Episode 47: Addressing Overly-Simplistic Reporting On Healthcare Economics w. Dr. Karen Sibert

May 11, 2020

This Episode

Interview w/ Dr. Karen Sibert

You Will Learn

– Addressing an inaccurate article posted by The Washington Post.
– Dr. Sibert’s opinion on how physicians can start to fight back against false journalism.
– What “medicare for all” really entails

Resources & Links

In this episode, Dr. Karen Sibert joins me to discuss some of the anti-physician journalism that we are currently seeing. Karen is an anesthesiologist in the UCLA Department of Anesthesiology and Perioperative Medicine. She is the past President of the California Society of Anesthesiologists and an accomplished writer. She has a critical voice, not only among anesthesiologists, but among physicians in the healthcare ecosystem.

Justin (00:04):
This week I’m talking to Dr. Karen Sibert from UCLA. I’m really grateful for Karen’s work because a lot of her writing addresses some of what I would call the annoyingly reductionistic anti physician journalism that we’re seeing out there right now in, I mean we can all admit that healthcare is very complicated and very broken with what’s happening right now out of network billing and other things like that. And Karen is really a voice of sanity and I think advocacy for the specialty and for the patient as it relates to trying to make healthcare a better place. So we’re going to unpack a lot of great ideas today. As always, thanks for tuning in.

Justin (00:58):
Hello and welcome to episode 47 of the anesthesia success podcast. I’m very pleased to be joined today by Dr. Karen Sibert. Karen is an anesthesiologist in the UCLA department of anesthesiology and perioperative medicine. She is the past president of the California society of anesthesiologists, and she’s an accomplished writer who in my opinion, has a critical voice, not only among anesthesiologists, but among physicians more broadly as part of the healthcare ecosystem. I’m really pleased that she’s able to join us today. Welcome, Karen.

Dr. Karen Sibert (01:25):
Thank you for having me here.

Justin (01:27):
So to start us off, tell us a little bit about your current career scope of duties and responsibilities as a physician.

Dr. Karen Sibert (01:35):
I’m in clinical practice at UCLA. I do a lot of, I concentrate on larger inpatient cases. The Rassic vascular bariatric, what have you, that’s really, thoracic is really my first love. So I’m primarily clinical, but within my department, I’m actually the director of communications. So I’m in charge of the website, the intranet, tweeting on behalf of the department, social media stuff. And I was actually the chair of the communications committee within the California society of anesthesiologists and I’ve just been writing for a long time.

Justin (02:16):
Awesome. I actually didn’t even know that communications part. That actually makes perfect sense. Now and you also have a blog at append point, P E N N E D P O I N t.com. And that was how I first became exposed to some of your work. I’ll talk a little bit about your background as a, as a writer and sort of how you came to be, what you are now. The director of communications.

Dr. Karen Sibert (02:38):
Right. Well, years and years ago when I was a little girl in North Texas, I was interested in medicine that for little girls in North Texas that was not a realistic career. So, but and I went to fairly, my father got moved around a lot in corporate, in corporate world. So I went to a series of pretty meteoric Republic public schools and high schools. But I managed to read in time, or Newsweek, I can’t remember that. The Ivy league colleges were going coed and I was ambitious, so I took it into my head to apply to Princeton. Excellent. And by some miracle I got in. But this was very early in co-education. And it was also a period of time when it was probably the most competitive to get into medical school than it ever was. It’s frankly a lot less competitive now because there are just a lot more medical schools and more positions open.

Dr. Karen Sibert (03:37):
And Princeton whose organic chemistry course was legendary for, you know, it’s cruelty if you like. I did not have the nerve to take it. I just didn’t have the science background. I was surrounded by people who had had AP or AP chemistry, AP bio chemistry and I just went, well, you know, that’s okay, I’m just going to do something else. So I majored in English and the English department was quite rigorous. They trained you well. And interestingly the college newspaper had a pretty direct track to the wall street journal. First I did a summer internship with the wall street journal. And then when I first got out of college I was a reporter for the wall street journal and the Atlanta Bureau. So I got some really incomparable writing training by people who did not suffer fools gladly. So that turned me into you know, as you kindly put it in accomplished writer. But after I got out of Princeton, I realized that there were a lot of people no smarter than I am who had gotten into medical school. So I decided that maybe this was worth a shot. So I took some premed classes and I got into medical school at the age of 26 with a four year old daughter. Wow.

