocus because you know, if you’ve talked to most of these trainees and many of the anesthesia providers, everybody has multiple interests. And so when the beginning of your career you’re like, oh yeah, I want to do that. That sounds interesting. I want to do this. That sounds interesting. You know? And so you start to get involved in just so many different things and it sometimes takes a while to figure out what really, what is your passion and where should you be? And for me it was teaching and global health like and, and if I could do those things together, which I often do, I’m the happiest, you know, with the days on teaching in Rwanda, I’m, high, I just absolutely could not be happier. So I think, you know, for me, leaving did a couple things. One, just getting a different perspective by stepping away from it all and just taking myself out of the quote unquote rat race, which it could be depending on how you frame it, but also it really just, it kind of gave me confidence and I know that sounds ironic, but you know, growing up in these academic institutions and then landing at Stanford, which was way beyond where I ever expected to land and being surrounded by all these amazing people, you know, you really feel like I’ve been able to do all of this good work because I had good mentors. I’ve been able to do all this good work because my department helped me with my master’s degree. I’ve been able to do all this good work because you know, of everything that Stanford did or everything my residency program did for me or that others did for me. And it took me kind of stepping away for me to realize that I did all of those wonderful things because I did all of those wonderful things. You know, I was, I was making use of resources and deciding to use, utilize, you know, the resources I had at hand, but really I was the one who created those things. And so it’s, and you know, it’s a, it’s a common theme of Imposter Syndrome or whatever you want to call it. But it took me realizing that just because I stepped away from Stanford for briefly, it didn’t take away, you know, my skillset, you know, or my drive or my passion, you know, I still, those things are mine

Justin: [25:49] and I bet you probably stirred up potentially, I would be willing to bet that if we can see things with 100% of missions, you start up some envy in the hearts of some of your colleagues. Would you say?

Dr. Crawford: [25:59] Oh, well, you know, I don’t know if envy is the right word. Maybe, but I have had, when people ask me what I’ve been up to and I tell them, they’re like, oh wow, they’re just so I actually, I ran into a surgeon, I worked with a surgeon the other day at Stanford and I haven’t seen him in years. And you know, time flies and he, and he’s like, Hey Anna, I haven’t seen you in awhile. And I was like, yeah, I think it’s been about three years. And and then, you know, we take care of the patient and like midway through the surgery he asks again, so where have you been? What’s been going on? And I said, well, you know, I quit. I moved to New Zealand, I mountain bike to my brains out, you know, I’ve been traveling, I’ve been doing all these things and be doing all this global health work. you know, I came back to Stanford just to do these projects, blah, blah, blah, blah, blah. And then it was probably another half hour and he goes, I just have to say that’s the best thing I’ve heard because most people said, oh, I’ve just been stuck in the ASC. Or I could have said, I’ve been in some other clinical location, just stuck doing cases. But no, you’ve been often it mountain biking in New Zealand or, oh, that’s great. Yeah, I think it’s, I think it’s important. Yeah.

Justin: [27:09] So when you said, I’m going to step away from this, what were you stepping away to? What did your life at that juncture look like?

Dr. Crawford: [27:14] Well, so I left Stanford really out of fatigue and so I had decided to do the private practice, so I had kind of knocked on a few doors to see what was out there and decided, well, I’ll just try it. I never really envisioned myself as a private practice physician just because of my love of teaching and, and all these other projects. But I figured maybe I could do both and figure it out. And that’s really what happened. So I stepped away to private practice and I lasted there for about really about a year and a half and I joined a really lovely anesthesia group and had a lot of respect for my colleagues. But the environment of that hospital was just really, really difficult. And I felt like it just wasn’t mine. My place. And then I had a couple interesting things happen personally where really the way I was able to have the freedom that I’ve had for the last two and a half, three years is that I had bought a house in San Francisco and then I sold that house, which is not about investment as you know, bay area pretty, pretty crazy. So I actually made the decision after leaving that private practice job, cause you know I’ve left Stanford out of fatigue and just a little bit like searching for my balance and what I needed. And then I entered this private practice job that I really just was very unhappy and, and so I started thinking, okay, what’s going on this? There’s something, something isn’t right. I’ve got to figure out what that is. And so that’s, I decided that after I sold that house I was going to take a year off. Yeah. And so I did, well I took six months off and then somehow it got this contract to do ICU in New Zealand, which was basically like having time off because it was just so amazing. And then when I came back from New Zealand, I took another six months off before I started working clinically again. And now I’m back working clinically at full time hours, just divided among a couple of hospitals.

