The Fauci Effect: An unprecedented rise in applications to medical school provides an opportunity, but might we miss it?

From the 2/19/2021 newsletter

Director’s Corner

The Fauci Effect: An unprecedented rise in applications to medical school provides an opportunity, but might we miss it?

Adina Kalet, MD MPH

Applications to medical school are at an all-time high. In this week’s issue focusing on Rural Health and Medical Education, Dr. Kalet considers the opportunities this may afford us to address the significant geographic and specialty maldistribution among the physician workforce and, thus, address health disparities.  Or not …

When I entered medical training in 1978 at the Sophie Davis School for Biomedical Education at the City College of New York (now the City University School of Medicine), I signed a contract committing me to practice in a medically underserved urban community. I thought I wanted to be a physician (What did I know? I was 17 years old!) and, compared to what I had heard about the competitive grind of the typical pre-medical pathway, the social mission of the six-year accelerated BS/MD program I was entering appealed to me. My classmates were typical inner city public college folks, over 30% of us were Black and Latino, most were from lower middle class and working poor families, and many were immigrants or first-generation Americans. As I discovered later in my training, ours was not the typical make up of a medical school class. 

Medical education is never simply a straight path an individual takes toward their clearly articulated career goal. Most medical school applicants share a desire to serve others, but few have a clear idea of what that really means, much less have any specific ideas of what they want to do. Instead, medical school and residencies expose trainees to a variety of opportunities while the curricula (both the explicit and hidden) mold, shape, and guide them. There are twists and turns along the way. Career choices evolve. Role models inspire and disappoint. Exposure to challenging societal and public health issues can leave deep impressions. Outside events intervene. Powerful forces influence choices and address societal challenges. 

Why are more students than ever interested in becoming physicians? 

This year, even as applications to colleges and universities have been falling, we are seeing an unprecedented 18% overall increase in the number applications to medical school. Some are calling this the “Fauci Effect,” attributing the increase to the inspiration provided to young people by Anthony Fauci, the physician, scientist, director of the National Institute of Allergy and Infectious Diseases (NIAID), and voice of science and reason during the  COVID-19 pandemic. When the history of this remarkable time is written, Dr. Fauci may well have a special place as the single most trustworthy public advisor of our era. With his comforting, thick Brooklyn accent, he expertly translates “science” into accessible language, giving advice to a broad national audience and demonstrating the courage to be truthful, objective, and - when appropriate - uncertain about the future. He has become the nation’s physician. 

Of course, there could be other explanations for the dramatic rise in applications. Perhaps a large number of recent college graduates simply have more time on their hands to complete the complex application process and study for MCATs. They are inspired by the heroism demonstrated by health professionals who - at risk to their own health and well-being - have cared unselfishly for others through their own physical and emotional exhaustion. This altruism should be harnessed and focused on what ails us. 

Why it is important to improve the primary care physician work force

Today at the Transformational Times, we turn our attention to rural health and our regional campuses. Small cities and towns face projected life-threatening shortages of physicians over the coming decades.  Despite an overall increase of 35% in the number of students graduated annually from US medical schools, the American Association of Medical Colleges (AAMC) is projecting a shortage of up to 139,000 physicians by 2033. More than two out of every five doctors now practicing will reach retirement age over the next ten years and this loss will disproportionately reduce access to primary care in rural communities. 

More worrisome, and despite evidence that greater primary care physician supply is associated with lower mortality, the density of primary care physicians has decreased by 11% over the past decade, leading to an increase in the number of deaths from preventable causes. For every ten additional primary care physicians per 100,000 population, the associated deaths from cardiovascular, cancer, and respiratory mortality dropped by 0.9% to 1.4%. Life expectancy improvement was more than 2.5 times that associated with a similar increase in non–primary care physicians.  Programs explicitly focused on training, attracting and sustaining the primary care physician supply should be a national policy priority. Medical schools are an important part of this equation.

