Episode 57 of the Hope4Med podcast features Dr. Olabunmi Agboola. She is a triple board-certified physician specializing in allergy/immunology, internal medicine, and pediatrics, owner and medical director of Ilera allergy and asthma center in Washington, DC, and founder of the organization The Physician Collective, an online physician advocacy and professional social platform. We discuss burnout and moral injury, and how knowing your “why” can help guide your recovery from burnout. Dr. Agboola discusses her physician advocacy, how we can take back control of the narrative surrounding the profession, and get back to our “why.”

Transcript:

[00:00:00] Dr. JB: Welcome to Hope4Med.

[00:00:04] Hi everyone. Welcome back to the Hope4Med podcast. I am your host, Dr. JB, and today’s featured guest is Dr. Olabunmi Agboola. She is a triple board-certified physician who specializes in allergy/immunology, internal medicine, and pediatrics. She is the owner and medical director of Ilera Allergy and Asthma center in Washington, DC. She strives to provide quality care and treat every patient. She completed her medical education at the University of Illinois at Chicago and fellowship at Duke University. Dr. Agboola also founded the organization T P C, which stands for The Physician Collective, an online physician advocacy and professional social platform. Welcome to the show!

[00:00:56] Dr. Agboola: I’m glad to be here!

[00:00:59] Dr. JB: So Dr. Bunmi, please share with my listener, your origin story.

[00:01:07] Dr. Agboola: Oh goodness. I think it might be a little easier to kind of talk from the origin story of why I became a doctor and how that kind of plays in, ‘cause it started very early on. Like I wanted to be a doctor since I was four years old, since I found my own pediatrician and I was like, oh, I want to be just like her. And I just had some great doctors growing up. So I just happened to be like really gifted at science and math growing up, so that definitely helped make things a lot easier than, I’m not fighting against some talents that I may not have because we’re all gifted in our own way. I was never really a big maybe sports person or something like that, but other people may be, so we all have our talents. So mine was a science and math and just the love of the human body and things of that sort growing up. I grew up in Chicago. We later moved to the Southern suburbs when I was like about seven, pretty much lived down there all the way up until like I left for college. And then I went to the University of Illinois at Urbana Champagne, which is just two hours away from Chicago, two hour drive.

[00:02:15] And then I went back up to Chicago to go to medical school at the University of Illinois at Chicago. And I also stayed at the hospital system associated with the med school for residency. Then I later went on to Duke University to do my allergy immunology fellowship, and shortly after fellowship, I, got a job up in DC, so that’s what brought me to the DC area and I decided to call this place home for now because I really do love this area. But you know, there– in my journey, of course, you encountered different things meet so many people from all over the world and because in the journey, I’ve done research summer programs away, stuff like that, which just, I feel like contributed to my full growth as an adult and just all the, all around, like what I like to call a well-rounded citizen and different adventures and things of this sort of stuff. It’s been a long time coming. I finally feel like, I’m at a point where I continue to grow professionally, but now I’m gearing things more so to what I want to do and what I really, really want to contribute to society, not only with my profession, but outside of my profession. So…

[00:03:31] Dr. JB: Well, I’m interested to know more about what it is that you want to do and what you want to contribute to society.

[00:03:38] Dr. Agboola: Oh, I know. It just sounds like it’s such a broad thing.  “I’m going to contribute to society.”

[00:03:45] Dr. JB: How are you going to change the world? Please share.

[00:03:48] Dr. Agboola: In so many different ways. So I’m starting my own practice that should be open March 1st and main reason for doing that, not only to service my patients but then to really be able to serve communities that may go overlooked, especially in DC, there’s a high rate of asthma as they like to say in “urban,” quote unquote communities. So really making sure that they’re getting the best or even above standard of care to make sure that we are handling that and people who look like me are getting the treatment that they deserve. And then also being able to do more community outreach, going to speak at like schools, going to small community programs, churches, and stuff like that in which I can really try to educate and people can see firsthand, like they can see you, they can talk to you, they could ask questions. So that, I think that really means a lot to people who don’t get that very often. I think as physicians, we’re also seen as being in like there’s high and mighty place in this ivory tower that no one can reach, no one can relate to, no one can talk to.