Justin (04:56):
Talk about that transition where you, so how did, you know, that’s a pretty big shift obviously coming from the newsroom to all of a sudden you’ve got a stack of textbooks that you’re up reading until midnight. How did that go for you?

Dr. Karen Sibert (05:08):
Fine. Just I think once you’ve had a child, you realize that sleep is just for the week. Yeah. So I used to actually, when I was at medical school, I could hurt a bed and go to sleep for a couple hours and I’d wake up and study from about midnight to three and then go back to sleep for a while and go to class. And it worked for me.

Justin (05:36):
They say that we actually had our first child just a couple of weeks ago,

Dr. Karen Sibert (05:40):
Exactly what I’m talking about learning this lesson right now. So actually I thought three in the morning, I thought internship wasn’t bad compared to having a newborn.

Justin (05:48):
Yeah. Wow. Okay, cool. So one of the reasons that I’m excited to speak with you this morning that there’s a few but one of them this refrain in the public discourse about, I mean, so healthcare broadly, but the physicians sort of place in healthcare and how that attaches to questions around the finances of healthcare. Now, one of the challenges that we’re seeing right now unfortunately is what I would call somewhat reductionistic journalism to put it nicely.

Dr. Karen Sibert (06:19):
Well, yes.

Justin (06:20):
And I’m curious, you know, as you’re a former reporter, so you probably actually have among the best perspectives on this, talk about what we’re seeing out there right now and how do you view that through the lens of somebody who used to be a writer for the wall street journal and looking at what’s happening in the Washington post. And there was another article I saw this morning in the New York times. It’s just a, I feel like we’re on a hamster wheel of it right now.

Dr. Karen Sibert (06:42):
It’s, it’s, it’s a problem and it’s going to continue to be a problem. Now the wall street journal to its credit focuses on accuracy and you’re far less likely to see anything sensationalistic in there. You could work for three weeks on his story and if you came back and told the editor, I’m sorry, it’s just not true, they would go, fine, thank you. You know, send you off to do something else. They really, and that is simply not true of other news media. Now the Washington post and the New York times, they don’t do, they don’t tell lies. They’re not the national Enquirer, but their focus is still very progressive. Now a lot of people in your audience may consider themselves progressive and that’s fine. That’s not what, that’s not what we’re here to talk about. But they are always interested in championing the little guy against the big guy again, which is fine except that a lot of times that’s really not telling the whole story, but it’s always easier for a reporter to find an individual to target rather than a larger entity because the stories are about people and they want to tell stories about people.

Dr. Karen Sibert (07:53):
So the Washington post finding a surgeon who wants to send this patient an astronomical out of network bill is such an easy villain, such an easy target. And I’m not saying that the surgeon in that particular Washington post article was justified in asking this patient to pay $15,000 for her appendectomy. That’s ridiculous. But that’s really the tip of the iceberg in medical costs. Physician pay is approximately 8% of all healthcare costs. So we are really not the problem. What we are is the easy target and in the simplistic viewpoint of a lot of the progressive media, all doctors are old white guys. Now you and I know that that’s not true. And your audience knows very well that that’s not true. But that is still the stereotype. Old white guys who play golf every Wednesday afternoon, which is ridiculous. I mean who does that? Do you know anybody that takes off Wednesday afternoon to play golf surgery every Wednesday afternoon? It just does. So you know this is ridiculous, but that’s the stereotype you’re playing off. And again, it’s just an easy target. Yeah. And it continues to be.

Justin (09:06):
Yeah. So there was this, you are, you alluded through the article and we’ll link to it in the show notes. So anesthesia, success.com/ 47 we’re going to talk about a handful of articles today. You can find all of them linked there. This particular one, the title is something to the, to the effect of we’re allowing our physicians to behave like muggers. Yes. And that put me right over the edge. Well you and me, both, you and me both. And it’s funny cause we come at this from opposite angles I guess. So I’m a physician, spouse and your physician, so you feel very strongly on behalf of your yourself and your colleagues. And for me it’s like you’re attacking my family. And it’s whenever we see these, just a broad brush, very simplistic, not accounting for all the nuance and complexity of the healthcare system and say like, doctor bad, Dr. Rich, let’s, yeah, that sort of tone.