Read the inspiring interviews with Deans Lisa Dodson of MCW-Central Wisconsin and Mathew Hunsaker of MCW-Green Bay. Look at their “soup-to-nuts” explanations of how recruitment, admissions, curriculum, financial aid, and social support can intentionally address the needs of rural populations. These smaller, mission-oriented programs demonstrate there are many paths toward educating excellent physicians. We are listening to them and learning from them. As we recover from the pandemic, the seeds they have sown might offer us great opportunities to mark the beginning of a new era in medical education. 

This year’s unusually large and more diverse applicant pool provides us opportunities to accelerate workforce diversification. Compared to the same time last year, the number of students representing racial and ethnic minorities who are taking advantage of the AAMC’s needs-based application costs is higher than ever, enriching an applicant pool with individuals from lower socioeconomic status. If, in addition, we attract more individuals who grew up in rural communities, and who are the first in their families to pursue professional education, we could begin to reverse the geographic and specially maldistributions which contribute to health disparities. Admissions committees can assemble medical school classes more likely to meet the missions of both the school and society. 

Debt affects career choices …

Of course, admission criteria alone are not enough. Medical school graduates finish with, on average, a staggering $241,560 of student loan debt, discouraging many from pursuing medical careers. Among those who do, indebtedness pressures students away from choosing lower-paid specialties even when they would find a career in primary care highly satisfying. A comprehensive set of incentives, dramatic increase in scholarship money and loan repayment, and payment and practice reform, to name a few, would be needed to dramatically improve access to primary doctors for those in rural communities.

I graduated medical school with about $25, 000 in debt, less than a third of debt typical of the newly minted physicians graduating that year, and one-tenth of typical debt today. I never took MCATs (medical school admission was guaranteed to all of us who maintained passing grades), calculus, or organic chemistry (we started with Biochemistry). And despite a great deal of initial angst (“Was I being brainwashed?”), I enthusiastically served for ten years as a Primary Care Internist in a publicaly funded ambulatory care center on the Lower East Side of Manhattan in one of the poorest neighborhoods in New York City. No one ever reached out to confirm if I had honored my contract; they didn’t have to; my education and mentors had prepared me and had ensured I would. Many, but not all, of my classmates did, as well. 

Alongside the usual foundational and clinical sciences, I took a course entitled “Community Health and Social Medicine” as a college freshman; this would be called Population Health Science in today’s parlance. Among other things, I worked in a clinic for homeless pregnant teenagers teaching basic health courses and spent a summer doing a community mapping and survey project for the Navajo Nation Health Foundation in Ganado, Arizona, a place as far from New York and as rural as one could get. The education in public health and the practical experiences I had with the people in these underserved areas opened my eyes and changed my life. 

… but, so do role models

Dr. Fauci isn’t so certain that he is the reason that medical school admissions are soaring. “It's very flattering," he said recently. "Probably a more realistic assessment is that, rather than the Fauci Effect, it's the effect of a physician who is trying to and hopefully succeeding in having an important impact on an individual's health, as well as on global health. So if it works to get more young individuals into medical school, go ahead and use my name. Be my guest."

We are on the cusp of changes in medical education and this unexpected bolus of applicants provides us a unique opportunity. Our country needs more primary care doctors. Our regional campuses have experience with matriculating classes of individuals who are more likely to enter careers in primary care working in regions that truly need them. We can learn from them. 

An active process is needed. We need deliberate planning and additional resources to recruit, matriculate, and support the “non-typical” medical school applicants who are statistically more likely to choose to practice in underserved areas. I think Dr. Fauci would tell us to plan, gather our resources, work together, and make a change. If we fail to act, it will be business as usual. 

