EP137: Balancing Life and Emergency Medicine: A Conversation with Dr. Dara Kass

Navigating Gender Equity, Mental Health, and Personal Resilience in Medicine with Dr. Dara Kass

In this comprehensive episode, we join Dr. Dara Kass—strategic consultant, healthcare communicator, and emergency medicine physician—as she delves into her advocacy for gender equity and mental health within the medical field. Dr. Kass sheds light on her efforts to support women in medicine through initiatives like FeminEM and Time's Up Healthcare. The discussion covers the systemic challenges in healthcare, the emotional toll of the profession, and the necessity for work-life balance, especially for parents and those undergoing reproductive health processes. Dr. Kass also shares personal experiences, such as the emotional journey of donating a liver to her son, emphasizing the importance of vulnerability, self-care, and emotional intelligence. The episode concludes with an exploration of peer support, mentorship, and systemic reforms essential for combating burnout and fostering a supportive medical environment.

00:00 Introduction and Guest Bio

01:18 Discussing Emotional Exhaustion in Medicine

01:47 Challenges of Scheduling in Emergency Medicine

03:42 Navigating Job Changes and Work-Life Balance

04:40 Advocating for Maternity Leave and Support

06:30 The Culture of Silence in Medicine

07:47 Shifting Clinical Comfort and Career Focus

09:30 Addressing Reproductive Health Policy

14:42 Personal Struggles and Transparency

17:00 The Importance of Openness and Vulnerability

17:37 Cultural Influences on Emotional Expression

18:03 Emotional Intelligence and Parenting

18:32 The Role of Cognitive Behavioral Therapy (CBT)

19:17 Self-Advocacy and Asking for Help

20:44 Balancing Work and Personal Life

23:42 Mentorship and Peer Support in Medicine

25:25 Advocating for Reproductive Health in Emergency Medicine

27:32 Final Thoughts on Staying in Medicine

Transcript

Christine Ko: [00:00:00] Welcome to today's episode. I'm thrilled to have Dr. Dara Kass with us. Dr. Kass is a strategic consultant, healthcare communicator, and emergency medicine physician dedicated to advocating for gender equity and better mental health support for women in medicine. She served as the regional director for the U. S. Department of Health and Human Services, leading efforts across New York, New Jersey, Puerto Rico, and beyond to address the healthcare needs of diverse communities. As the founder of FeminEM and a founding member of Time's Up Healthcare, Dr. Kass has been a trailblazer in challenging the toxic work culture in medicine, especially for women. Through her leadership and advocacy, she's helped create platforms for women physicians to combat burnout, emotional labor, and the systemic issues that contribute to inequality in health care. She has also served as a living donor, donating part of her own liver to one of her children, and I will put a link to an article about that in the show notes.

I'm so pleased to [00:01:00] be speaking with her today. Welcome to Dara. How are you? 

Dara Kass: I'm good. Thank you. for that's actually one of the better bios I've ever heard. It's 20 years since I graduated from residency or medical school, like the combination of the two, and it's a pretty good synopsis of what I've spent my time doing other than taking care of patients in the ER.

Christine Ko: Oh, good. I would like to start off talking about emotional exhaustion and stress. Different parts of my career, I've accepted that's just part of the job. Could I have been doing something else?

Dara Kass: Not all emotional stress and burden is the same. In emergency medicine, there's an enormous amount of stress that comes with the actual clinical practice of emergency medicine. And I actually find that as I get older and actually as my life gets more complicated, there are aspects of the clinical practice of emergency medicine that are not healthy for me. One of the biggest areas of our jobs as physicians that I have tried to protect in emergency medicine is the schedule: what it means to be available 24 7, what it means to feel [00:02:00] like you have a never ending pile of notes to write, what it means to feel like somebody has a window into access to your time when you're trying to protect your weekends and nights. There's a level of abuse that comes with the idea that your employer can tell you what your days are free at any time and in three month increments.

Christine Ko: Yes. I'm not in ER, but I can imagine that a system or hospital does need to cover the ER with an adequate number of workers, 24 hours. But of course, as a mom, I recognize that would be really impossible for me if, after a three month block, I have no idea how to plan for Christmas or spring break that's coming up.