Justin (09:52):
It’s, it just feels to me kind of irresponsible. So I guess the question is to follow that up, how, how can we engage in the public discourse with the media, with all of these types of inflammatory headlines flying around from these institutions that need to sell ad space? How do we, how do we compete with that? How are you working against that in the work that you’re doing? Or maybe do we need to take a total end around sort of like Allah, Donald Trump, where it’s just we go straight to the people with our Twitter account. We don’t need the news media anymore and we can just, you know, that that type of approach.

Dr. Karen Sibert (10:24):
Well that’s, that’s frankly it because, you know, they’re not interested in the facts. They’re really not. They’re really not interested in serious rebuttal. So that’s why I actually do take my opinions and comments straight to social media and it’s very gratifying to see a, an opinion column like mine take off because my blog, I’ve never monetized it. It’s really been a labor of love. Or as my husband would say, Karen, thanks. Everyone is entitled to her opinion. But my husband and my set of both physicians just to, just to put that out so they’re attacking my family too. Right. I think, I think really we do, we do more that way. The, my little blog has already had more than 400,000 views of that, of that column. A podcast interview I did with my Chesky has gotten over 500,000 views. I don’t, I don’t think those people are reading the Washington post, the vast majority of them.

Dr. Karen Sibert (11:19):
I really don’t. So I think that that way we can do more that way if we can tell our story in a way that that resonates with people. That’s the, that’s the mega view, grand view. But I think that one on one still is the most important way that we establish relationships with patients. And that’s a problem we have in anesthesiology with the current production pressure. You know, 10 minute turnovers. If, if I haven’t met that patient before, how am I supposed to establish any kind of physician relationship with that patient in three minutes now? Right. You can, you can go a long way to do that. You really can. One thing that I really do try to do is have a business card, give it to my patients. Say, you know, I’m, I’m Dr. Sibert, I’m with anesthesiology, here’s my card, here’s my office phone, here’s my email, here’s a little information about me.

Dr. Karen Sibert (12:17):
And I put, you know, when I went to medical school where I did residency training, because as you, I’m sure you will know in anesthesiology, not all the public even knows we’re doctors, right? And the nurse anesthetists are doing everything they can to blur those lines. So everything that we do, one on one to say me, doctor, and I’m here to take care of you and I’m responsible and I’m accountable. And if you have any problems afterwards, call me. Don’t just give, you know, a bad online review or don’t complain on your press Ganey scores. I’m here to take care of you and I am responsible for you. That goes a huge amount of the way. A lot of anesthesiologists, I feel, make the mistake of wanting to stay anonymous, wanting to stay under the radar. So if the patient has any problem, they don’t really even know who to go to. That’s a mistake. That’s a real tactical area that we’ve made.

Justin (13:14):
Yeah, and I think obviously the specialty kind of selects for people like that, right? Because it’s, it can and, and so the talk a little bit about maybe the unique challenges of the anesthesiologist and the context of the things that we’re just discussing as, because it’s, it is a little bit more of a, you know, you’re not in the limelight as an anesthesiologist there. There’s more of a need for anesthesiologists perhaps to be assertive in these discussions, to be able to share their opinion and their perspective, especially in the context of the way that money is moving in through health, in and through healthcare and with the way billing works with anesthesiology and things like that. It’s easy for, if the anesthesiologists don’t you know, speak and advocate, then there’s a danger that they’re going to get run over potentially by

Dr. Karen Sibert (13:59):
Absolutely. I mean, I’m sure you’ve heard the expression, if you’re not at the table, you’re on the menu and that’s our problems often within hospitals because we can’t get out of the, or just to go to committee meetings. So is it, you know, in the morning or at lunchtime or whatever. So every group needs to make time to have somebody who’s representing their interests within their hospital or health system. It’s just critical that there’s no, there’s no way around it. The second point is there really is a lot that you can do with your medical, local medical society and your anesthesiology society. That’s why I think involvement with the CSA has been so important for me. It’s taught me so much about advocacy, about the issues that affect us all, but we just can’t be silent. If we’re silent, then we’re screwed. And what I think your audience really, really needs to understand is that we are paid on average 27% of our usual and customary fees by Medicare and probably even less than that by Medicaid.

