EP143: From Survival to Thriving: Dr. Amy Oxentenko's Journey

Thriving in Medicine: A Conversation with Dr. Amy Oxentenko

In today’s episode, we sit down with Dr. Amy Oxentenko, MD, a Professor of Medicine and gastroenterologist specializing in celiac disease and malabsorption. Dr. Oxentenko shares her journey from surviving to thriving in the medical field, emphasizing the importance of self-care, particularly adequate sleep and exercise. She highlights her leadership roles, including her current positions at the Mayo Clinic and the American College of Gastroenterology, and shares insights into fostering diversity and equity in the workplace. Dr. Oxentenko also discusses the pivotal moment in her career influenced by Dr. Julie Silver’s leadership course and the importance of patiently pacing oneself through career opportunities and learning to say no. This episode provides valuable lessons on balancing professional and personal life for sustained success.

00:00 Introduction to Dr. Amy Oxentenko

01:07 Thriving in Medicine: Tips and Tricks

04:15 Balancing Family and Career

06:03 The Importance of Self-Care

13:11 Leadership and Career Development

22:22 Fostering an Equitable Workplace

26:33 Final Thoughts and Takeaways

Transcript

Christine Ko: [00:00:00] Welcome to today's episode. I have the pleasure of being with Dr. Amy Oxentenko, MD. She is a Professor of Medicine and a gastroenterologist with expertise in celiac disease and malabsorption. She completed her medical training and residency at Mayo Clinic in Rochester, where she earned prestigious awards. Dr. Oxentenko has held various leadership roles, including Program Director of the GI fellowship programs, Internal Medicine program, and Chair of Medicine at Mayo Clinic in Arizona. Currently she serves as Vice Dean of Practice for all Mayo Clinic sites and is the program sponsor for the Whitney McMillan Physician Leadership Business Academy. She is also the American College of Gastroenterology President, 2024 to 2025, and is Vice Chair of the ACGME review committee for internal medicine and its subspecialties. She actively promotes diversity, equity, and inclusion through her social media platform. And you can find her [00:01:00] @AmyOxentenkoMD on Twitter, and I'll put a link to that in the show notes. Welcome to Amy. 

Amy Oxentenko: Hey, thank you for having me. 

Christine Ko: I'll just go ahead and jump in and ask, how have you learned to thrive rather than just survive in medicine?

Amy Oxentenko: Yeah, it's a great question. Probably the most important part of that question is the word learned, meaning this isn't something that we all completely have figured out from the first day of our jobs. It is something that over time, we learn the tips and tricks of what we can do to exactly thrive rather than just survive. We all see many colleagues who are probably in survival mode and lots of reasons why that happens. So many of them are systemic, institutional, structural sort of things that are out of their control. I look back to the earlier point of my career, there were times that I clearly felt like I was in survival mode, when I was trying to make it in academic medicine, work on academic promotion, which is obviously a currency of [00:02:00] leadership roles, managing three young children in a physician marriage. Many times I felt like I was just surviving, burning the midnight oil to get all of those things done. 

It's hard because I suspect we all go through periods of our careers where we feel like we're in survival mode. And that's just an important thing to normalize. Not that we want to stay in that survival mode. I don't think that's healthy by any means, but there are times where the workload just increases and we need to figure out ways to balance. I think honestly, it's been in the last probably five to eight years that I have really been able to figure out for me personally, what is it that has allowed me to thrive rather than survive?

And it sounds so obvious when you say it out loud, but I think much of that is because I have taken better care of myself outside of work. Meaning, when I was early in my career, with young kids, I would stay up until one or two in the morning, finishing talks, working on papers, getting very little sleep, feeling like I could get by with little sleep. Exercise and those sorts of things just came when [00:03:00] there were spots in the calendar, which were pretty much non- existent.