For further reading

https://www.aamc.org/news-insights/applications-medical-school-are-all-time-high-what-does-mean-applicants-and-schools

Basu S, Berkowitz SA, Phillips RL, Bitton A, Landon BE, Phillips RS. Association of Primary Care Physician Supply With Population Mortality in the United States, 2005-2015. JAMA Intern Med. 2019 Apr 1;179(4):506-514. doi: 10.1001/jamainternmed.2018.7624. PMID: 30776056; PMCID: PMC6450307.

Zabar S, Wallach A, Kalet A. The Future of Primary Care in the United States Depends on Payment Reform. JAMA Intern Med. 2019 Apr 1;179(4):515-516. doi: 10.1001/jamainternmed.2018.7623. PMID: 30776050. 

Adina Kalet, MD MPH is the Director of the Robert D. and Patricia E. Kern Institute for the Transformation of Medical Education and holder of the Stephen and Shelagh Roell Endowed Chair at the Medical College of Wisconsin.

Valentine’s Day: I am Not (but, Thank Goodness, My Husband is) a Romantic

From the 2/12/2021 newsletter

Director’s Corner

Valentine’s Day: I am Not (but, Thank Goodness, My Husband is) a Romantic

By Adina Kalet, MD MPH

In this week’s Director’s Corner, Dr. Kalet talks about the links between love at home and high quality, world-changing science at work. She highlights the importance of strong, egalitarian partnerships in creating a life of meaning, purpose, and flourishing …

COVID-19 has highlighted the importance of having clinician investigators “on the ground” to care for both patients and populations. This group is the most likely to detect emerging disease variants, run innovative therapeutic trials, and move new discoveries to the bedside and into the community. Translational scientists save lives. We need to nurture these clinician investigators as they fulfill their vital scientific and societal roles and provide them with the resources they need to stay healthy and train the next generation of physician scientists. 

Despite their importance, though, over 40% of well-trained physician scientists leave academic medicine, causing a serious shortage of physician researchers and a resulting in a huge loss to the health science workforce. Given how exciting and important their work is, why do so many step off the track? 

I believe they leave because of the constant and recurring challenges these individuals face trying to balance their own lives while attempting to pursue meaningful clinical and research careers. Without solid, deep, and meaningful support both at home and at work, the challenging lives of clinician scientists can become overwhelming. 

What does this have to do with Valentine’s Day? 

In our recent paper entitled “Challenges, Joys, and Career Satisfaction of Women Graduates of the Robert Wood Johnson Clinical Scholars Program 1973–2011,” our group, including Dr. Kathlyn Fletcher, reported on a long-term study of the women graduates of this highly successful fellowship aimed at training change agents in the transformation of American healthcare quality. Among many findings, we identified that - of all these remarkably successful and influential women - the most satisfied were likely to describe their work as “…deeply meaningful and have egalitarian spousal relationships.” The views of these well-trained women clinician scientists offer important lessons to those interested in repairing the leaky pipeline of clinical researchers.

Most of the program graduates in our study were in committed, dual career, personal partnerships. What did “egalitarian spousal relationships” mean to them? It was very complex. We asked the women, some younger and some close to retirement, to reflect on the course of their working lives. On one hand, successful respondents noted that culturally determined and structurally maintained “traditional” gender social roles became flexible and negotiated over time as the needs of the couple changed. A small number of the women in our study reported that, during the child rearing stage of their lives, their partners were the primary parents while they were the sole employed spouse. Most women, though, were constantly juggling home and work. While some respondents reported satisfying lives of “serial monogamy,” divorce was uniformly reported as disruptive to careers and life satisfaction. 

Even as they support early career clinical investigators and scientists, funders such as the National Institutes of Health, the Robert Wood Johnson Foundation, and the Doris Duke Charitable Foundation, have not explicitly and formally addresses how to create, maintain, and sustain “egalitarian spousal relationships” that might be associated with a thriving, impactful, and flourishing life in medicine and science. This might be an area for future study.

What would a relationship curriculum for clinician scientists (and others) cover? 