Dr. Karen Sibert (15:09):
So when you hear the phrase Medicare for all, you should be having nightmares because it really will be the end of our specialty as we know it. This is not a joke. This is a real threat. The second point to that, and it goes back to my column, is that out of network billing or surprise billing is a huge issue. The solution that happened in the legislature in California, which believe me, the CSA and the California medical association fought hard against, and the current bill that got inactive is a compromise which we are deeply unhappy with and which is having terrible consequences. But the California solution provides that any out of network charge or surprise billing charge, whatever they’re synonymous is going to be linked to either the average contracted rate or 125% of Medicare. And what that does is it provides the insurers with huge incentives not to negotiate contracts anymore because 125% of Medicare is always going to be better for them than the historical average contracted rates.

Dr. Karen Sibert (16:26):
And that’s what anesthesia groups in California are seeing is that the companies are just completely unwilling to negotiate new contracts. Blue cross has told some grids flat out, we’re not negotiating a new contract, get over it, we’re better off with you out of network. And that makes us look really like bad guys when the anesthesia group can’t get a fair contract and then they end up sending out of network bills and then patients justifiably are very, very upset. And this is, this is the danger with what’s going on in Congress right now because two of the current bills that are before Congress, the Alexander Murray bill and there’s, there’s another one there. There are different versions circling around between the ways and means committee and other committees. They are again linked to benchmark rates. This is a disaster for us. Other specialties, their Medicare rates are much closer to their usual and customary anesthesia is actually the worst. So the ASA is fighting this tooth and nail and there is one bill. It’s sponsored by release and row. It’s HR three five Oh two, and that is actually a bill that’s modeled after new York’s bill, which is based on fair health average. And that is the bill that the ASA supports. And everybody out there should be calling your Congressman and telling them support HR three five Oh two, because that is the only one that really is going to help our specialty survive.

Justin (17:56):
Great. So we’re going to link to that in the show notes. HR three five Oh two. So anybody out there who’s interested in trying to advocate for fair compensation or fair reimbursement for the anesthesia specialty, definitely go check that out. Call your local congressperson. So I’m curious Karen, you know, you said this, you threw out this number, 27% of the usual and customary rate. Can you break that down and say like what exactly does that mean compared to maybe other specialties and just walk us through the math of that.

Dr. Karen Sibert (18:26):
Well, I’m not sure how much more detail I think go into, but, and a lot of other specialties, what they get paid by Medicare is roughly 80% of what a commercial payer would pay them. So they don’t care if you know it. So they take a little bit of a loss on Medicare. They don’t take they, especially in private practice, you can limit the number of Medicare patients you take, et cetera, et cetera. The more you’re in a health system, they’re going to negotiate that for you. You really have no say in that, but, but still salaries have large, they’ve gone down historically it relative to inflation. I mean what, what anesthesiologist made in the eighties was much, much more than they make today. I mean, pay has just slid inexorably down. But in anesthesiology you see we were always as a procedure based specialty and we had a lot of procedures.

Dr. Karen Sibert (19:21):
You build for every case you build for every unit you built for every arterial line you build for every central line you’d go for, you have a dural, so being a procedure based specialty as opposed to primary care, which was office visits, we did very well. So when that, when these, originally it was about a third of of customary insurance payments for Medicare. Now it’s sort of slid down a little further to 20 about 27% on the average. Now that’s going to turn into some real real money if, if every out of network bill goes to anything tied to Medicare rates, it is just a disaster for us, much more so than for any other specialty. So the ASA is a Washington continuously trying to fight against these bills. Luckily we have some people in Congress who are physicians like Dr. Luis from California. He is an emergency physician.