I've taken a very different approach in recent years where I know that if I don't get adequate sleep regularly, it just takes a significant toll. So honestly, I prioritize sleep probably above most other things in my day because I realize now I can handle things so much more effectively with good sleep compared to what I was doing when I was multitasking, burning the midnight oil. You know, I also prioritize exercise, not just because of the physical benefits of it, but because it honestly helps with my cognitive managing of all of the other things I have on my plate. It is probably the best stress reliever for me so that when I go out on a run, whatever issues or challenges that I've had in the preceding days, I leave them all out in the road. That's just my therapeutic purge. That has allowed me to really thrive and show up to work every day with my best self, being rested, being energized. And, family is also a huge [00:04:00] priority for me. 

Learning, what are those priorities for you? Making sure that we each have our own set of priorities and you're true to those priorities. If you fill up your own cup on those, it'll allow you to be in that thriving mode rather than just that reactionary survival. 

Christine Ko: I love your answer. You said about five to eight years ago was really when you started to learn how to thrive. And so, to me, I think some relevant things would be your age, when you finished training, and how old your kids were about five to eight years ago. 

Amy Oxentenko: That's totally fair. So I'm 52. Probably, I would say in my early to mid forties, I started to get a better understanding of these things. So at that time, my kids were probably all in the early high school age. And so I suspect part of that key was suddenly they were more independent, right? I could leave and go on a 10 mile run and not worry about someone falling down the stairs or getting into trouble. That was probably a turning point [00:05:00] when my kids became more independent, and my husband and I were able to do the things that we also felt like we needed to do for our own kind of health and wellness. That was a big key. We didn't start having kids until I was in my late twenties, finished having kids in early to mid thirties. I have three college age kids right now and have an empty nest. That control over one's calendar just allows so much more flexibility. When our kids were two, three and four, it was just a very different situation.

Christine Ko: Yes. A lot of what you said resonated with me. When my kids were younger, like very young, like babies, especially they're completely dependent on someone, right? In my partnership, it was really me. I'm also married to a physician, and he would be on call whereas I wouldn't be. So he's literally not even in the house. So it's not about a willingness to help. He was working. 

Amy Oxentenko: Right. 

Christine Ko: You beautifully touched on the different [00:06:00] tensions that there can be. 

Amy Oxentenko: Yeah, absolutely. 

Christine Ko: When you talked about really taking care of yourself which, you said it sounds silly to say aloud, but it's true. I've recently been grappling, mentally, with the fact that women are traditionally taught to put themselves second or third or last or whatever; mothers are also often taught kids come first. And I think physicians traditionally also are really like the patient comes first, and in some ways, I think the patient absolutely does come first. But if the doctor is totally falling apart, that doesn't help, right? Can you talk about how you do prioritize sleep with those tensions as a, a mother, a woman, physician, all of those three things?

Amy Oxentenko: Yeah. It's tricky for the reasons you mentioned. As physicians, we go into medicine because we have a nurturing component of our personality. Women [00:07:00] probably have a bit more of that oftentimes. And motherhood. It's additive in terms of each of those layers of that nurturing sort of piece. So we often look to what needs to be done, who needs to be fed, who needs to be cared for, who needs to have X, Y, or Z done. And so we often have that perspective and can go all day in that nurturing mode, taking care of everybody else. It's tricky, like you said, you can't delegate to your partner if your partner's on call and isn't there, but, thinking about ways that you can invest in yourself literally and figuratively, meaning what resources can you bring in to help you with those sorts of things. We were fortunate to have a nanny for 16 years, the same one, which is like finding a unicorn. And she was amazing. And she became that person for me who allowed me many of those things. But just also thinking of how to find those pockets of time, those little cup fillers for yourself. I can't tell you how many countless thousands of hours at track meets, cross country meets, [00:08:00] baseball tournaments; transporting from event to event. When I was in that mode, sometimes it's, like, gosh, I haven't had time to do things for myself. I would love to go on a run yet I'm sitting here watching a weekend baseball tournament. I don't have time. And so, I learned how to be creative. If I had to bring a kid to a practice for an hour, I had my back seats stocked with running gear. So I would just put things on and find a path around to get in a run while my child was in their activity. In my mid 40, like that's when I started to see things in a different way, creatively. Okay, I'm going to have to be stuck at location X. What can I do at location X to feel like I got something done for myself? Just being creative. Maybe it wasn't the most ideal place that I would want to run, but doing it was better than not doing it at all. And sleep. You mentioned sleep. Coming back to sleep. That was fundamental. You know, again, running is my safe space, my passion. I couldn't do that if I wasn't rested. And if you're not rested, you're more likely to be injured.

