Perspectives on Physician Wellness

Transcript

Hello, everybody. Luke Cicchinelli, I'm a podiatrist, DPM, also a Fellow of the American College of Foot and Ankle Surgeons. My current role and title is Chief Medical Director for PICA. As a background of my career, my wife's a podiatrist as well. So, I was in private practice in the United States between North Carolina and Arizona for a total of about 21 years and then overseas, predominantly Spain, for about 10 years. My background was training in Atlanta at the Podiatry Institute. So, reconstructive surgery of the foot and ankle and sports medicine has been my career. And then my wife did diabetic foot care. She was also a pedorthist and we had a diversified sort of, complete coverage private practice as well as in Arizona with East Valley Foot and Ankle Specialists and colleagues there with all diabetic and trauma care as well. So, I'm based out of Philadelphia at the moment.

So, how does the foot ankle community define, physician wellness in general? Let's take our profession, podiatric medicine and surgery, specific to that I think they define it as essentially having enough time on a weekly and monthly basis to be enjoying their lives in parallel to their professional pursuits. I think that's how they would define it as an ideal. Then I'm sure follow-up questions will be whether you think we're there or not. But I think it's a question really of defining how we and maintain ourselves with the appropriate level of enthusiasm, passion, engagement around ourselves as individuals while, of course, giving the best absolute care to our patients and running our practices and the necessity of being successful at earning a living and maintaining a livelihood, right? I would say that's how they would define it if we were to go in the hall of the meeting and pull them all and say, you know, what would be your definition of this? So I would say, where are we with this concept today versus five, 10, 15 years ago, I would say we're at a much higher level, 100% in recognition of the importance of it. The sort of systemic approach to trying to implement it both structurally, let's say in hospital systems, organizationally, systemically, let's say at physician leadership levels of big groups, hospitals and so forth versus, definitely in the last five years, it's completely on the radar, right? So I think recognition is very, very high. 10 years ago, I think it was just started to be talked about and 15 years ago, I don't think it was really on the radar at all. I think 15 years ago, we were still 100% in the suck it up mentality and grind. And this is what you chose as a profession and sort of find your way forward. So I think in the last five years, the recognition is very, very high about the importance of it, right?

And everyone always refers everything back to COVID. Well, I think that's sort of become a very overly convenient excuse. I think maybe it pulled back the covers even further from what was already there. And I always remember, and I liked the word essential versus non -essential and I think that's what COVID really did was it peeled back and made us all stop and say, okay, professionally and personally, what's really essential, what's not and what's taking up time that maybe doesn't really need to be and then we've moved from there. So I think recognition is really, really high in the last five years, absolutely. That doesn't mean that I feel that we're where we need to be at all. So my personal opinion is that we need to retire the word balance in the concept of work-life balance and Because I don't think it exists in healthcare and when I say retire that word I'm not retiring the concept I would like to replace that word with work-life harmony because I do think harmony can exist a hundred percent and for many people it does, and then for many people it does not. So we could broaden that conversation a little bit. So I think work-life balance as a concept makes more sense in a industry of, let's say, I don't know, maybe teaching or banking or something where you're structured around a nine to five day, let's say. The problem with healthcare and work-life balances, I think it actually is creating, that terminology is creating even more angst. It's kind of like the pursuit of happiness, that the concept that you're pursuing it makes it almost unattainable. And the reason I would say it is a bad term or not an ideal term for physicians or let's just say healthcare professionals, because it's all inclusive, right? Anyone, all healthcare professionals, nurses, people working in hospitals, everybody, all of us. It's that people don't get sick just nine to five. And so when we say work-life balance, I think the human nature of us all is to say, well, I want to stop at a certain time every day and then I want to pivot back to my normal life and I want to pursue parallel passions and maybe that's the gym or maybe that's some hobbies and maybe that's family activities, maybe it's church, maybe it's whatever, right, but it doesn't work that way in healthcare because it's just not reality. And so I think we need a different terminology there. And I like work-life harmony and Ithink it's really orchestral, it's like music. I mean, you can have certain things and I think this is how healthcare works. You can have certain intensities of certain obligations and certain participations that occupy certain time, and then there's a lull, and then something else comes in. So just think of it as an orchestra and so forth. So I think we have to change terminology, and that makes sense. And I think there's harmony there. And then I think also the harmony is specific to every individual healthcare practitioner. And I like to say, and this is sort of metaphorical around music, right? But you're only going to ever dance to the music that moves you. And I think when we make it and observed and read and use myself and then my own, my wife's and my family and careers with our kids. We have three children and all the international exposure and living overseas and things like that. So that's where I'm at. And I believe that it's a nice way to look at individualizing for all docs, because I believe what happens is we create, it's almost like, I don't know, you can make up a million analogies, surgery or procedures. Does everybody need a Lapidus? Or does everybody need a certain ankle fracture repair?

Well, it's just not black and white, is it? And why should wellness be black and white? And I think the word balance creates this expectation that it should be some sort of nice, neat, tidy boxes that things need to go into, and until you can show me two people who are exactly the same, even identical twins in the way they think emotionally, mentally, physically, spiritually, right, the four pillars, whether, until you can show me two people who are exactly identical, well, then I don't think there's any balance that's going to fit for everybody. So I like, I like to use the word harmony. I think that terminology change would help right away. And then I do think that at the organizational level, the other thing that's nice but still not completely there is the ability in organizational medicine to feel comfortable in identifying that you're asking for help or that you feel like you need help and not having to fear perhaps a repercussion of that. Now, I don't necessarily have any answers for that, but I think recognition is one of the first factors. And then helping people that need help feel that they're in a safe sort of a safe harbor to ask for that help without that then being perhaps something recorded in an HR file or that there might be some sort of sequelae from that, right? I think that is really important to be addressed because in healthcare, you're the one who's supposed to have everything all tidy and wrapped up and under control because people are coming to you with their problems, right? No one ever comes into our offices and tells us, "I'm doing great. Thanks. I have no foot or ankle problem. I thought I'd just stop by and say hi." Right? That never happens. They're always coming in with their problem, Logically and so we need to feel comfortable about ourselves. It's almost like physician heal thyself but they still need to have resources to address whatever the physician themselves might be suffering from.