[00:04:54] And I think that also does a disservice in which when, if we have that type of rookie patient and we allow other people to tell our stories for us, and then so that’s why I’m not surprised at all of the distrust that some people have developed for the medical community as a whole, because we’ve let the narrative go too far to where only the bad stories get highlighted and told and patients experience difficult situations and when they’re encountering the healthcare system. So, there’s so many aspects that we can do. And then also I think it’s really important for me, trying to help other physicians who have that same vision, who want to see more physician and patient relationships grow and communication and not to get too bogged down by all of the burdens that we have in medicine. Like, so we’re finding that we’re having a lot of burnout or moral injury. And even if some cases, I’ll even say abuse. How do we, just because we decided to choose this as our professors, how do we alleviate those barriers so that we can go back to the fundamentals of why we even did this? Why was it when I was four years old, I was like, I want to do that is either I’m a physician or bust. So, I had no plan B. I had no plan B. I don’t even know

[00:06:24] Dr. JB: [laughter] Plan B was bust, you had a plan B.

[00:06:28] Dr. Agboola: Oh yeah. Yeah, plan B, I would probably be on my mother’s couch right now though, that was probably plan B. But I just think there’s just so much more that we can do. I’ve worked for different hospitals systems, I’ve– and when you look at those contracts that are very limiting in some cases, in which doing some of the community outreach you might want to do always have to be affiliated with your workplace versus affiliated with you. And I feel like we as physicians are our own brand in which we carry that name in our reputation as well that, you can affiliate it with your workplace but there’s just so much more that we can do if we aren’t restrained in some sorts. And so, yeah, I, I like the fact that I’m going into a private practice. I hope it does well. I’m going to work on it to do well, but I just feel like it opens up a lot of opportunities for me to fulfill those goals of just anything, anything is possible. And the main thing, centering around the physician and patient relationship.

[00:07:39] Dr. JB: Well, you mentioned so many things that, are really important, and important for me to highlight. And one of which was you mentioned burnout and moral injury. Do you feel like moral injury is a bigger concern now than it was before?

[00:07:56] Dr. Agboola: I do. I do. I feel like with moral injury, it almost creates the feeling of just being, just being disheartened about why you chose your profession. Why did you make all those sacrifices for all those years to get the most knowledge? To be able to treat people in a way that we’re not just doing any old thing to people, like there are reasons behind why you choose certain medications and things, and then treatments and stuff like that. So we spent all those years getting that book knowledge, getting that tactical knowledge, and we do our residencies and then to go out into the workplace and be treated like a number, to be treated like a hamster on the wheel. And then for people not to really care about you as the physician. Like you’re just supposed to just chug in and chug it out. And that is not why most of us went into this. We, most of us and from what I find, most of us went into medicine because we truly have a genuine care to help people. And how do we tap back into it?

[00:09:05] Like, I really hate it when I see a really good physician who just got burnt out by the system, whether it was just too much administrative work or they couldn’t get the time off to really deal with whatever personal issues or family issues they may have going on. Because we’re not really looking at them as a person who has flaws and that is dangerous and that is bad because it takes so much to make a physician. So we shouldn’t be, we shouldn’t want to see physicians leave the practice in medicine, especially when there’s so many people who need our services. So how do we balance or make things better to where we can keep physicians or how do we transition physicians? And that’s really what TPC will be focusing on. Because moral injury is not just usually one thing, it’s a multifactorial system, to me, that creates an environment that makes people either want to quit, unfortunately some may take their lives, some may have a mental breakdown, sometimes it exacerbates mental illnesses, and we also have to consider that as a factor too.

[00:10:22] Dr. JB: So, what can physicians do to battle some of these challenges?

