See, Hear, Feel

EP99: Dr. Ashley Wysong on balance, burnout, and burners

January 31, 2024 Professor Christine J Ko, MD/Ashley Wysong, MD Season 1 Episode 99
See, Hear, Feel
EP99: Dr. Ashley Wysong on balance, burnout, and burners
Show Notes Transcript

Dr. Ashley Wysong is a force of nature, and I recently had the pleasure of hearing her lecture at Yale. She seamlessly integrated practical advice in a presentation full of clinical pearls. She's learned a lot to help her be successful, and she shares some of her useful tips with me. Dr. Ashley Wysong, MD is the University of Nebraska Medical Center Department of Dermatology Founding Chair, Professor, and William W. Bruce MD Distinguished Chair of Dermatology. She is a nationally recognized leader, Mohs micrographic surgeon, and translational researcher. She is passionate about educating and mentoring others.

[00:00:00] Christine Ko: Welcome back to SEE HEAR FEEL. Today, I'm with Dr. Ashley Wysong. Dr. Ashley Wysong is the University of Nebraska Medical Center Department of Dermatology Founding Chair, Professor, and William W Bruce MD Distinguished Chair of Dermatology. She is a nationally recognized leader, Moh's micrographic surgeon, and translational researcher. She is extremely passionate about educating and mentoring others, and I had the great pleasure of being able to listen to her lecture recently in my department at Yale. 

[00:00:30] One of the things that you did during the lecture was you had some quotes here and there. One was from your mom, and it really appealed to me, your whole lecture, but that too. So I asked if you would be on this, and you said yes. So here we are. Related to those quotes, I was wondering if you could tell some advice that you wish you had known earlier.

[00:00:52] Ashley Wysong: I'm really glad that my Grand Rounds lecture at Yale spoke to you in the sense that I think it's wonderful when we impart medical wisdom to each other, and we teach each other the importance of all those other intangible things that we have to learn along the way, to really have not only successful careers, but really successful lives. And I think those are the things that we don't necessarily learn in medical school. To directly answer your first question, what advice do I wish I had known earlier? It would probably be, enjoy the journey along the way. We just miss so much of the journey, and we miss so much of the relationships and the other ways that we can grow. We all have to work so hard for a really long time, and keep our heads down to not only survive, but really thrive in medicine. Celebrate the wins, because we're so easy to move on to that next thing, that next achievement, that next rung on the ladder to success. 

[00:01:53] In addition to developing that clinical expertise and the research expertise and the education and mentorship piece, we've got to identify and equally develop the other burners of our lives beyond work, and I think that's extremely important, and something I've had to learn along the way.

[00:02:12] Christine Ko: I like it.

[00:02:13] Ashley Wysong: Now as an attending physician and particularly as a chair, I'm so much more aware of that leadership shadow and what I'm really projecting to others. 

[00:02:22] Christine Ko: I love that. I haven't heard that term before. Leadership shadow. That's really true that people are looking at you/ us and, without maybe at least me really being aware, sometimes judging me, whether good or bad, on my decisions.

[00:02:41] Ashley Wysong: Yeah. And not just judging, but learning from you. 

[00:02:44] Christine Ko: Yeah. Do you have any tips on how to enjoy the journey?

[00:02:48] Ashley Wysong: How to enjoy the journey.... I will share with you today. I've been through 2 real cycles of burnout through my career. I've gotten really good over the years of knowing my early warning signs, am I just not quite getting enough sleep? Am I starting to think more about work? Am I waking up first thing in the morning, knowing those early warnings? Did I skip the gym this morning? Some of those things have been really helpful. And I think being really deliberate around developing those other burners, as we've alluded to, beyond work, what are those other things that are really important to me? Think about all those other aspects of you and who you are that ultimately bring you joy and happiness, both inside and outside of medicine. When you know the things that are really important to you, when you prioritize your time accordingly, I've gotten a lot better at setting specific boundaries, whether it's around my time, around the things that I'm going to say yes or no to, and really making sure that I'm doing the work that I want to be doing when I want to be doing it. And I'm able to shut that off. Whether it's at the end of the day on nights and weekends, or for vacations, it's been a very deliberate journey along the way. And, as I've shared, I've not gotten it perfect, but I can continue to recenter around the things that are really important to me and make sure I'm prioritizing my time accordingly. That's what has been the most helpful for me over the years. 

[00:04:18] Christine Ko: Yeah, you touched on celebrating the wins. Is there anything you do to celebrate the wins for yourself or in your department? 

[00:04:26] Ashley Wysong: I love anniversaries. So we really try to be thoughtful, especially as a new founding department. So right now we're about ready to celebrate our six year anniversary in May. Um, we know everybody's work anniversaries and birthdays, whether it's like the daily wins, just finding the joy, the gratitude and expressing that to others. Just saying the thank you when a nurse has gone above and beyond, or when you notice somebody doing something, you know, that's expected or not expected, or just celebrating the clinic going well. Stopping and celebrating in ways that are meaningful to you, finding your own little rewards that are not externally motivated that are meaningful to you. 

[00:05:07] Christine Ko: You mentioned that you're pretty open about these two different periods of burnout. Do you mind sharing a little bit more about that? 