Justin: [29:01] Okay. And did you find that time restorative and what would, what did you spend your time and effort on in those? In the time off?

Dr. Crawford: [29:08] That’s been the best part of my life, I have to say. It’s, it was, I can I call it many different things, but one thing is like my midlife retirement, you know, I think most responsible adults would have taken that money from selling the real estate and pop it into their retirement accounts and you know, part of that. But you can really live on very little, especially if you are camping, which is what I did a lot of. I did a big road trip through bunch of national parks with my dog and camped all over the place. I visited family and stayed with family and then moved to New Zealand was, you know, it was a locums position, so I was very well compensated. And that was really fun. And then when I came back from there, I, I got an apartment again and just said I was going to use a little bit more of that money for six months and then stay in the bay area and figure out where I wanted to work. And so part of that was Stanford. Obviously. I never really truly left Stanford. I always maintained an adjunct appointment even in New Zealand and stayed engaged in the global health process throughout. Like I’ve never detached from that part of the job. Yeah. And then started figuring out where I want to work clinically and I have found a couple of really nice places that give me a good mix of both anesthesia and ICU in the bay area and so I’m really happy. Happy with that.

Justin: [30:24] Okay. In some of your writing, you spoke about this journey that you’ve taken with regards to mashing down the gas pedal. You know, you said everybody’s in a sprint. I think that’s a great descriptor for that cohort of very smart, very high achieving physicians who are at the top of their game at a top institution who have been just going for it for

Dr. Crawford: [30:42] super ambitious.

Dr. Crawford: [30:44] Yeah.

Dr. Crawford: [30:45] Remarkable people.

Justin: [30:46] Yes. And then you at some point, you know, starting to ask questions about what are my goals and priorities and are they the same as all of these people that I’m like running a million miles an hour in this group with, or is this only for a season of time and does it make sense to reevaluate? So what you said was establishing a clear and personal definition of our own goals and priorities. Is the problem alluding to like the burnout stress and that negative experience? So it sounds like you’ve, you’ve been very intentional during this year and a half ish of a very different pace of life to give some thought to your own personal definition of goals and priorities and how you want that to play out for you for, for this next stretch of time. So I’d be interested to hear, and I’m sure there’s other physicians right now who are in this group who are just sprinting and who are looking for perspective on what does it mean to pause and to consider what are my goals and priorities and does this current environment continue to support those or, or do we need to start questioning some of the assumptions? How, how did that play out for you?

Dr. Crawford: [31:53] For so many years? You’re kind of forced to perform in this system. Meaning you go to university, you take your m cat, you go through these required levels of training that’s very prescribed. And then when you finish, it’s really during that time that you have to figure out what to do next. And there’s not, there’s no longer a prescription, there’s no longer somebody telling you what to do. So some times such as with myself, it just takes a little while to figure out what to do next. And so I think what happened is, although I was ambitious enough to complete, you know, design and complete these projects that were my, I mean, they are my passion projects. They still are. I was still in some regards following along in the system, you know, where I felt like I was doing things because I thought that’s what I wasn’t supposed to be doing in order to advance my career or according to my division chair, my chairman, my colleagues, my mentors, whoever I was doing things because I thought that’s, that’s what I was supposed to be doing. But a lot of times, you know, such as the comment about you could be a chairperson. The reaction that I had to that internally was very tough. I think I was always a big one. But also, you know, watching some of these people that I absolutely admired and respected and my mentors were so amazing and they still are my mentors and they still are amazing. But watching how hard they work, and the amount of sacrifice and I’m trying to be careful because I think that that’s commendable and respectable, but I think each individual has to determine what value that is to them. And I feel like a lot of us when we work like crazy, there is this somewhat toxic validation and feedback that we get from that, that just makes us feel like we’re doing a really great job, even if it’s at the sacrifice of family or friends or health. And for me personally, I felt out of balance and I feel like I really had to examine the motivations of me being overly committed. And again, yeah, the direction in which I was headed. So doing what you’re supposed to be doing to advance according to others versus really finding your own direction in your own path. I think for me the key was autonomy. I want to be doing all these things and I still am. I’m just as mad as I was. It’s just on my terms. Yeah, it’s on my schedule and I have a little more control. I would argue over how hard I work, how often, cause I think we’re all a little manic at times and then a motivational at times. And I feel like I have a little more control over when I can meet manic and if I’m tired, I’m tired and, and I, you know, I take a little time off.