Dara Kass: For me, it was always important that I could predict my time because that's part of the way that you can compartmentalize, right? I advocated for myself. I've left jobs when I can't get a clean back and forth on the predictability of my schedule. I don't mind taking for the team the coverage that is required to make the place work. But what I [00:03:00] require is an ability to communicate with my family, my friends, my children when I'm going to be home. We're bad at that as physicians because we're from a culture of not just service, but the system is bigger than us. Our voices don't entirely matter. And again, it isn't to say that you need to put demands on your employer to meet your needs at the expense of clinical coverage or the environment that you're working in, but it has to be a partnership so that people have a survivable life. 

Christine Ko: So, there are different types of stress, but one is related to scheduling. You also said you'd had to leave certain jobs because of aspects of emergency medicine that aren't tenable. Can you elaborate? 

Dara Kass: Somebody once asked me, you seem to change jobs a lot? I've had four jobs in 20 years. What it really means is when something isn't working for me I look around and see could something work for me better, right? The areas I look for improvement are not always salary. It's not to say that I don't try to [00:04:00] work within the system I'm at because god knows changing jobs in hospitals is a pain in the you know what, but it is that central to my survival is that I am going to work with joy and take care of patients with joy. And if I resent the environment that I'm in because it's taking away my ability to be joyful at work, within reason, I'm not unreasonable in how I want to get that.

I'm very lucky in that the ability to be mobile, is a privilege. There's so many layers of obligation that a full time job gives you that you can't just up and leave necessarily. I understand my privilege in being able to find jobs that fit my needs, but also I try to make that job better for people around me. Advocating for maternity leave and lactation support and a possibility to schedule around pregnant people without burdening the pregnant person to feel like they are disappointing you was something that I did through all of my pregnancies. You can do that with mid levels. You can do that with flexible scheduling. You can do that with job sharing. You can do that with all kinds of investments in the [00:05:00] person that is pregnant and the system that they work in. So that when they come back from being pregnant, they have a job that they want to come back to, which is a cheaper solution for the employer than finding somebody new. 

Christine Ko: Yeah, that's a really good point that in pregnancy, if you go on bed rest, or you need more time off, even if it's just well visits during pregnancy, but even when you're preparing for a parental leave, you often do feel like you're disappointing or burdening others by your absence. 

Dara Kass: I remember 20 years ago, one of my best friends when I was a new attending, was going through IVF. When we look at physician women over time and how we get pregnant historically, there's an increased frequency of using assisted reproduction. People start their assisted reproductive journey quietly. They don't share because they don't want to burden anybody with their experiences or their needs. Assisted reproduction is a burdensome [00:06:00] process timewise, and it is hard on your body. It is emotionally tenuous and then if you're trying to do that around the clinical schedule that feels unrelenting, you're almost like you're hitting your head against a rock. If only we could be open with our employers and say, we're going into the IVF process. We're really excited to start a family. Let's be supportive, right? Just think about the culture that would be. If we felt like we could be more open, it would be more humane. And I'm sure plenty of places are getting there in the 20 years since my cohort started trying to get pregnant. 

Christine Ko: I agree a lot of the culture of medicine is about silence, silence around trying to start a family, whether it's through IVF or other means or, even silence around infertility, miscarriage, or other health problems not related to starting a family.

Dara Kass: People are better now talking about miscarriage, but it's one of those unspoken things, right? 

Christine Ko: In general, physicians don't feel comfortable a lot of times disclosing any illness or condition. [00:07:00] Most of my career, the culture is, unless you're literally dying, you go to work. 

Dara Kass: Yeah. And I think that one of the things that the pandemic gave us is this understanding that being sick at work is not a gift to our patients, and it's certainly not good for us. We're all whole humans. The pandemic has given us an opportunity to reframe our work life commitments in a more equitable way. I think that's good. I hoped it would be more robust after the pandemic. We do see more flexibility in staff meetings. We see hybrid staff meetings all the time.

Christine Ko: Would you elaborate on your comment that different aspects of medicine at different points in your life aren't right for you and how you might recognize that?

Dara Kass: My clinical comfort in emergency medicine has shifted. The King's County Emergency Medicine Residency taught me how to be an incredibly solid ER doctor. And I went to work in a community hospital that gave me a little bit different [00:08:00] experience than I got at Kings County. I started a residency and did all the things that I had thought I would do in academic medicine. 

My husband was an investment banker when I married him and is now working at a hedge fund. He works five full days a week and isn't picking up my children, making lunches, or scheduling doctor's appointments; the entire emotional load of parenthood lays on me. And it's not just being a parent. It is important to acknowledge that plenty of people that do not have children have obligations outside of work and that. That is healthy. We want everybody to have the life they want. And so I talk a lot about my experience as somebody that has three kids and a partner that works full time, but that's only mine. It's important to remember that all of us have lives, and we need to balance that.