[00:05:15] Ashley Wysong: Yeah, absolutely. The first one was actually when I was a chief resident. I had an awesome residency. I loved it. It was outstanding. And I was elected chief resident, along with my co-chief, so there were two of us. And that year, our program director left, our program coordinator left, our chief of pediatric dermatology moved on, and we felt like we were the only ones that really knew what was going on with the residency. In all sincerity, I just took a lot of responsibility on myself in addition to all the typical third year chief year resident roles. And it's the first time I ever drank coffee, which is amazing. I got all the way through undergrad, graduate school, medical school. All of residency. I worked constantly. I felt a lot of pressure. I felt a lot of responsibility, and I found it hard to take care of myself in a meaningful way. And I was stubborn about it. I remember people who cared about me, my husband, others saying, you're doing too much, you're taking on too much, but I just kept pushing. That was really my first real experience with burnout.

[00:06:24] Christine Ko: Yeah, thank you for sharing that. Residents don't have much power, actually, right? Burnout being a system problem and really any blame should not be put on an individual. It's not that I'm trying to blame your program or anything, but just really, the system should not have really allowed you to take on so much. But I can imagine, and I'm just making stuff up right now, I don't know. But I can imagine that the system, the program was like, Ashley, you're awesome! You're doing all this stuff! You're carrying us along! Or maybe they didn't even, and it was just your own internal sense of responsibility that kept you going. But that shouldn't have happened to you that way. 

[00:07:04] Ashley Wysong: Oh thank you for saying that. I think there are always system ways that we can help prevent this in others. And I was really good at not letting anybody know. And if I could share anything with any of your listeners and any premeds and anyone who just, you know, really pushes themselves to the max: You've got to recognize those tendencies within yourself. You've got to identify those early warning signs. You've got to invest in self care above all else, because, without that, you cannot be at your best. None of us can. I was not good at asking for help in the earlier years. That's something I've gotten a lot better at. I had a lot of pride around that. I was going to figure it out myself. I could do it. I could show others I could do it. I could show myself I could do it. 

[00:07:57] Christine Ko: These experiences, hard as they can be, are important because they do help us grow and change. Can you talk about how you continuously improve?

[00:08:05] Ashley Wysong: I would say a way that I continuously improve is surrounding myself by rock stars; hiring, promoting, investing in people who are even smarter, stronger, better than I am. I think it was Jim Rohn who said, you're the average of the five people that you spend the most time with. And I think that's absolutely true. Who are you surrounding yourself by? And are you helping, promoting, bringing up people that are even stronger than you are? That's really important. And I think continuous improvement also comes from putting the mirror up, and I would say self reflection, right? but also eliciting that feedback from others. How did we do today gang? What can we do to be even better? How can we be even stronger? Having that culture of feedback is really important for continuous improvement. 

[00:08:54] Christine Ko: I recently spoke to Benjamin Doolittle, who has a Master's of Divinity, but also is an MD, and he's done a lot of work in burnout, and one of the things he told me is people who have wellness in their life don't necessarily have work life balance. They really love what they do, and they have hobbies, they know how to turn it off. But it's not necessarily like they feel that their lives are in balance. Knowing that he said that, I was like, Oh, maybe it's the wrong thing to strive for balance 'cause I've never been able to achieve it. How do you approach that? Do you try to aim for balance in the things that you do? 

[00:09:29] Ashley Wysong: The reality is it's different for everybody. For me, it's been different at different stages of my life. And I think balance is absolutely a mindset, right? Are you happy in your day to day? Are you happy with the way you're spending your time? What does balance mean for you? For me, again, it's changed a lot over time.

[00:09:53] There are things that I've been really deliberate about to help with that. We talked about some of those tactics earlier for avoiding , right? The avoidance piece, like setting boundaries, learning to say no, early warning signs of burnout. Those things." But in addition to that, there are the things that I've added to my life for balance. For me, that's been practicing gratitude. Genuinely practicing gratitude. I have a gratitude journal. I think I seek constantly to be expressing that gratitude as well, which I think is really important. 

[00:10:28] The other thing that I think has helped me a lot for balance is being present, really being present. Literally I have it right here on my desk. Be here now. Focus on staying in the present. And I think that has really helped me from a balanced perspective.

[00:10:44] I shared a little bit earlier around the self care piece, and for me, that means moving and being active in some way, investing in whole foods and real nutrition, making sure I'm drinking water. Focusing on things that will help me age well and be highly functional well into my, God willing, older years.

[00:11:04] Asking for help has been really impactful for me around balance, and even more specifically, I think a lot now about what I like to call giving the gift of delegation. I have a decision making algorithm, along the decision tree, Is this something only I can do? Is this something that in this situation requires my unique and specific involvement? And if not, give the gift of delegation, empower others. Build your team. Elevate another dermatology leader. Elevate another physician leader. Elevate another administrative leader. 

[00:11:42] And then finally, sorry, this is a long answer. You can tell I thought a lot about balance. I think developing new hobbies. Hobbies are super important. My latest is jewelry making. That's just a fun way to aim for new types of balance over the years.

[00:11:56] Christine Ko: I love it. Do you have any final thoughts? 

[00:11:59] Ashley Wysong: Oh my goodness. Final thoughts. One, thank you for having me on. I've really enjoyed discussing some of these extremely important topics with you. If I could leave your listeners with anything, it's just, You only go around once, so live life to its fullest. Never take our time on this planet or those around you and your loved ones for granted. I know it's something I think about constantly and I'm constantly tweaking my life and hence balance around that. I think when we live that way and can live our life with no regrets and recognize it for the gift that it is, I think we make decisions accordingly.

[00:12:37] Christine Ko: I love it. Thanks so much for spending the time to be on this. I really appreciate it with all that you're doing.

[00:12:43] Ashley Wysong: Thank you, Dr. Ko, for having me on.