Dr. Crawford: [34:56] But I think finding your balance is a very personal thing and I think it takes a lot of practice. I mean, I am still learning and I hope I always am and I’m still evolving in this area and I hope I always am. But you know, balance is a practice. Happiness is a practice, just like medicine is a practice. So I think, I think that those things you really have to, you do have to be intentional. But I think the biggest takeaway really is that it’s okay to be selfish, which is something I had to learn, you know, doing things because other people think you should be doing them is not going to make you a better physician if you’re selfish and you take care of yourself in, by selfish, I just mean take on the projects that you’re truly in instead of doing a project because somebody else thinks you should be doing a project, really looking out for your health, getting enough sleep, and then in that is quality time with friends and family. Those things were, we’re out of balance for me. And I think you can view them as being really selfish, but I think selfishness is not necessarily a bad word and it actually makes me happier, healthier, and in that a way better physician, a way better teacher away, better mentor to others. Yeah. I think it’s just, it’s pretty invaluable.

Justin: [36:05] That’s right. And unless you protect yourself, you don’t have anything to give and to share and to build with the fact that you are really pressing into that for yourself, I think is really awesome.

Dr. Crawford: [36:16] Yeah. And I think you nailed it Justin. Like the, what you just said resonates in that. Like if you don’t care for yourself, you don’t have anything else to get. And I felt like I had gotten to the point where I had a little bit of resentment creeping in, a little negativity in my attitude creeping in. I’m a really happy person. And one day one of my colleagues said, Anna, you lost her smile. And that was really telling to me. So I realized that I really did need to make a change just for myself. And you know, maybe I’m wealthier than my colleagues, but I don’t really care. I’d rather be balanced and happy and mountain biking sometimes, you know?

Justin: [36:56] That’s right. Yeah. No one, no one would be able to call you a slacker with the CV that I’m looking at right now. So thanks. Thanks for asking. That’s nice. So if I am interested in this global health thing that I’m hearing about from you, and maybe I went all the way through residency and I didn’t know global health is a thing other than people that doctors without Borders participate in. But the fact that there could be, for example, a global health fellowship that is like totally news. Why don’t you maybe explain a little bit about what that is and how you seek to equip young physicians to be able to have that global perspective.

Dr. Crawford: [37:30] You’re absolutely right. A lot of people don’t really understand what global health does or know what both photos and that’s part of the fellowship and part of the resident pathway is really just defining global health. But again, I think the core of global health is advocating for patients no matter where they are, whether they’re in Africa or the bay area. So it’s global patient advocacy and making sure that those patients have equal access to to house. So most of you know, in the past I’ve done, some of the service based traps we call mission trips. I think that I’ve gotten away from that personally and really found a lot of value. And some of the key words these days are sustainable and capacity building or however you want to call it, becoming involved in projects that actually impact the health care system. Therefore improving patient outcomes. So whether that’s research, mentorship, whether that’s teaching, whether that’s a quality improvement and safety, so people that are interested in global health problem, we have a little bit of background. Maybe they have a trip like I had to Kenya under their belt or maybe they’re just interested in learning more and they can really get involved. There’s several institutions. I think our global fellowship was one of the first that we were launching it. Right. Besides several of our partners in academics such as you CSF and Vanderbilt and the Canadians are are a step ahead of us too. They’ve got several fellowships as well, so, and all of these academic institutions are very collaborative, so if a trainee has an interest in global health, they can check out all these different programs across the u s and Canada as well, and Australia and New Zealand have a time as well.

Justin: [39:08] Okay.

Dr. Crawford: [39:09] The American Society of anesthesiologists has that global humanitarian outreach committee. We have a website. They were constantly posting opportunities, whether it’s for a service based mission or whether it’s for a learning opportunity there scholarships for residents through the Asa. Personally at Stanford we had to Acg me approved rotations. One has run Rwanda and another is in Zimbabwe. You CSF, I know also does a lot of work in Uganda, so if you just started cruising around the academic institutions, you’ll find lots of global health opportunities and the global health fellowship. I think the biggest reason people go into that is he is twofold. One, they’re either looking to get that NPH or that masters in public health or global health, which some of the global health fellowship programs offer hours does not offer that. But what we do offer is a very flexible year. It really allows the fellow to dedicate their time to a project. Most of the peoples seek a global health fellowship because they want, I know how to incorporate global health into their careers. So I think that my colleagues and I have demonstrated pretty well how will that can be done in an academic setting. But we also have this huge network across the globe of people doing all kinds of really amazing things for health care. And so you can work in academics, you can work with Ngos, you can work with, you know, industry even to really get involved in some of these amazing projects. So I think the benefit of spending a year doing global health is wine because you get to see what it’s like to either initiate a design and or follow through on a project, but also just an introduction to, you know, some of the things if you don’t know what global health is, so you know that we can help you define that and define all the stake holders and different types of collaborations and partnerships, but also to just really harvest that really vast network of people doing great things.