[00:10:29] Dr. Agboola: I will ask most physicians to really look at themselves and really find out your why. Why did you go into this? And if your, your why is really in tune with the care of people, then how do we get you back to that? So kind of starting with your why and then fostering an environment in which your “why” can flourish. So for some physicians, depending on what career field they chose, we will have to kind of figure out what is best for them. For some docs, maybe it’s something as simple as going down to part-time. For some, they may be leaving academia and going private. For some, it may be going to stop taking insurance and going into a direct-care type of practice. So I feel like there’s many ways to work around where you can still practice your profession without having some of the time limitations. If that’s the concern, if it’s time off, then asking for that or seeking that and getting that, or even having to leave medicine for a while and then coming back, that could be a solution. Like, I didn’t feel like there were several solutions out there, they may not be popular solutions, but there definitely are solutions. It really depends on the “why” and what is the main cause of concern that makes them feel like they’re having that sense, that feeling of burnout or moral injury because if it really is a toxic workplace environment, how can we undo that, or how can we address that? So starting with the why and trying to find a solution from there.

[00:12:19] Dr. JB: And have you experienced any symptoms of burnout?

[00:12:23] Dr. Agboola: Oh, yeah. Oh, absolutely. And I wasn’t even a practicing physician at that point. I was still in training. Honestly, I felt like I kept going like from undergrad all the way until like I finished the clinical part of my training. So I did an allergy fellowship, which is typically two years. I did board certify after two years, but I stayed on an additional two years to do research just because I knew I needed a break. Like I said, before I went to go and practice, I needed a time out, so what I ended up doing was doing research, which I loved but then I worked as a locums hospitalist because the real bills have to be paid. But I really enjoyed it because even though my research pay wasn’t that much, but it was enough to keep the lights on, having a little bit of extra income doing locums and working contracts, where I can choose my schedule, whether I do 6 shifts a month or 14 shifts a month. And these will be 12-hour shifts, so there was always space like I could go home and rest and be left alone. But I definitely did not want to jump back into a, a controlled environment in which someone was telling me where I had to be when I had to be there and, blahzay blahzay, because right after fellowship, I did think about going the academic route. I was offered an academic position but for me at that point, it really wasn’t worth it. With the research I was doing, it did well, couldn’t get funding for it to see it all the ways through and in order to continue to try to get funding for your research, a lot of times, if you don’t already come with that finding, you’re likely going to have to pick up clinical work in order to– until you can get funding for whatever project that you’re doing, whatever research that should do. And I just decided like, you know what, that’s not the right one to take. Like looking at the contracts, it was very demanding on my time. The salary was, you know, very low, lower than what I was making working 9 shifts a month. I was making, when I worked nine shifts a month as a locums, I made double what they were offering. I was like, wait a minute, this salary…

[00:15:01] Dr. JB: They’re probably trying to offset it because with locums, you don’t have benefits, right? And so, a salary position, maybe, but that doesn’t equate for double, no way. But go ahead.

[00:15:12] Dr. Agboola: I was making double working less, less than part-time and I’m making more as a locums. And that, and for the academic contract doing clinic four and a half days a week, doing call, teaching, and then trying to get your research established. That’s a lot. I knew right then and there, I said, absolutely not, because for me, it kind of gave me a visceral feeling of when I was a fellow just trying to keep my head above water. I had so much going on, not only the demands of my time because of fellowship, but then also had a few personal things going on as well. So, I do not want to go back to that place at all.

[00:15:59] Dr. JB: Yeah. Something that you mentioned was that burnout started early, and did you say undergrad?

[00:16:09] Dr. Agboola: No, no. I said, like I started to experience small bits of it in undergrad.

[00:16:15] Dr. JB: Mhmm, in undergrad.

[00:16:15] Dr. Agboola: So after basically going from med school and up. And I realized for me what made me the most unhappy and what made me want to pull away from my “why” was the demands on my time. Now there’s some, like I had to deal with it and in residency, you don’t have a choice, but I dealt with it the best that I could, but I was not my happiest. Like right now, I’m my happiest. So that’s a big, big factor for me. So finding out what, you know, really tapping into my why, and what’s keeping me from really being happy with achieving my “why.”

[00:16:57] Dr. JB: So, how did you figure that out? Like how did you figure out of all the other things, that it was really the time constraints for you?