Love relationships, although universally seen as positive and important are, typically, firmly in the personal and private domain. Most of us learn how to make a life from our own families, our particular cultural groups, or our close peers. Career-focused women in my generation, facing lives very different from that of our parents, had to be creative. We talked “offline” with our peers, scanned our mentors’ offices for evidence of outside lives (e.g., family photos, children’s artwork, dry cleaning, grocery lists), and asked directly when it seemed safe: “How do you do it all?” “Who does the laundry?” “When the kids are sick, who stays home?” “When do the grants get written?” “How do you decide if it is right to relocate?” 

When I was raising my own children, I loved gently interrogating medical students and residents who had “working mothers.” I asked about their experiences and views, hoping to learn anything that would improve my chance of being a good mother. Since then, there has been an accumulation of material to read and discuss. Role models are more common. We can now think about what a structured curriculum might include. 

There is much to learn about finding love, building healthy relationships, and negotiating lives of meaning while not driving each other crazy! When I was starting out, it would have been great to have access to “paired” autobiographies, such as Michele Obama’s Becoming and Barak Obama’s A Promised Land, to gain insight from each partner’s point of view into how hard, but inspiring, it is to maintain a loving relationship under the pressures of “dueling” careers. We can learn from others as they cope with the types of accumulated, complex life experiences that author Nikos Kazantzakis had his protagonist, Zorba the Greek, lament when he said, “I'm a man, so I'm married. Wife, children, house--everything. The full catastrophe."

Ah, yes. The “full catastrophe.” 

A curriculum on creating egalitarian relationships might include exercises on how to determine if each partner shares values and a common view of the future. Children: yes or no? Bedroom window: open or closed? How important it is to “fight” fairly and forgive often? But in the end, it is not those issues alone that make a relationship work for the long haul. 

What might men in egalitarian relationships report? I suspect it would be very provocative but reassuring. To understand how best to create lives full of meaning, we must think deeply about how both people contribute to nurturing, sustained, and flexible loving partnerships. 

Let me tell you about my Valentine … 

My husband has received many “kudos” for playing nontraditional roles, yet when we both switched to four-day work weeks after the birth of our first child, colleagues were supportive of my choice but warned that it would “ruin his career.” (Today we are both tenured full professors.) When we share that he does most of the cooking, he gets showered with praise yet my years of boiling the water for pasta or broiling the fish still go unacknowledged. Thus, as my experience exemplifies, egalitarian relationships are better for both partners but still require different sorts of internal and external negotiations for men. Attention to this, with a reliable evidence base could lead to greater flourishing for all of us. 

Here comes my Valentine’s Day theme. I have had the benefit of such an “egalitarian” loving partnership, and it has made all the difference. I met Mark in July 1984 when we were the interns on the 16 East medical team at Bellevue Hospital. Needless to say, we became very interdependent that summer, meeting regularly in the ICU to replace central lines or draw blood cultures, writing progress notes side-by-side well into the wee hours. I suspect there are few ways to get to better know a person’s character than sharing a 2:00 a.m. cup of cold “food truck” coffee. That summer, well before we became a couple, we were partners.  

Mark recalls that time with much more “romance” than do I.  He has always been the cornier one. I am the “realist,” skeptical that romantic love even exists. I have been free with my feminist critique of all that life has thrown at us. He is the one who still believes in magic. 

Over thirty-three years of marriage, there has been lots of tension and compromise.  There were certainly many ways it could have - and almost did - go wrong. We have challenged assumptions, gained self-awareness, believed in and pushed each other, experimented, and occasionally jumped off the deep end.  We never seem to get it exactly right, but we have gotten better at getting it close enough. We have made a home, raised children, and had our share of adventures. Our egalitarian relationship is a perpetual work in progress, more of a constant juggle than a harmonious balance. We are both better people because of it and, I might add, we have both found rewarding roles as clinician scientists and administrators.