Justin: [41:00] Yup. With regards to the specific mandate for the global humanitarian outreach committee, what is within the Asa? What is the job of that committee and what’s your participation like? And if somebody is interested in either partnering with that committee or getting some resources from them to be able to understand how they may pursue some sort of global health initiative, what, what would that look like?

Dr. Crawford: [41:20] So the ASA GHO is what we say in the birds. It’s really its main motivation is to provide asa members with opportunities to get involved in global health. We have several programs that run anyone annually. And then as a committee we also evaluate other potential projects to see if we have the resources to support those. We have a limited amount of funds, but some of those projects we haven’t overseas training for Graham in Rwanda, which of which I’m the program lead, which I can talk to you all day long about. It’s a really great program. Basically it started in 2006 in Rwanda had one anesthesiologist in the entire country. It’s a very densely populated country in one anesthesiologist is not gonna cut it. So since then we’ve developed an anesthesia training program and graduated several physician anesthesiologists, so much so now that they’re actually running the training program. So we’re starting to focus more on sub specialty training. There’s a similar program that is only a few years old and Guyana, which is a similar format in that we’re starting a residency training program there and helping that the local faculty develop, to support themselves to that. There’s a resident scholarship that is offered, so that American residents can travel abroad and get an introduction to global health. further we have another scholarship for young anesthesia faculty from lower resource settings are low and middle income countries and they actually come to the u s and they rotate at an institution. Then they go to our conference that the asa annual conference. Okay. Yeah. Cool. Lots of good stuff going on there.

Justin: [42:59] Great. Ana I’m going to wrap it up. I have one last question I’d like to ask you. You are a physician who has achieved a lot and impacted many and are continuing to do so. And this is obviously required a lot of sacrifice. I like to hear just a a little reflection on a time when you have had this interaction perhaps with the patient or maybe with a project you’re working on where you thought, this has cost a lot, but in this moment with these things we’ve been able to accomplish the lifestyle I’ve been able to impact. This has all been worth it for me.

Dr. Crawford: [43:29] There’s really clinically, there’s not a day that goes by that I don’t feel grateful. I just feel like it’s a, it’s a huge, huge privilege to be able to take care of of patients and their families. Just that moment of bonding before a surgery when a patient’s really nervous is, is pretty amazing and similarly dealing with critically ill patients and their families specifically at the end of life is a very challenging time and when you can help a family go through that confusing, often confusing and emotional time, I think that’s just such a intimate time in a patient’s life and then a family’s interaction. It’s really quite a privilege to be there. I have many, many, many stories about patients specifically and families, but I would argue that really every day I’m grateful to be where I am and to be just sometimes just looking down at a sleeping patient. I’m just blown away by the skillset that we have to get somebody safely through surgery. It’s pretty amazing. Pretty amazing stuff.

Justin: [44:29] Yeah, it absolutely is. Well, Dr. Anna Maria Crawford,

Dr. Crawford: [44:33] Thank you very much for joining us today on the anesthesia success podcast. Thank you. It’s been a pleasure.

Justin: [44:41] Hey Justin here. This may shock you to learn, but I am actually not a fulltime podcast. I also run a financial planning company called quantify planning where I work closely with anesthesia and pain docs to build and implement customized financial plans. If you’re interested in working with a financial planner who knows many of the ins and outs of your profession, shoot me an email or head on over to quantify planning.com for more information. If you’re resident or fellow, I can also offer you a free student loan analysis if you’re interested, but there might be a waiting list. So check out the link over there to see if you’re interested in learning more about the topics we discussed today. Head over to anesthesia, success.com to join our community, residents and attendings and others to ask a question or get more free resources. If and only if you liked this episode, please leave us a review and subscribe. Thank you very much for listening to the anesthesia success podcast.