Christine Ko: In survival mode, especially earlier on in my career, I didn't feel like I even had the [00:09:00] time to think creatively like that. Sounds silly. Like, how long does it take to plan that? Maybe 30 seconds, maybe five minutes. But I felt like I'm like just barely getting the kid to where they need to go. I realize in retrospect that it's sad. I probably could have had that 30 seconds. It's just, I didn't prioritize myself enough, I think.

Amy Oxentenko: Once you start, just a few times, prioritize that for yourself, then you'll realize how good it makes you feel. And then it becomes like a positive cycle, right? Because right now people sometimes get stuck in a vicious negative cycle of, I don't have time. I don't have time. So they don't do whatever it is they want to do. Once you break that cycle a few times and you realize the positive impact it has for you, suddenly then that 30 seconds of prioritizing, getting a workout outfit in your car or something like that is worth it because you know the payback for it is going to be incrementally so much greater than whatever investment of time you had to put in to make that happen.

Christine Ko: Yes, [00:10:00] absolutely. That positive reinforcement, how good you feel, is helpful. And then also, just the idea of creating a habit, which apparently just takes just like two to three weeks or something. Honestly, something that sort of held me back is that it did feel so good and freeing that I was almost afraid that on an extreme, I'll exaggerate, that I would like leave my kids and my family because I'd be like, it is so nice to just think about one thing, like myself. Right. This is coming back to I am a selfish person. And I think, to some degree we all are and we all should be, but I'm also a little bit embarrassed to say that out loud. 

Amy Oxentenko: No. First of all, self care is not selfish. If it allows you to be a better physician, mother, partner, et cetera, then that's not selfish if it allows you to do those things better. I suspect everyone has those sorts of, gosh, what if I go and do this amazing thing? It's so amazing. I never want to return. But that probably tells [00:11:00] you're not doing those things often enough. If you're so hungry and craving for that escape for just a brief period of time, if you build those more naturally into your schedule, you'll still get that, positive affirmation about it, but it also can then be balanced in the reality of, your day to day life if you do realize you don't have to wait months or years to have one of those mini escapes again. Having something with some regularity allows you to feel like you don't have to wait so long to get that fulfillment again.

Christine Ko: I really like how you gave a nice tool to create a small pocket for yourself: just plan and have some running gear in the back of your car. Can I ask what your sleep regimen is now, and how you set it up? 

Amy Oxentenko: I'm usually physically in bed and if not asleep by 10 o'clock. That's pretty much a pattern that I have. And part of that is because I enjoy running early in the morning because I know that's the time it's going to happen. I will get seven and a half to eight hours of sleep. Seven and a half hours is truly [00:12:00] my minimum. On a regular basis. Yes, I'll have a day where I'll get six hours just because of crazy travel or something, but I know that for the most part, if I get about seven and a half hours a night again, I am just a totally different person and so much more productive than if I'm chronically sleep deprived.

Christine Ko: Yeah. And how are you able to find that out for yourself? Like how much sleep you need? Was it just trial and error? 

Amy Oxentenko: A little bit. Again, it's in the context of how old your kids are and if they allow you to do this, but when you have a weekend where you can just sleep in a bit, you probably naturally wake up at the time where your body is rested. You start to know, okay I'm starting to wake up around this time. And whether they're accurate or not, we have so many wearables that tell us, your body battery is zero, you need to do something different. That's helpful as a gauge, and it keeps you honest, if you think you're getting good regular sleep, but on average for the last week, you've gotten five and a half hours every night, that's the reality that you're probably not getting the sleep you need, and at least gives you some objective data, whether [00:13:00] it's completely accurate or not.