So, is this just good luck? Maybe. I certainly feel lucky. I know many of our junior colleagues think of us as a “dynamic duo.” My response when I hear this is “Forget the Marvel Comics version and come to dinner, see our messy but warm home, meet our kids and the cats, and watch us work it out.”    

For further reading:

Kalet, A, Lusk, P, Rockfeld, J, Schwartz, K, Fletcher, KE, Deng, R, & Bickell, NA (2020). The Challenges, Joys, and Career Satisfaction of Women Graduates of the Robert Wood Johnson Clinical Scholars Program 1973–2011. Journal of General internal Medicine, 35, 2258–2265.

Kalet, AL, Fletcher, KE, Ferdman, DJ, & Bickell, NA (2006). Defining, navigating, and negotiating success. Journal of General Internal Medicine, 21(9), 920-925.

Adina Kalet, MD MPH is the Director of the Robert D. and Patricia E. Kern Institute for the Transformation of Medical Education and holder of the Stephen and Shelagh Roell Endowed Chair at the Medical College of Wisconsin.

Learning about Growth Mindset from our Students

From the 2/5/2021 newsletter

Learning about Growth Mindset from our Students

Marty Muntz, MD

Dr. Muntz shares how to recognize trainees with fixed mindset and shares how small group coaching exercises can be game changers …

How often have you heard someone say, “I believe my intelligence, personality, or character is inherent and static. Locked-down or fixed. My potential is determined at birth and doesn’t change”? Rarely, if ever, hopefully. But have you worked with a learner or colleague who hides failures, desires to look smart, sticks to what they know, avoids challenging tasks, seems threatened by the success of others, is intensely self-critical, or seems resistant to feedback? These behaviors, which may signify a fixed mindset that can limit achievement and ongoing improvement, are not uncommonly observed in our clinical learning environments. 

To address this phenomenon, coaches in the 4C (Coaching for Character, Caring, and Competence) Program are trained to foster a growth mindset in their students. In her book Mindset, Dr. Carol Dweck suggests that learners with a growth mindset are likely to confront uncertainties, embrace challenges, learn from failures, and find lessons and inspiration in the success of others. A growth mindset helps one realize that feedback is a statement about current skills – and an opportunity to improve – rather than a personal attack.  

Ellen Arndt and Katherine Lumetta, MCW-Milwaukee medical students and near-peer coaches in the 4C program, recently developed and taught an interactive faculty development session for our coaches and created the lesson plan for the small group coaching sessions. After learning about this concept, both students and coaches brainstormed barriers to employing a growth mindset during different phases of medical school training and their careers. Unfortunately yet unsurprisingly, the list is long and includes grades, awards, the hierarchical structure of our teams, competition for research and other opportunities, and the residency match. 

In their coaching groups, students were asked to compare and contrast challenging life experiences they approached with both fixed and growth mindsets – and consider how the outcomes may have changed with reversing their approach. The coaching groups also discussed student behaviors that might signal to teachers and teammates that learners are fully invested in their personal and professional development despite barriers. Our near-peer coaches shared how their perspectives have changed during clerkship and other clinical rotations, providing concrete examples from their experiences. 

We are confident that small group sessions like these with trusted peers and faculty coaching starting early in medical school will help our students enter clerkships with the confidence and skills to set and achieve lofty goals. This, coupled with faculty development in programs like KINETIC-3 and 4C to encourage growth mindset, can help transform our learning environments to more fully support our students in their individual journeys to identify and achieve their goals.  

Martin Muntz, MD is a Professor of Medicine (General Internal Medicine) at MCW. He is Director of the Curriculum Pillar of the Robert D. and Patricia E. Kern Institute for the Transformation of Medical Education.