The work life integration that I needed as a parent, and honestly, as a parent married to somebody that didn't flip traditional gender roles, meant that I started working part time in emergency medicine. Once I had kids and started structuring my life differently, advocating for change, I started FeminEM. I needed space to do the thing that fed me emotionally, which was creating change that was sustainable and mentorship and [00:09:00] development for women, in this space of gender equity. 

And then I eventually wound up working in the federal government for a couple of years, started doing more in politics. So even though I graduated from a clinically intense and amazing residency, I now choose to not work in critical care as much as I used to. I only work one day a week in the ER. I insist on working one day a week. I love being in the emergency department. I'm good at other things now, and accepting that is okay as an emergency physician, I don't need to be the first pass in every critical illness, but I can still be a proud emergency physician.

I spend a lot of time working on policy around reproductive health care. I think a lot about the care of women in states with restrictive abortion bans and the collateral damage on miscarriage care and ectopic pregnancy. I am internalizing the harm happening in our country on a daily basis. If I always, every day, was thinking about somebody dying in front of me or the policies that lead people to have harm, I think that would be too much. So when I say I'm shifting my time, it's about the fact that I spend so much time on life altering [00:10:00] policy, I want to deal with emergency medicine that's more fixable, some rashes, fractures, things that I can solve. My emergency medicine shifts are solvable problems, whereas the policy stuff I work on feels in some way eminently unsolvable.

Christine Ko: Appreciate your honesty. Part of the culture of medicine is actually to feel like you're a "better doctor" or maybe a "best doctor" if you see the most difficult patients. I don't mean the patient is difficult, but their issue, their diagnosis, the coming to the diagnosis is difficult. It's not easy. You have to be smart, experienced, etc, to recognize it and give the right treatment, management, etc. And if you're just seeing a rash, and giving a topical steroid, you're just not as good a doctor. The culture of medicine you touched on is that the more you work, it's like a badge of honor, or, you're a "better" or best doctor [00:11:00] for working a lot. And if you only do a day of clinical work, even if you're full time and do four days of other work, including important policy work, like you just said, it's still, oh, you're not really being as good a doctor as maybe you would be if you worked more.

Dara Kass: That's exactly right. We have to acknowledge our whole selves and what we're bringing to the work and how to be in this job for a long time, right? Our patients deserve us to be around. And if it means me working one day clinically and doing other stuff full time that is productive and interesting, or maybe it means that I am taking a couple of years and really just doing homework every night and making sure my kids survive their high school experiences.

The kind of competitive shit isn't healthy for anybody, right? This competitive nature that I have to achieve the most always, and I have to be the most productive and I have to generate the most revenue is an unhealthy culture for anybody.

Nobody survives that well. When you only prioritize [00:12:00] production and consumption in healthcare, you create a forward feeding system that isn't patient centered. Ordering more tests, doing more procedures. Seeing more patients in a single day. We have plenty of data that shows that physicians that spend a little more time with their patients, order less tests, have better outcomes, because it's not always about how many tests you order or procedures you do. It's about taking the right care of the patient. And when our reimbursement structures are centered around that, when our incentive structures on employment and promotion are centered around that, you're thinking about systems change.

I can give you an example that I'm thinking about a lot now, which has to do with the initiation of contraception in emergency medicine. Totally feels like it's an out of the box, side, non sequitur, but it'll make sense. In talking to different physicians, there's a lot of motivations why people would have the conversation about contraception in an emergency department.

ERs bear the burden of care falling apart in our communities. You can't see a dermatologist. I'm getting better at rashes. I know what needs a steroid. The initiation of contraception has benefits, not [00:13:00] just the prevention of pregnancy, but of course the prevention of pregnancy. Some will be incentivized by the equitable need to access contraception, but some will not. Others who get paid in an RVU basis want to know what is the billable code for contraception counseling? Is there a billable code for placement of long acting contraception? So like a Nexplanon or an IUD. I can offer that to patients if patients want it. I also get to bill for the procedure. The reason I bring that up is, as a part of a large conversation of this is a change we need to see in healthcare, how do we meet everybody where they are? There are physicians in the United States that have been cultured and forced to think about revenue first and foremost as they create the day, right? Not to say they're bad doctors. They're not. When your employer counts your revenue at the end of every day, and the incentive structure is dependent on your generation of RVUs, of course, you're going to follow that rubric. And so I, as somebody that wants to create change, have to speak the language of that [00:14:00] algorithm or else I'm not going to get people to meet me where I am. 