[00:17:03] Dr. Agboola: I think it came, it came later. I think it was an accumulation over the years. I started to notice that I dreaded going to work. I dreading going, even though like, I mean, I would just like almost be like angry the night before, especially if I knew it was like one of my long weeks because at that time I did Q4 call because it was right at the time that the like no more than 16 consecutive hours or something like that for interns took place, so like that was like, cause that was med 3, we had a 15 month internship so I got to experience some of that. But when we were on Q4, and you know how you have your long weekend where you’re working that Monday through Friday, your on-call Saturday, off Sunday morning just to go back Monday? Oh, that was a killer. I would be so angry. Or when I had my golden weekend and that Sunday night, those feelings came back. And it wasn’t that because I hated my job, like I hated work, I actually really liked working with the patients, now I’m not going to lie, I wasn’t a big fan of night shift, but I did actually like patient care.

[00:18:29] But those inpatient months when that time constraint is really, really, really intense, I, I just, I, I was always in a place of just survival. I really can’t even say on the way how are survived it, it’s just, I just did it and it was kinda like I tuned everything out and just did it. Like, I just slept when I could and just went to work. I became a zombie, honestly.

[00:18:58] Dr. JB: And you didn’t want to continue being a zombie after.

[00:19:01] Dr. Agboola: Yes. And I think that’s the reason they do this in rotations and try to space them out some, because you can’t do that to a person back-to-back. Just so crazy to me.

[00:19:16] Dr. JB: So this is your first venture out into private practice?

[00:19:20] Dr. Agboola: It is.

[00:19:22] Dr. JB: And what are your thoughts around that?

[00:19:25] Dr. Agboola: I like challenges. I think it’s definitely my next challenge. I feel like I’ve done a lot in my medical career so far that I’ve wanted to do. So I’ve done research and worked in a private practice group setting. And now really venturing out on my own, this way I can put to vision the things that I would like to see. How I would like to see a clinic run and the ideas I have around the clinic and also centering that with the surrounding community as well.

[00:19:59] Dr. JB: And could you tell me a little bit more about the work that you do with The Physician Collective? I know there’s an emphasis on physician advocacy.

[00:20:10] Dr. Agboola: Yes. So kind of like what we were speaking about before, moral injury being a big concern. A lot of physicians were, really felt this sense of moral injury and some even expands what I like to call just plain abuse of their labor during the times of COVID. Whether it be “you’re not needed,” you’re, you’re kind of disposed like garbage because maybe you do elective surgery and right now the hospital doesn’t feel the need to support you even though you have a mortgage and a family and this and that and the other going on. So it really made a lot of physicians look at themselves and look at what they contributed to the profession and have second thoughts. Like, if they could just treat me like garbage then why did I do all of this? And like I said, the main goal is like, I want to see these physicians continue to be physicians, like to retain the physicians. Absolutely, that’s one of the main things. And I think the way to go about it, and the reason why I called it The Physician Collective, is that we as physicians don’t talk as much as we should. We don’t um, I would feel like we should communicate more. If someone has like, like with me starting this practice, I got help from several of my colleagues.

[00:21:37] So really creating that social platform where someone can really reach out and get really good advice on things that they’re pursuing, whether it be an employment contract, looking to do locums, maybe opening up a private practice right out of residency, whatever that they may need help on.  And I think that will also feed into their “why” and help with that moral injury part because they really understand their “why,” they understand why they’re working. Because one thing I do find is that people don’t mind working hard, especially if they’re working towards a goal, especially if they’re working towards maybe even their own goal.

[00:22:15] Like, I don’t mind the fact that I may work long hours with this clinic because my why is even bigger. I think with The Physician Collective if we have the advocacy platform that we need to try to legislatively put in either different bills or try to challenge what’s already on the books to make physicians lives easier, more efficient, and to maybe even put a halt to some of the misuse of us and our credentials. I think that will help a lot. I also do one thing that I did find when I started The Physician Collective is that a lot of physicians didn’t feel that anyone was really representing them or really spoke toward their voice of concern. So, yeah, so The Physician Collective kind of started off with that idea that we would come together, work together towards the goal that we think would help us as physicians practice, keep that physician-patient relationship intact and grow versus like having all of the outside forces that kind of pull us away from that, so this way we can get back to our why.