Providing Space to Shed Tears may be Key to a Better Post-COVID Future

 From the 2/5/2021 newsletter

Director’s Corner

 

 

Providing Space to Shed Tears may be Key to a Better Post-COVID Future   

 

 

By Adina Kalet, MD MPH

 

 

COVID-19 is wreaking havoc in the lives of working women. In this Director’s Corner, Dr. Kalet shares some learnings from Dr. Ellinas’s work in the Center for the Advancement of Women in Science and Medicine (AWSM) and talks about what to do when someone cries …

 

 

Over the past couple of weeks, I have witnessed more tears among my colleagues and mentees than I normally see in a year. Even though I care deeply, I am not particularly worried about those who have cried. I find it reassuring that they reached out, seeking support and a reliable pep talk. I know that while shedding tears in someone else’s presence makes one vulnerable, it is also a sign of strength, resilience, and self-care. These individuals are bending under the prolonged pressures of the COVID pandemic but are unlikely to break. 

 

 

On January 21, 2021, Libby Ellinas, MD, Director of the MCW Center for the Advancement of Women in Science and Medicine (AWSM), Associate Dean for Women's Leadership, and Professor of Anesthesiology at MCW, gave Kern Institute Grand Rounds on Women in COVID. Her talk was a tour de force of cautionary tales and sobering data. She reminded us that the majority of people on the front lines of healthcare and education – and nearly half of our medical school faculty – are women. Data from multiple sources are consistent: women as a group are under special pressures during this pandemic. This poses a threat to both our medical education and health care systems. 

 

The ways in which COVID-19 has disproportionately affected women

 

Dr. Ellinas shared survey data from the USC Dornsife Center for Economic and Social Research confirming that the mental load – including concerns about the health of their families, themselves, and financial strain – is significantly higher among women compared with men. And while married men with children have the lowest mental distress, women with children have, by far, the highest. This is not news.  Sociologists have shown over-and-over that being married with children is associated with better health and more happiness for men while, for women, being married/partnered with children is associated with relatively high levels of stress and distress. Women do measurably more emotional work than men, both in families and at work. While often this work is energizing, it is a mental load that can overwhelm. 

 

Among MCW faculty members, Dr. Ellinas demonstrated that the social isolation necessitated by the pandemic is wreaking havoc for working women. With schools inconsistently in session, direct childcare hours have increased for both men and women, but the number of additional hours per week has been greater for women. Data from an MCW AWSM COVID survey show that while nearly 60% of male faculty have spouses employed part-time or not at all, this is true for only 21% of female faculty. Thus, MCW working women with families are much less likely to have robust support systems than their male counterparts.

 

There is also heterogeneity in how COVID-19 increases stress. Some find value in working from home, but many do not. Clearly, working from home – for those privileged to be able to do so – allows more flexibility and autonomy, reduces time spent commuting, and decreases costs associated with working away from home. It might even provide unexpected “quality time” with family. However, especially for working women with school-aged children, working from home is associated with less sleep and decreased self-care. Adding to this, the intersectionality of race and gender can weigh even more heavily on Black and Brown women. 

 

And, as if that wasn’t challenging enough, there are signs that the COVID-19 pandemic negatively impacts the academic productivity of early-career women more that it does men. The long-term impact of this is worrisome and may lead to the reversal of recent gains in women’s academic status on the whole. These are challenges for us all. 

Institutional solutions are critical and complex

What did Dr. Ellinas recommend? She offered a number of institutional recommendations that are consistent with AWSM’s inspiring and audacious vision that “MCW will be a destination for women leaders, cultivating an inclusive and vibrant culture that supports all genders to grow and thrive in the health sciences,” and mission “to advance the careers of women at MCW through data-informed strategic projects that enhance opportunity and improve workplace climate.

• Evaluating leadership structures to ensure women are well represented in decision making
• Valuing parenting through generous parental leave and creative childcare
• Supporting women to “step forward” rather than depending on “step back” policies
• Valuing the hard work of mentoring, equity, diversity, and inclusion 
• Valorizing women role models for us all

 

We need policies that can be individualized and flexible over time. Extraordinary caregiving responsibilities may be acute, due to an illness or urgent need, chronic, as in having a child with special needs or an aging relative with evolving needs, or both, as in this stuttering pandemic. Community resources are distributed unevenly. Some people do not have enough help while others have what they need, if not to excess. Institutions like ours can improve the quality of life for our employees and community by offering concrete services, such as low-cost, high-quality childcare, sick childcare, food preparation and delivery, and help with chores. 