Christine Ko: Absolutely. I love it. It's very smart the way you phrase that. It's a great example. To your point, patients are getting what they need. And, the system is getting what it needs.

I'm going to ask you another question related to you have had a lot of different jobs and roles, and you've transitioned sometimes because you're looking for something different. Because there are intense demands in the emergency medicine field, do you ever feel pressure to show that you have it all together? As a doctor, mother, or friend, are you able to openly share your struggles? How have you navigated that? 

Dara Kass: I'm pretty transparent about the challenges in my life. The perfect example is my son, he did liver transplant, right? That feels like an enormous thing to lots of people, right? Like you give birth, your child is small. You find out they have this genetic condition that you and your husband gave him, by the way. So here you are, you're defective manufacturers.

And now all of a [00:15:00] sudden, as you go through the course of medical evaluation, he's going to need a transplant. You're the best chance he has. So you not only are going to help hold your child's hand, but you're also going to go into the OR, and you're going to give the organ that he's going to getto survive. That feels like a lot. Part of what I did when I was going through that was break it down into pieces, deal with what I could that day, not get overwhelmed by everything, and really be open about what we were going through as a family because I did need certain considerations.

The month before the transplant, I stopped putting in my own IVs. That sounds crazy. Why? If I had gotten a needle stick, and I was exposed potentially to HIV on antiretrovirals, they may have canceled my son's surgery. That was not a risk I was willing to take. Now, I couldn't reduce all risks that something would happen to the surgery, but I could reduce that.

And maybe I felt like I was a little more in control, and I needed to exert that control. So I said to my nurses in the ED on shift, remember the transplant's in a month. I'm going to need you to put in all the IVs. I shared that with the [00:16:00] nurses. 

I then wrote an article in the New York Times about giving an organ to my son, because I wanted people to know more about the process because it was a gift to our family. Even in the face of a terrible disease that theoretically would have ended my son's life, I was able to help him survive. And I needed the rest of the country to feel like that was possible for them too. It takes an army and lots of people. Sammy had his people in the OR, in the waiting room; and I had my people. I got friends to visit me. I didn't have to be the mom for about two weeks. When you're under anesthesia in the operating room, and they're harvesting a third of your liver, you can't be the person in charge, and I needed to give that up.

So I would say that I personally feel like being comfortably vulnerable is important for my survival. When you're going through something hard, if you hold that all in, you wind up often resenting the fact that the world is not being kind to you when you need help. And it's not because you are trying to be [00:17:00] resentful. It's just that people can't read your mind. 

Now, I am not a huge fan always of everyone being forced to share their trauma and their stories all the time. But if you're the kind of person that knows that you're going to need a little more space, because you're going to have feelings, it's okay to be open early and let everybody be there for you. You'd be surprised how many people would be there for you if you gave them a chance. It's okay to be open at the beginning of a journey. And then if, and when there's a hard moment, you'll find more people will be there for you organically.

Christine Ko: Do you think you learned to be open growing up? Or is it a skill you took on? 

Dara Kass: I'm Jewish, right? So we do a lot of things out loud. Our culture is about family and being loud, and kind of sharing things ourselves. Togetherness is part of my family culture. I don't know what it's like to be stoic and hold things in. I don't know what it's like to feel like I need to put on a brave face. Culturally, it is part of who I am. And it may not be natural for everybody. I would say it's been important for my [00:18:00] processing. There are days that I fall apart. I got a lot going on.

Christine Ko: I would say that, touching on emotional intelligence, being able to be open and vulnerable falls under that concept of emotional intelligence. I did not grow up with emotional intelligence. My family did not talk about feelings. I'm trying to bring up my kids a different way.

Dara Kass: I will also say... how can I say this? I like to say I'm not nice. I don't wallow. I move on, but I'm super honest about how I'm feeling. As a parent, I really try to teach my children to acknowledge their feelings and identify, what are they making you do? Like, this is very CBT, right? I'm an operations person. A strong J on the Myers Briggs.

If you're upset about something, what is the thing that's making you upset and how can you fix it? To me, acknowledging feelings and then doing nothing about them is a recipe for disaster.