Dr. Karen Sibert (20:16):
He’s one of the sponsors, the original authors of HR three five Oh two, we have Andy Harris from Maryland who’s the only anesthesiologist in Congress. And I help support his campaign every two years because we really need him in Congress even though I don’t live in Maryland. And Dr. Cassidy who is from Louisiana is a hepatologist, a liver specialist and he’s actually spoken a great deal in the media about the dangers of, of these misguided bills. He just had a, there was just a commentary and Ned page the other day with Dr. Cassidy going through several of the bills and saying, what a, what a problem there because there really are a problem for everybody, not just us. It’s just that for us it’s just that that extra helping of worse. Right.

Justin (21:03):
So you mentioned for a moment Medicare for all, and I’d love to drill down onto this for a moment and just talk about, you know, what is, so right now, if we’re talking about 27% of usual and customary reimbursement it sounds like if commercial, the commercial gap, like the premium that commercial payers would pay based on a procedure is it’s going to kind of, I guess go away or maybe it’s going to change drastically if Medicare for all something like that is enacted. Talk a little bit about kind of the implications of that and what that mean for this specialty.

Dr. Karen Sibert (21:36):
First of all, I don’t really think that commercial insurance is going to go away if that’s thousands and thousands of jobs depend on it. No matter how much you hate in personal insurance. I really don’t think that that’s a realistic scenario in anybody’s wildest dreams. But what can happen is that we could go to some kind of system where the insurers are much more able to negotiate rates tied to some multiple of Medicare or even part multiple of Medicare. Which again, if you want to take a three quarter percent pay cut, you know. Okay. But I would rather not. I think that that’s, that’s not, that’s not fair. Life is not fair. So, you know, we probably should just get over fair right now, but I think, I think that a lot of younger anesthesiologists really just don’t know that simple fact. And I’m here to help tell you that because it’s really important, it’s really important for everybody to understand. The more people end up in employment situations as opposed to private practice. You think that you’re protected from this, but you’re not.

Justin (22:54):
Yeah, there was, I saw an article on Becker’s the other day, maybe you saw it, it was a bunch of a big, it was team health and their emergency physicians. There was a big contract negotiation with one of the payers. I forget which one it was, but they basically were playing chicken and TeamHealth kind of lost. And so he just slashed. There’s like a 5% cut across the board, a physician salaries, and that’s doctors who were in a W2 situation.

Dr. Karen Sibert (23:18):
That is the Canary in the coal mine right there. So if you think it can’t happen to you because your big health system is going to keep continue to pay your salary, it’s not going to happen.

Justin (23:33):
So if we reality, yeah, if we zoom in on maybe one of these situations, it could be the one in the Washington post or just a similar sort of, somebody comes in and it’s an in network hospital and maybe an in surgeon talk about why does, what is it that enables surprise billing, like who is happy about surprise bill? Who’s winning when a surprise bill happens in that sort of context, whether it’s the anesthesiologist or an emergency room physician, why are, why are, I think pretty much everyone agrees that surprise billing is bad. But obviously if someone wasn’t being enriched or if someone didn’t have a a benefit from surprise billing, it would no longer exist. So why is it happening still?

Dr. Karen Sibert (24:15):
It largely benefits the insurance companies. That’s, that’s who it benefits. Those are the only people that benefits and I don’t know what the difficulty is in seeing that. I think the difficulty from the public perspective and the media perspective is that the bill comes with one doctor’s name on it. So automatically that’s the bad guy or now and it’s that simple. But here’s the origin of the problem. There are gender. The problem is that a lot of changes happen in the insurance industry with the affordable care act, the affordable care act legislated a lot of things for insurance companies that they had to cover that were not historically covered. People were actually able to buy policies like my children are grown. So I would have been able to buy a policy that didn’t cover maternal fetal care or you know, things like that, that does not exist anymore.

Dr. Karen Sibert (25:16):
So the insurance companies not being idiots then found other ways to make up what they were going to lose and having to do more comprehensive coverage. And the easiest way to do that is to make your network very narrow. So you probably heard a lot about president Obama having said, if you like your doctor, you can keep your doctor. And that ended up being a pipe dream. People couldn’t keep their doctors and the insurance companies are, have really not done a great job of telling patients how narrow, how narrow their networks were. The websites for covered California, which is the affordable care act arm, and in California you can’t find any decent information on their website to save your life. So people have a hard time finding out if their doctors are in network or out of network. The lists are out of date, they’re inaccurate, et cetera, et cetera.