[00:23:39] Dr. JB: So you mentioned that we are, we as physicians, are not necessarily the ones that are sharing our narratives. So who is sharing the narrative for us or on our behalf?

[00:23:55] Dr. Agboola: Everyone else. This is how I know we’re not basically showing our own. I don’t know if you’ve ever noticed that the biggest news stories, and that’s kind of across the board, people don’t talk about the good things. Like if you’re watching the nightly news, they might have one feel good thing but then everything else in like all of the bad stuff going on in your local city, you’re like, well, I don’t want to go over there, they got shot over there. I don’t want to go, there was a carjacking or a train wreck, it’s just like you hear all of the bad stuff. And I understand, I mean that’s marketing, that’s what people hear, that alerts people and gets their attention but it has painted a narrative to where people are like, I don’t trust physicians, they’re all just in it for the money or they’re getting pharmaceutical dollars and stuff like that. And yeah, maybe some, but I think the majority of us are in it with good faith and that’s not highlighted. Maybe highlighted in your newsletter with whatever company you’re affiliated with, but that’s usually about the limit to as far as it goes there. So I think creating a platform where we can talk to each other, talk with our patients, put out the information that we would like to see put out.

[00:25:13] That’s why, like even going back, I think if we, if patients trusted us more, COVID probably wouldn’t have been as big of a mess as it was. A lot of the, yeah, just trust of the government, distrust of the medical physicians, we were yelling like, please get vaccinated, please get vaccinated, and people were like listening to, why should I, like looking at us like why should we listen to you? I mean, even though like, them almost dying and they come to the hospital, which is also an oxymoron to me. Right? It’s crazy. And I’m like, it started a long time ago, like we don’t control the narrative. And I think part of that is driven by outside forces, people who are looking to monetize off of painting physicians in a bad light. Now we have a lot of. I wouldn’t say bad, but interesting career path of alternative medicine that I’ve never heard of. Like, I’ve heard of acupuncture or stuff like that, but I see, like on social media, like people doing things that they say are to treat certain medical conditions and I’m like, oh, so we’re basically back to where you could sell snake oil it seems like. So all of, all of that to me is just related. It’s all related. Our image and our reputation is related to how the public sees us. And I do, I understand why some patients have concerns. Absolutely. You shouldn’t just listen to just anybody and say, yeah, I’m just going to believe everything you say a hundred percent, but, you know, I do ask patients to critically think about where their information is coming from.

[00:27:01] Dr. JB: So now what can we do to take back control of the narratives? I know that one of the things you mentioned at the beginning, depending on where it is that you’re working, it’s hard for you to go out and do anything because you’re linked to your place of employment.

[00:27:21] Dr. Agboola: Yeah. I say join The Physician Collective. Our membership will launch pretty soon, we’re working on the website now to be able to support membership, but basically, I mean, physicians are busy. We should be, we should be busy doing our “why’s,” seeing patients, interacting with patients, or research or whatever it is that drives us, but the monetary contribution, although very small, as a collective will help us basically advocate and lobby for physicians we have to be able to put out more stories about what we as physicians do, kind of change the narrative in the public view and so much more. And also helping each other thrive. So there’s going to be plenty of resources there for whatever type of physician you are, whatever type of practice pathway that you took, whether it’s private, locums, employed positions like that. And then there’s things that, so we’re transparent, like our voting systems, sopeople will be able to vote on the things that we decide to advocate for versus like you’re putting money in the organization and they’re just advocating for whatever they want to advocate for and it may not be to your benefit. And I think that’s what some of the concerns that physicians have about other organizations, is that they feel like they’re paying but they’re advocating against their interests. Well, that’s a little crazy. It’s things that we want to see, we want to happen, we want to have bills introduced into Congress. It’s focused on us, but it’s focused on us to, so we can get back to doing what we really, really went into this profession for.

[00:29:13] Dr. JB: And who can join The Physician Collective?