Understanding CBT. right? How do you feel? What are you doing about it? How does that affect the world? It's innate to who I am, but I have spent time teaching my children those skills, sending them to CBT therapists, and living that way by [00:19:00] example.

Christine Ko: Yeah. That's awesome. So CBT, I assume means cognitive behavioral therapy.

I'm just getting to know you a little bit through this conversation, but it seems to me definitely your ethos and aura is to be a helper, but also to self advocate and also be a doer. Importantly, you're willing to help yourself. So when you're saying you were a patient as well, when you're donating a third of your liver, you set up that you're a patient too, and people visit you. How did you do that?

Dara Kass: I don't tell this story a lot, but they asked me if I wanted Valium the night before the transplant. And I don't take benzos historically. I hadn't. They said parents, specifically donor parents, have a lot of anxiety the night before the surgery. I said yes, and the reason I said yes was I don't need to be a hero. I don't act like I don't need help. I try to check myself regularly to say, do you need help now? Is there something that you need? Is there something you should be doing differently? Are you actually happy with what's [00:20:00] happening in your life? And if not, do you need somebody to help you with it? Is there something that you need? And again, that goes back to the prediction of needing people when I was a patient. In a transplant, this was an experience I could not control. I didn't know what it was gonna be like in the recovery room. I didn't know what it was like in the ICU. I felt like having a doctor in the room who could tell people I needed more medicine or could make sure that I was getting what I needed: Probably not a bad idea And so I made that happen. The point i'm trying to make is I do know my own limits of what I can control and I try to acknowledge them regularly. As I get older, I may need it more.

Christine Ko: Clearly you're very strong and independent, and I think part of that is being able to ask for help and think about when you might need help. That relates to a very practical strategy you have, the self check in that helps set boundaries and avoid being overwhelmed or overloaded emotionally or with the amount of work you have to do.

Do you have other tips on how people [00:21:00] can successfully do that? 

Dara Kass: Yeah. A couple of things. You have to know your environment. I'm super clear about what I can and can't handle, what I will and won't do. Like, I don't cook, right? I've said this a lot over the years. I do not cook. I don't want to cook. I don't like to cook. I make food, which is not the same as cooking. And I don't really care what I eat. So in my life, having somebody who can make sure there's food in my house is something I outsource. I don't chef. I don't want to do meal planning. I would be happy if my kids ordered lunch every day. That is not me. 

Knowing the places that you will never go, really knowing who you are, right? Knowing the things that you're going to want to learn or you're going to want to do is important. And then having a system that lets you see your time and your space clearly, right?

Where you could pull back and say, this is my week. These are my days. These are the ways I'm spending my hours. Is this how I want to spend my hours? I only have so many in a week and so many in my life. Everything doesn't have to be perfect. Plenty of people go to work and don't love their job. They have to [00:22:00] pay their bills.

I am fortunate enough to love my job, and I have to pay bills. As long as I can make those two things make sense, I'm better off. The life I have now is what I call a portfolio life. I work a little bit in the ER. I do a lot of consulting. I have a bunch of people that have hired me to do different things and so I need to make sure that I'm able to meet my obligations. I could be on the phone or on the computer 24 7 solving other people's problems. And that also includes my children who now need me more than they've ever needed me. We need to acknowledge that as our lives cycle, the thing in front of us may not be what we need to prioritize the most, right? So look at your time, look at how you're spending it, decide if it's authentic to what you want to be doing. If you're doing something you don't want to do or it's more time than you want, figure out how you're gonna process that to say, okay, I'll do this for a year but then I'll look for some other opportunity. Or, this thing is gonna change and that's why I feel like it's okay. You just gotta feel like you're in control of something and then I think you're okay.

Christine Ko: Yes. I love it. Each person has to [00:23:00] figure it out for themselves, right? What is really meaningful to you? How do you really want to be using your time? And what are the things. that are truly pain points, like you were saying, like cooking. Can I just ask, this is an aside, but I'm just curious, what's the difference between cooking and making food?

Dara Kass: Making food is like heating up leftovers, toasting bread, really taking a food product that is mostly done and finishing it, okay? Cereal is making food, eggs are making food, omelets get close to cooking. I'm not fancy with food. I want to not be hungry anymore. My kids, they're getting resilient and learning how to cook for themselves because they sometimes like better food than what I'm providing when I'm heating up leftovers, kind of thing.

Christine Ko: Yeah, okay. I love it. Can you talk about mentorship and peer support, especially with FeminEM, in building a supportive network for physicians facing burnout or stress? Because we will, I think the reality, we will face burnout and stress in our careers.