So, that's my other thought on that so I think once terminology and then once organizational structure which I do see a lot written about you know improving workflows automation, certainly the interfacing of artificial intelligence around streamlining processes that take up so much time, the, you know, the pajama time of record-keeping and all this kind of craziness that goes on after, you know, you've seen your last patient of the day, all this other time, time commitment, there's ways that that's being improved and it's certainly being talked about. So that's wonderful, but It's got to be fully implemented. You have to feel comfortable in asking for help as well. I think it's around self-analysis, introspection, and saying to yourself as you go into practice, what do I want my life to feel like and look and on a weekly basis, okay, or at least a bi -weekly basis. I think we also beat ourselves up unnecessarily, thinking that everything can be accomplished in 24 hours or seven days a week, right? I think we should think it's an old fashioned word, but I've always liked the word fortnight, which is two week blocks of time. And when you live in like Spain, for example, they talk in times, the blocks of time, they'll say 15 days or 30 days, And so I think if people would look at the culture that they create in their work environment with their staff, their assistants, even their patients, and train them around your own vision for your life on two-week blocks of time, I think that would go a long way toward people just creating the lifestyle that they'd like to have. I mean, time moves really. And, you know, you look around and all of a sudden you've been out of your residency 10 years, or you've been out of your residency training 20 years, or you graduated from Podiatric Medical School 25 years ago, and you just can't believe where the years go, right?

So, it's so important, I think, on the front end, after you finish up the nice tidy four-year blocks of time where we all go through education, like, let's say, middle school, high school, college, political medical school, residency, those are all nice three to four year blocks of time. Then you get on private practice and all of a sudden the rest of your life is staring you straight in the face and you save yourself logically at some point while you're driving back and forth to the office. My gosh, now I'm going to be doing whatever I'm doing for 30 years, 40 years, for 35 years, how long, right? So at the front end of all that, those that. That first year of practice, you have to stop and say, "What are all my life to look like?" And you need to build those parameters right away. And unfortunately, I think most people take about that first one to five years and just plug into the system that's around them. And what they do is they shortchange their own wellness. They put on the back burner their own wellness and what's actually important to them as an individual and that can be as a physician or it can be as a parent. It can be as simply an individual with other hobbies. I like to call them parallel passions, things that you've always liked to do or you used to like to do before you had to focus on getting education. Identify those things right away early in life, early in private practice life, I mean, and create that model and then stick with it. And don't be afraid to take time off. American culture is not taking enough time off. I think people would be very well, I don't think, I know, people would be very well -served to take a two -week vacation every year or even two-week vacations every year instead of just trying to extend a weekend into a Thursday and you're still stressed out. You never really fully relax. And then by the time you get back to the office, even if you had a day off over a long weekend, you tend to get slammed in the office Monday, Tuesday, Wednesday. We need more of a concept of mini sabbaticals that still fit into the flow of work. And the reality is everyone years. 

I'm a big Tom Petty fan, unfortunately passed away a few years ago. But he has a great line in one of his songs, Crawling Back to You, where he says, most of what I worried about never happened anyway. And it's one of my favorite lines. And that's a Tom Petty classic for me. And it's true. We tend to worry about things that never happened anyway. And there's another great line about worry, which is that worry is the misuse of our imagination. If folks would just commit to a two week vacation, absolutely once a year, even better twice a year, plus around holidays and so forth, I think they would find a whole mega jump in wellness as they get that chance to do like a mini sabbatical. You You know, university professors have been taking sabbaticals forever, a research year, go to another country, take time away from their daily obligations, and physicians, healthcare professionals just rarely, rarely, rarely ever do that. And yet, we have probably one of the most stressful occupations you can imagine, right? Other people's wellness, there can be very acute issues, They can be very emergent issues and yet we tend to suffer many times while worrying about someone else's health. And there's something terribly upside down in that. There's something terribly upside down in physicians suffering themselves around wellness while worrying about and treating the wellness of others. So it takes introspection early on and don't be afraid to chart your own course.

There's no one path that works for everybody. That's what I know for a fact. And people need to, of course, learn from the experiences of everybody, but they need to have the fortitude and the vision and the enthusiasm as an individual and then in couples, right, your significant other, whoever, you know, your core, who's important to you, right, and to build that vision for yourselves and don't be, and just sort of do it unapologetically, right, unabashedly. It's your life. You only go around once. We all, you know, everyone's talks about board certification certificates. We all get two certificates in life. One's called a birth certificate, the other's called a death certificate. We all get the same too and guess what's in between a life your life your life You got to live it and it's got to make sense to you and That's what we all have - the luxury and the privilege of doing between the same two certificates. 

©2025 HMP Global. All Rights Reserved.
Any views and opinions expressed are those of the author(s) and/or participants and do not necessarily reflect the views, policy, or position of Podiatry Today or HMP Global, their employees, and affiliates.