Christine Ko: I actually have a wearable. I have an Oura ring. It did help me. It confirmed I'm better with probably about seven hours of sleep. I'm gonna transition to a slightly different topic. I read that you wrote that Dr. Julie Silver's leadership course changed your course. Could you talk about that?

Amy Oxentenko: Yeah. So anyone who knows Dr. Julie Silver knows that anything she does is amazing. This ties well to the topic we just were discussing about investing in yourself. The year that I went to Dr. Silver's course was in 2019, I remember. The content was amazing, but I think what was pivotal for me is, first of all, it was the first course I was going to where I wasn't speaking at it. I didn't have a responsibility. I invested in myself to go and just be able to completely take in a leadership course. So I think, again, it goes back to that investing in yourself in whatever way it is. So this was the first time in many years I'd invested in myself to go to a course for my own kind of leadership development. I also think what [00:14:00] was so pivotal is I went at a time when I knew I was going to be ready for a leadership change within the next year. I remember sitting in this course and literally every speaker I felt was speaking to me. I felt like everything they said resonated so deeply with me. I've gone to her course a number of times since as a speaker and sat through the same lectures, and they hit differently depending on where you are in your career and what decisions you're having to make. That year, the stars aligned, where I had no other distractions at the course, just my full investment of my time and attention. From the first day of the course to the last day of the course, I made a complete pivot about what I was going to do in terms of my career trajectory. I really think it's so important again, investing in yourself because oftentimes we'll go to this course where we're giving a talk or we're doing this because we're presenting a poster or something else. But thinking about what course or what activity could I go to that is an investment of my own career development [00:15:00] where I really want to hear from others of how to develop this? And I'm open and willing to take that advice to move the needle in whatever way. I think that's why it really changed the course of my career.

Christine Ko: That's neat. What did you pivot toward? 

Amy Oxentenko: Yeah. The first day of that course, I just had some discussions with leadership in Arizona about the department of medicine chair role there. And at the beginning of Julie's course, I had a conversation with the leadership and said, you know what, it's great opportunity for some other person. It's just not the right time for me. And, thank you very much. And at the end of her course, as I was sitting and listening to all these lectures, talking about how as leaders, you have to be adaptive. You have to think in new ways. If you're encouraging other women and other people to take on challenges and opportunities, if you're not looking in the mirror and taking those things on yourself, then, how authentic is the advice you're giving to others? So, literally the last day of the course, I called up Arizona leadership and I said, I think I gave an uninformed "no" could you please [00:16:00] grant me the benefit of a trip down. I want to explore this opportunity. And that led to a complete change in my career, which was one of the most fulfilling, professional opportunities that I had. You have to be willing to step out of that comfort zone. And I think when you do, especially in your leadership, the rewards of what you have to gain are so much greater than just seeking the path that feels comfortable and easy. If it's easy, you're probably not going to really be challenged to elevate in your leadership. If it feels a bit scary and daunting, those are the things that are going to challenge you. Those are going to be the things that will allow you to learn in new ways and lead in new ways. 

Christine Ko: So it sounds like you moved then to Arizona. 