Dr. Karen Sibert (26:12):
So when you have extremely narrow networks and the patient doesn’t know that that’s how this happens. And so a responsible insurance company of which there may be some, I don’t know, but there might be, they will try to make sure that everybody has the basics. You know, an internist, a pediatrician, a surgeon in the case of the patient in that Washington post article, clearly she went to a hospital for emergency services and the surgeon on their emergency coverage panel, the person taking call was out of network for her insurance. Now that’s actually kind of outrageous. First of all that the hospital would allow that, cause I’ve never worked anywhere when my services just weren’t covered. In other words, if you know, I used to work at a big private hospital in Los Angeles, Cedar Sinai, but if a patient walked in the door and Cedar Sinai accepted them, I accepted them and I just, we just got paid whatever, whatever it was collected period. You know, we just, I’ve never had to ask, anytime a patient asked me, are you on my insurance? My answer was automatically yes or I wouldn’t be talking to you. And so the hospital had some responsibility to make sure that surgeons on their emergency coverage panel, we’re in network with major insurers that that’s really part of their responsibility. And the insurance company must’ve had very narrow networks or else, you know, refuse to negotiate a fair contract with the surgeon either, which is, is equally likely. Right. So that, that’s the brief brief history.

Justin (27:55):
And so if there was to be either a legislative or some sort of systemic fix to the current situation, what might that look like? In a perfect world, obviously there’s in a perfect world, there’s no more out of network billing. What is it going to need to take to get us to that point? Or is that, is that the ultimate end? I don’t know.

Dr. Karen Sibert (28:13):
Well, the ultimate end would be that insurers do have to negotiate some sort of reasonable contract with, with anesthesiologists and other physicians and everybody that delivers services and it’s going to be up to the government to try to sort out the problems which have led us down this road where the insurer has just create more and more narrow networks and refuse to negotiate contracts to drive people out of network so that the problem falls on us. That is really the crux of the situation. So any bill like these other bills other than HR three five Oh two which was to set a benchmark rate is leading us in an inevitable circle toward the bottom, you know, down the drain. And that’s really where things need to stop. So everything that we can do, you know, the AMA CSA, everybody to get in touch with your, your Congressman.

Dr. Karen Sibert (29:12):
You know, I’ve been in personal touch with my Congressman and he is one of the co-signers of HR three, five or two, and that’s what everybody needs to do. Otherwise, honestly, that’s important to understand. Just the point that Dr. Cassidy has made, it’s not just us, it’s hospitals too, because hospitals have always supported their charity care with the overage from what commercial payers paid. That’s why if you follow to read Becker’s and other things, that’s why so many rural hospitals are going bankrupt because they’re the most fragile, but hospitals are going bankrupt all the time. I’m sure you heard about a Honamin hospital in Philadelphia, and that was, that was personal for me because my son was a Drexel resident who was left scrambling for a position to finish his third year. So it’s not just tiny rural hospitals, which enables people to think, Oh well that’s not never going to be my problem. That was a big city. I’m a big city hospital, took care of a lot of indigent patients, a lot of Medicare and Medicaid and plant broke. Now there’s more to the story about who bought it, what they did with it, and did they want to just let it go down the drain because the land was worth more than the hospital. All of which is possible. But nonetheless, hospitals can’t and do go bankrupt for exactly the same problems that we’re talking about with physician payment.

Justin (30:33):
Right. So there’s obviously this is a comp and this is the conversation we’re having right now is exactly why this can’t frankly be responsibly covered in like a, you know, 250 words on the, the right hand column of a newspaper is just, there’s, there’s a lot of stakeholders, there’s a lot of implications, there’s a lot of unintended consequences of taking any action and these overlies don’t want to think about it. Yeah, I mean it’s hard to, it’s hard to, it’s a tough problem to solve obviously, but it’s a very important one. We’re at a really critical juncture in it too. So there’s a lot to obviously be discouraged about. We don’t have to look very far. We could throw a rock and hit 10 10 problems with healthcare. Is there anything right now as you’re looking across the landscape, is there any work that anyone’s doing or any progress or any relationships that you’re building maybe with somebody across the aisle where you think, I think that there are some sane people out here who want to build a system that’s going to serve patients well in the long run.