 

To support women (and men) whose academic careers have been impacted by the pandemic, some institutions have found ways to provide assistance that enable researchers to continue collecting and analyzing data while they tend to a “special” personal need. One program, the Doris Duke Fund for the Retention of Clinical Scientists (see “For Further Reading” below), has funded such efforts. Many workplaces provide access to high quality food, recreation, and other wellness services. Much can be done. 

 

How do we, as an institution, come out of COVID-19 better and stronger? We need a flexible range of options going forward that includes working from home. Our men need to engage. We all need to honestly complete surveys to have quality data that inform best solutions.  Men who have the relative privilege of having more support at home and at work – as well as having disproportionately higher salaries – need to be allies and advocates for equity and flexibility. No one should assume that they, alone, know what will work; we need to ask women. Don’t insist on “fairness” or “equality” until you have a full-thickness view of the situation. 

  

Back to crying

 

I have always kept a box of tissues on my desk. When seeing patients, the box was discretely tucked just out of view, easily slid toward the patient at the first glisten in the eyes. As a colleague and mentor, the box would be brought forward when the face flushed, the head dropped, and the tears rolled. It has been my experience that, most of the time, a good cry in the presence of an empathic other is the most efficient way to clear the air and help the words and problem-solving flow. People cry for all sorts of reasons. Sometimes it is sadness and grief, but just as often people cry because they are overwhelmed, angry or frustrated. I have come to believe that an effective mentor, like the good physician, must learn to invite and sit with the tears of others without needing to fix anything; just listen, sit quietly, check in.  Fighting back tears takes energy, blocks thinking, and keeps others away. Letting tears fall clears the air and loosens the voice. 

 

Did I say that it is mostly women who shed tears in my office? Well, it is. But occasionally, the men cry as well.  Three times in the past three weeks, I have spoken with distraught educational leaders, people who are deeply respected by colleagues and beloved by trainees. They were emotionally and physically exhausted from the expanding and rapidly evolving needs of school-aged children and elderly parents. They had less help from their working spouse than they needed. Their jobs presented new and growing demands on themselves and their trainees (e.g., being “deployed” to care for critically ill COVID-19 patients). They feared a loss of income. They were at the brink. 

 

In each case, I pushed the virtual box of tissues. Why doesn’t Zoom design a “tissue box” emoji?

I hope my message is clear: It is okay to cry here. I am not afraid of your tears. I will hear you out and empathize. You are not crazy, this is hard. I know you will find your way through this. I will help if I can.  

 

These folks do not need to be fixed, they just need a shoulder to cry on, a good night’s rest, regular meals, and an occasional walk in the woods. I think we can get them that. 

 

 

 

For further reading:

Jagsi, R, Jones, RD, Griffith, KA, Brady, KT, Brown, AJ, Davis, RD, ... & Myers, ER (2018). An innovative program to support gender equity and success in academic medicine: Early experiences from the Doris Duke Charitable Foundation's Fund to Retain Clinical Scientists. Annals of Internal Medicine, 169(2), 128-130.

 

Jones, RD, Miller, J, Vitous, CA, Krenz, C, Brady, KT, Brown, AJ, ... & Jagsi, R (2020). From Stigma to Validation: A Qualitative Assessment of a Novel National Program to Improve Retention of Physician-Scientists with Caregiving Responsibilities. Journal of Women's Health, 29(12), 1547-1558.

 

 

 

Adina Kalet, MD MPH is the Director of the Robert D. and Patricia E. Kern Institute for the Transformation of Medical Education and holder of the Stephen and Shelagh Roell Endowed Chair at the Medical College of Wisconsin.