[00:29:18] Dr. Agboola: Residents and above, so residents, attendings, fellows. Initial membership would be $125 for attendings, $75 for residents or fellows, so very small contribution. And it really is helping us one, to keep the web platform going, hire the staff that we need to hire that’s going to go over on Capitol Hill and make a fuss on our behalf because obviously, none of us can leave work and doing– some of those can, some of us can, and then, also engaging the physicians who want to do that type of work. And it’s so hard to know what’s going on in one state versus another state, because a lot of the things that affect us, it usually started off in one place and then it happened over time like a monopoly. And then by the time they get to you, you didn’t even notice that. It was, it was something that started long ago and it was used as a way to be introduced in another state.

[00:30:17] So things like that, keeping some feels on different bills that are being passed and stuff like that. I think, is not going to be easy, obviously but all we can do is try, that’s all, all we can do is try, try to make the environment of practicing medicine better so hopefully we can take away from some of the moral injury that some of us are experiencing. Like things that I would like to see, I would definitely like to see a mental illness diagnosis not being used against physicians who are stable and able to practice within safe boundaries. I feel like it’s a shame that so many states bar physicians from practicing just because they may have a diagnosis on the record, or they have to continue to prove that they’re better, maybe they just had a moment in their life where they may have experienced depression or something like that, because we have such high suicide rates and I feel like part of it is because we’re afraid to really seek the help, that work that we need.

[00:31:23] Dr. JB: Yeah. And there’s no outlet to be able to talk about it. So you just keep it inside and then you just get more, feel isolated and lonelier. So that’s what these conversations on this podcast is about, to really share these stories and let people know that they’re not alone. They’re not isolated. And that they’re human. We’re human, remind constantly remind–

[00:31:47] Dr. Agboola: We’re humans! We’re humans that just chose a profession. That’s it.

[00:31:53] Dr. JB: That’s it! Not heroes, not heroes.

[00:31:56] Dr. Agboola: Absolutely not.

[00:32:00] Dr. JB: So, if my listener wants to find out more about The Physician Collective, where do they go to find out more information?

[00:32:07] Dr. Agboola: I would say go to our Twitter page, it is ThePhysCol1. We have a Facebook group, but I understand everyone’s not on the Facebook group, but if they follow our Twitter page, there’ll be updated on the new website. So the other website that’s there now will be taken down, so don’t even bother, but the new website will be up in a few months and then they can join that way, ‘cause I do know that like there’s several physicians who are on Facebook, I think we’re very active, about 26,000 physicians on the Facebook group and we hope to turn that to a, an official organization, that’s where the website will take place. So people from outside of Facebook cannot obviously join. And yeah, follow us on Twitter. And if they’re not sure, just check in a few months and with the SEO optimization, hopefully Google will put us up there so we can easily be found, ‘cause we’ll definitely advertise for sure.

[00:33:14] Dr. JB: Awesome. All right. So, I think that the work that you’re doing is absolutely amazing and it’s so needed.

[00:33:21] Dr. Agboola: Thank you. I have a great team, so I would say great team of physicians to help with trying to bring this vision into fruition, I definitely can’t do it alone. And again, that’s what The Physician Collective is about, is about us coming together in a systematic way because we don’t want chaos. But that’s what that social platform will be. So, we can actually get things done that help us all.

[00:33:55] Dr. JB: So, in closing Dr. Bunmi, do you have any pearls of wisdom that you would like to share with my listener?

[00:34:06] Dr. Agboola: Yes. And this could be for anybody. We have one life to live. Understanding what drives us in our lives and what we really care about and care for, we should pay attention to, bid to, and definitely seek out our why. I love that, just basically seek out your why and trying to go from there. We’re not perfect, all we can do is try, but when you know your “why,” I think, I think the way life falls for you, it starts to be almost ordained by whatever you believe in. So definitely, definitely understand your why.

[00:34:53] Dr. JB: Who says a doc can’t rap? D O C T O R J B. The greatest doctor to ever touch the mic. The greatest podcast ever broadcasted or prerecorded. Come learn some. Each one, teach one. I’m done.