Dr. Karen Sibert (31:27):
I think that’s, I think that’s true also and it’s still a great job. Yeah. That I still really enjoy it. Yeah. That’s when you look at people in Silicon Valley or sports stars or actors, you know, now they’re over the Hill at 30. You can practice medicine for decades and it’s a, it’s a wonderful career. It’s, I never have to go to work and think about, am I going to do anything today that’s really gonna cheat anybody or you know, they’re in the corporate world. People are really often between a rock and a hard place about doing things that are ethical or unethical and is my career based on encouraging people to buy things that they don’t need and can’t afford. You don’t have to, you don’t have to think about that. It’s really, it’s really one of the noblest professions there is and I think we lose sight of that sometimes that the gratification and the personal rewards of being a physician are in measurable.

Dr. Karen Sibert (32:39):
Now you read a lot these days about burnout all over the place and to the degree that the production pressures are too, here, we have a responsibility to push back against that. There. There are times that you just have to say, no, you know, no, I’m not ready to take this patient back. We have X, Y, or Z. To think about. The other aspect to it also is that this is, this is always something that whenever I say it, people roll their eyes, but I think work life balance has been more of a problem for burnout than people realize and here’s why. As soon as you really start to think that work life balance is the, is the, you know, the be all and end up well, to me the opposite of work is leisure. The opposite of life is death. If you, if you have a job where you seeing your work and your life in opposition to each other, then you need to find another job.

Dr. Karen Sibert (33:42):
Don’t be a murder you. I mean, you know, we’re well-educated, smart, ambitious, hardworking adults. You don’t have to put up with a job that you actively hate. Now, if it turns out that the job you actively hate is medicine, period, that’s a, that’s a different conversation. But if the conditions at your workplace are such that you feel just chronically exhausted, unhappy, find another job, you don’t have to live like that. For me, the solution has been, I really like big, long, ugly, complicated, challenging cases. I just do that has the advantage that everybody knows they’re sick and it takes me a while to interview them and find out everything. If it takes me a while to put in all the lines and get the case going, nobody is, nobody is bugging me and I deal with it most half a dozen patients a day, which enables me to really know them, to spend time with them, to organize my life that way.

Dr. Karen Sibert (34:44):
That’s my choice. And so that’s the choice I made. That has been very satisfying for me. If what you want to do is work in an ambulance for a surgery center where you have no nights, Nicole, no weekends, nobody’s really sick, then you’re going to have that kind of production crusher where you feel like you’re on an assembly line because you’re going to be doing 10 or 15 cases in a day. But that’s a choice that you get to make. And if that’s your choice, then I don’t think you’re justified in complaining that the turnovers are 10 minutes and you’re always pushed for time. Yeah, there are trade offs. There are trade offs everywhere, but you have to take some ownership of what you’re doing and why. Yeah. Makes sense.

Justin (35:25):
Would you say that how does the, you know, consolidation and anesthesiology, how does that impact this? Because you might say, well, if I’m going to practice in a certain geographic locale or even a small city, if there’s only one or two games in, and neither of them look like good options, it might be. It might be that even though there is the internal locus of control, I can control my situation and I can make a decision that’s going to positively impact myself in my family. I guess you have to decide whether or not you want to go somewhere else. Yeah,

Dr. Karen Sibert (35:55):
I mean I can’t, again, you’re kind of percent right if you really are just limited to one geographic area that’s going to limit your options. That’s just, you know, that’s just the way it is. But if you are working at a place that you feel that the term I think that people are using that’s inflicting significant moral injury on you than if you stay there and put up with the conditions as they are, it is going to make you crazy and sad and that’s you know, that’s the way it is. So we have to fight against workplaces that are like that. And you know, if we, if we

Speaker 4 (36:33):

Dr. Karen Sibert (36:34):
Only looking at ourselves as individuals, which I think physicians tend to do, then there’s no hope that you as an individual are going to make an impact in that. If your whole department feels the same way and you can get on the committees and you can say this is unsafe, we cannot work like this. That’s different. That’s a collective action. I’m not saying a union, but a collective action that’s going to eventually get attention. Particularly if your whole department is really United. And if you can take it to the media.