Amy Oxentenko: We did. Yes, we moved. We moved literally within the first few months of the pandemic. My formal interview for that role, March 16th, 2020. The first day of the week the country shut down. We did end up moving that spring to Arizona. And, it was incredibly challenging. I'm not going to minimize that at all. At the time I had three high school kids in [00:17:00] ninth, 10th and 12th grade. We hadn't really anticipated what it would feel like to move in a pandemic. And the time when we got there in the first four to six months were incredibly challenging for our kids and our family as it was hard for them to meet new people, to integrate. And after a year, I've been very open about this, my husband and I realized our kids and our family were not thriving. So we moved the family back to Rochester a little over a year later. I loved my role, and I continued in that role for another year and a half. I commuted back and forth every other week from Arizona to Rochester. And again, it's another one of those things that people may think, how in the world did you make that happen? But I figured out a schedule that made it very efficient, very seamless. When you've made those priorities in your life, it allows you to take the best things you love, prioritize them. To have a family that was thriving, I didn't have to sacrifice professionally to make that happen. I was very fortunate in that I had a very supportive workplace. And it just [00:18:00] shows you don't have to pick a path, right? You don't have to pick the family path. You don't have to pick the career path. You can pick your own path right in the middle to allow you to prioritize the things that are most important to you and yet thrive professionally. Maybe different ways. I pivoted to a new leadership role, which is very different than my department of medicine chair role. Again, learning in new ways. 

Christine Ko: Thank you for sharing all of that. It's not necessarily easy, and it can be hard on us as well as our families and those around us. But, it's still worth it.

Amy Oxentenko: Oh, absolutely. Yeah. Those were a few of the hardest years professionally just because of the challenges that any leader had to face at that point: managing a clinical practice in the setting of a pandemic. Being a new department chair. I stepped into the role on day one in crisis mode, managing all of the fires that were going on. I just had to be able to be adaptive to say, gosh, I had this great vision for this department that I'm just going to have to put on pause for whatever length of time until I make sure that I'm meeting the needs of the department, and the department [00:19:00] members, and the patients we serve. The challenge wasn't in the skill set. I felt like I had the skill set to do the job. The newness of it, and just exerting leadership skills, that adaptiveness, and crisis management, and those sorts of pieces was just a great challenge, and I learned so much. 

Christine Ko: So you mentioned you had the skill set. Even physicians who don't have a formal leadership role, like title, are leaders. We lead patients, we lead our families, we lead our colleagues, junior trainees, medical students, et cetera. Do you think there are some core skills that are helpful? 

Amy Oxentenko: Oh, absolutely. Focus on the fundamentals, and that self reflection of the fundamental leadership skills. Everything from, effective communication, being visionary and strategic, being a team player, being authentic, being an active listener, learning how to problem solve and deal with crucial conversations effectively, [00:20:00] negotiating skills.... Emotional intelligence. All of those things are just core leadership skills. Sometimes people say, aren't those all linked to our personality? Don't you either have them or you don't? And I think really all of those are teachable. They're all fundamentally skills that can be learned. If you focus on well rounded leadership skills, the opportunities will follow because people will see that you're a strong leader, and you have, you know, well rounded leadership capabilities that will allow you to tackle any sort of leadership role.

And sometimes people don't know, where are those weaknesses that I have? Asking whether you do it on your own or through your workplace to have a leadership assessment, because sometimes we may not recognize our own leadership deficiencies, right? So being vulnerable and asking for whether it's a 360 or multi source feedback, specifically about your leadership capabilities, so that you can see where you might have gaps. You can really work to then sharpen those [00:21:00] skills through very directed skills training in those elements that you might otherwise not be strong in.

Christine Ko: I personally do think emotional intelligence is key to all of that because a lot of it rests on communication and being able to communicate well and listen well and be empathic for other people. Do you have any other advice you would give to a younger self or a younger physician?

Amy Oxentenko: Yeah. Pacing yourself through the opportunities is really important. I see people who are coming out of training who are so fearful of saying no to any opportunity, because they're so afraid that if they say no, that opportunities will dry up. That's where having a trusted advisor or mentor to help filter those opportunities that come your way to say, which one of these are really, going to align with where you're looking for your career to grow and build versus which of those are a really significant time filler that the value equation is just not there. Just being [00:22:00] very thoughtful and having that trusted advice or advisor to weigh in on those sorts of things. It's okay to take on fewer things, but doing them at a higher level rather than taking on so many things.

Christine Ko: The ability to say no is important. And I like how you tied it though to having a trusted advisor because it can be really hard to decide for yourself. If we pivot a little bit, you're really dedicated to fostering an equitable workplace for everyone, but especially women and underrepresented minorities. Can you talk about how each of us can foster that kind of supportive environment?