Dara Kass: Yeah, mentorship and peer support is important for everybody. [00:24:00] Regardless of whether you're a physician or not. One of the first things I figured out is your peer mentors and your hierarchical mentors did not have to be at your institution. There are voices outside of your institution, that is like clarity. Once you go across institutions, and you compare notes... you're like, Hey, wait, you're tolerating that schedule. You're making that amount of money. They're taking vacation requests only one month in advance when we could be doing it six months in advance. You start to develop like a better menu of options to solve your problems, right? That you can take with you. So if you change jobs, your peer mentorship and your peer network is not beholden only to the institution you had.

To me, the secret sauce to great both peer mentorship and hierarchical mentorship: build outside of your own box, because you can take that with you no matter where you go. And that creates a permission structure to leave, which doesn't mean you will, it just means you can.

In our world, there are many days as a physician where you feel like your decision is the only [00:25:00] one, like it's between you and the patient and the decision you make is their life or their thing or whatever. So it's lonely. It feels burdensome, it's responsibility. And we're not going to get rid of that. And plenty of people love being the final decision maker. But at the same time, our shared experiences of patient interactions, debt, development: that journey is unique to doctors. Peer support can get you through that. So you don't feel crazy. And you also know that sometimes the system needs to change. It's great to have people that want to change the system with you.

So one of the things, Feminem, which I did for years, and now this other project that I'm working on called Access Bridge, is about improving emergency medicine, reproductive health care in emergency departments. And really having a similar cohort of physicians, residents, fellows who want to improve miscarriage care, ectopic pregnancy management, contraception, and even medication abortion in EDs.

There are women physicians and, male physicians too, trying to improve reproductive health care in emergency departments around the country for years. I have a really good friend, Kelly Quinley, who's been trying to advocate for manual uterine aspirations in [00:26:00] the ED for miscarriage for years, working so hard to get it done, but it hasn't taken off the same way that it's going to now.

And the reason I bring that up is because I found all these people around the country doing this work and feeling a little crazy because they're like screaming into the void. By bringing together a hundred physicians around the country, in states with new abortion bans, in states with new permissions, in states that have not changed the laws at all, we're creating this permission structure to say, I'm creating change in my environment that's a little different than yours, but we're all doing something together, right?

That level of support is critical to survival. That's the peer mentorship, right? We did our first call for AccessBridge this week, and it was like 30 fellows across states from places like Mississippi through New York and California. All different structures of restriction on abortion access or healthcare. Every one of them was like, this is the best call I've been on all week, or, this is the best thing I've done this year. And it's because looking around this virtual room of people trying to make the same change is invigorating.

[00:27:00] And we do these individual mentor calls, which is to say somebody like me, who's made change in spaces, who understands different systems, I may have one conversation with a kind of a physician who works in rural Arkansas, about providing better miscarriage management in a state with restrictions, or I may have a conversation with a doctor in California about the opportunity to provide medication abortion in their ED like they're doing in their family planning clinic. That mentorship, around systems change is different, but the opportunity to have a mentor is amazing. 

Christine Ko: Awesome. Do you have any final thoughts? 

Dara Kass: I have a lot of thoughts. I love what you're doing about trying to just have people figure out like what makes them whole and how they can stay in medicine. Often there are podcasts and conversations about alternative careers and side hustles. I had a real estate broker's license for a while. We didn't even talk about that. There are plenty people looking to create revenue outside of medicine, and I'm cool with that.

At our core, we spent [00:28:00] our entire formative life figuring out how to become doctors. If you asked 14 year old me what I wanted more than anything in the world, it was to be an emergency medicine doctor. I am not going to let this system force me to give that up. I will fight to make the system better so that I can still do the thing that at the end of the day I was built to do, which is to take care of patients in an emergency. Creating a life that includes clinical medicine is important to me. That's the change I want to be part of, where we're excited about staying in clinical medicine. Because our patients need us. I'm a really good emergency physician. I want people to come into an ED and see me a whole happy, joyful physician who has 20 years of experience solving their problem that day. They deserve that. I deserve that. And no really terrible system of burnout and abuse and RVU generation is going to take that away from us. Don't let them take this away from us is what I'm going to leave you with. 

Christine Ko: Thank you. I love the [00:29:00] passion. I'm in total awe of you and everything you've done and are doing. Thank you so much for spending this time with me. 

Dara Kass: This was fun.