Speaker 4 (37:06):

Dr. Karen Sibert (37:07):
Media con can be your friend.

Justin (37:10):
Yeah. It’s a little bit of a dance with the devil sometimes. I feel

Dr. Karen Sibert (37:13):
It is. It is. But you know. Yeah, I agree. Now you gotta you gotta uncover the, you know, you gotta move the rocks and let things crawl out sometimes when things are bad enough.

Justin (37:24):
That’s right. Well I really appreciate your time today, Karen. I want to end on like a reflective, upbeat note, something redemptive. So you’ve obviously, you have a very, I mean, long and diverse career, not only starting in writing, but then moving through clinical practice and leadership and advocacy and lots of different things that you have pushed into and accomplished in your career. As you look back on all the, you know, the many things that you’ve done. Tell me a story about a time when you really invested and gave yourself and really tried to accomplish something and then you found actualization and you were able to achieve or to that moment of patient care or that moment of advocacy for your profession. Or tell me just a, a brief story to encapsulate something that, as you remember it, it’s something that you’re proud of. It’s something that you’re grateful for and that, I mean, it’s very clear that you’re, you’re glad to be an anesthesiologist. Why

Dr. Karen Sibert (38:17):
I’m going to, okay. Then I’ll tell you a story of a patient I took care of a few months ago. So this isn’t a brand, you know, national accomplishment, but this is what makes the job ultimately, I think either soul destroying or soul gratifying. This was a patient that got added my schedule in the afternoon. He came in from the clinic, he had a carotid stent that was included. So I wasn’t even on call, but I ended up, you know, the timing was such that I put the patient to sleep and he was an incredibly challenging patient to take care of because he had taken all his antihypertensives. It was critical to keep his blood pressure up. So many things were important in the case and it was just a, it was a moment to moment challenge to, to try to keep the, you know, they were doing EEG monitoring and you know, the slightest thing happened and the waves would start to damp and when I’d be pushing the pressure up again. And so first they sent and I was covering it solar for the first two hours because every Tuesday afternoon our patients go to electric. So at five o’clock they sent a nurse anesthetist in to relieve me and I said no.

Dr. Karen Sibert (39:34):
And then a while later they said, well, so and so can take over the case for you with a senior resident. And again, I just felt like I just can’t, I can’t, you know, because I had met this patient pre-op, I knew what his mental status was. And he was a charming, very with it, you know, really funny, nice guy in his late seventies. And I, and I thought if he wakes up confused or different, people were just going to say, well he’s, you know, 77 or whatever it was. They’re not going to know that he’s different. And so I finished that case through all the way til nine o’clock. And then the other thing that’s a challenge with somebody who’s having carotid surgery is you’ve got to extubate them smoothly because if they cough and they get a hematoma in their neck, it’s a disaster, you know, swelling, et cetera.

Dr. Karen Sibert (40:26):
So I did a very smooth extubation, but still he was awake within five minutes and, and talking about different brands of pizza and what was his favorite and Hawaii and everybody in the or was just about ready to jump up and cheer because it had been technically challenging for the surgeons. It’s certainly been challenging for me. We were all there to be and, and the patient did really well. I went home two days. Now when my children were small, I wouldn’t have had the luxury to do that and I totally get that, but I can do it now and that’s my choice. And cases like that are still just so gratified and they make you glad that you went into anesthesia and then when you take over a case from somebody, let’s be blunt, that patient is a slab of meat on the table. They’re already asleep. You don’t know them, you’re not going to be available to evaluate them after you’re not really ever. That’s not a meaningful relationship. So part of it is us, it really is and I find it worth doing. Thank you for

Justin (41:34):
Sharing that story and Dr. Karen cyber, thank you very much for joining us today on the anesthesia success podcast. You’re very welcome. It’s my pleasure. If you liked what you heard this week, head on over to anesthesia, success.com where you can find more content and free resources to help you build a successful career in anesthesiology and pain management if you want it to leave a review on iTunes. I would also really appreciate it. Thanks for using some of your valuable time to join me today on the anesthesia success podcast.