Amy Oxentenko: Yeah. As we all go through our training and our careers, we see areas where it clearly is not equitable in terms of whether it's opportunities or, you name the, metric. But I think when we're coming through our career, we're not necessarily feeling like we're in a safe space to call those things [00:23:00] out. I remember very specifically there was something in our workplace years ago where I was wanting to be the vocal person because I was so passionate about a wrong that I saw happening over and over. And I remember talking to a senior woman leader about it, and she said, Amy, this is not a sword that you should be falling on in this point in your career. Let me take that because I, at this point in my career, that sword is not going to have the impact that it would for you now. And she did. Think about how valuable this was. Thinking about it in that way and having those trusted allies who are more senior than you, who can be that voice, is really important. I think about how I can pay that forward to what that person did for me. That's a really important thing as senior leaders to think about how we can do that when we see our junior colleagues struggling in some way, how we can be the voice for them even if it may mean, the pinch of a sword a little bit. It's probably feels less pinch for us than it would be for [00:24:00] them. 

Once I got to a point in my career where I was promoted to professor, I really felt like it was my responsibility to now be the voice, to make sure that we started to change things to be more equitable. I could be the voice because I felt like the consequences of me speaking up were not as great compared to someone who's just starting in their career, who early on could get labeled as the disrupter. And to me, it just became very comfortable, very respectively calling out where there may be inequities in a inquisitive fashion, such as, I see we're approving speakers for this course. Can we see the breakdown of men and women, those from underrepresented backgrounds? I started to ask for the metrics. It's really hard to argue with data. When you see data that shows that the opportunities are not equitable or proportional, [00:25:00] then at least that gives you a starting point. And I think it's really hard for people when they see the data and see that it's not equitable to somehow support a continued status quo. Once you're able to create an environment to speak about it in a respectful way around the table, that's when you can start to make changes. It's stepping out of that comfort zone a bit and making yourself a bit vulnerable to have that conversation to raise that concern. But I think once you do you'll see that other people will be the voice. 

Christine Ko: I like that. I like how you put that. Sometimes we really don't have power, especially earlier on and it's probably necessary to wait till you have a certain amount of power. And then the flip side of that is I think that we all have more power than we think. And so we can at least make certain small changes, and any leadership tables that we are sitting at, we can bring things forward. You displayed your leadership skills with your answer [00:26:00] because you said to do it, maybe inquisitively or definitely respectfully, and to be more like opening up a dialogue rather than just coming out with like fire, and also to have data because data, as you said, is very helpful.

Amy Oxentenko: That's key. You have to approach it in that way to build allies. If people approach it like a bull in a china shop, it's just not successful, right? People will be on the defensive and that's not going to be positive at all. 

Christine Ko: Yes, I love that. To summarize so many great things that are so resonant, you know. Definitely we should think about ourselves. It's not selfish. And that is key to thriving, even if it's just 30 seconds to really prioritize, figure out what you want. Learn to say no. And cultivate, just in general, the skills that are needed by leaders like emotional intelligence and the ability to be empathic and a good listener. And also, maybe wait [00:27:00] until you have a certain amount of power, and maybe take it to someone else who has a little bit more power and hopefully they'll make some changes that are needed rather than you if you are earlier on in your career. It's all such great stuff. Thank you so much. Final thoughts? 

Amy Oxentenko: It's been a great conversation. Hopefully anyone who's listening will think about just taking one or two of those things, and being able to put them to action in terms of, the things you summarize, finding those pockets of time. And, not feeling guilty about it because I think that's again going to be the way that you're going to sustain your career and make you feel like you're thriving for sure. Whether it's through, fitness, courses, coaching, whatever it may be, thinking about small ways you can invest in yourself is going to pay for itself and then some long term, over your career and in both your personal and professional life, for sure.

Christine Ko: Thank you again. 

Amy Oxentenko: All right. Thank you.