The mind is one of the most powerful tools we have as humans. A minor change in a person’s mindset have have lasting effects. If you think a situation is hopeless or impossible, then it will be. But, is it possible to change a hopeless situation around?

This question and more is what episode 72 explores with featured guest Dr. Tonya Caylor. Dr. Caylor is a family medicine physician and physician coach in Anchorage, Alaska who coaches in family medicine residencies to help faculty members and residents enjoy life and thrive in their chosen careers. In the podcast Dr. Caylor shares how she managed to regain her lotus of control and the transformative power a shift in mindset had on her career and life in general. 

Connect with our guest:

www.joyinfamilymedicine.com

Dr. JB  00:00

Welcome to Hope4Med for med.  Hi, welcome back to the Hope4Med podcast. I’m your host, Dr. JB and today’s featured guest is Dr. Tonya Caylor. She is a family medicine physician and physician coach in Anchorage, Alaska. She focuses on coaching in family medicine residencies to help faculty members and residents enjoy life and thrive in their chosen careers. Welcome to the show, Dr. Caylor.

Dr. Caylor  00:30

Thank you so much for having me.

Dr. JB  00:32

So let us start from the beginning. I love hearing your origin story. So please share it with my audience.

Dr. Caylor  00:40

Oh, gosh, okay, so I’m born and raised in Florida, and trained in Mobile, Alabama, for medical school, and residency. And really, we did things My husband was a physician as well. We did things not in the necessarily traditional way we had our kids during medical school and residency, just to add a little extra layer of adventure,

Dr. JB  01:08

Spice. Add spice to your your life.

Dr. Caylor  01:11

Yes, and fortunately, they turned out to be well functioning adults. So this is good news. And then, you know, I always tell people, people ask me how I got to Alaska from Florida. And I just say, I’m really good wife, my husband, like for two years kept talking about Alaska. This was before even the reality shows, were a big hit. And I finally said, you’re serious. And he’s like, Yeah, and I said, alright, well, let’s just go check it out, like off the plane and saw mountains and water and just amazing nature. I was like, Okay, I think I could do this. But it was a great move, because I had always wanted to get back into academic medicine. And they had a residency program here. And so I became core faculty. And I did that for about eight years. Before I have my own little burnout story that we don’t need to spend too much time on,

Dr. JB  02:07

Oh, no, we’re gonna spend a lot of time on that one.

Dr. Caylor  02:12

And then I had this like period of healing, where I remained as on call faculty, so you can kind of think about is like a PRN position where, you know, I get pulled in when I need extra hands, and was working in a community private practice with a husband and wife that set up their practice to enjoy medicine rather than to maximize profits go figure. And it was just I healed. And then what I found was, I had created too much margin, so to speak in my life, and I was really missing residence about that same time, there are social media groups that I was involved in, I was watching so many early in their careers, like want to know how can I pay off my loans and get out of this? And what else can I do with these skills that I’ve learned, you know, they wanted to leave medicine so early. And so it was kind of saddened by that trying to figure out how I was going to find this. Way to like, fill the needs that I was missing curriculum development and collaborative collaboration. And so I had a friend recommended a physician coach, and I just have to say that I had never actually heard a physician coaching at all. So I was like, Okay, fine, you know, let’s see. And so I hired her to kind of be in career planning, right. And I had all these ideas that are lifestyle medicine, I’ve been doing a lot of work in and culinary stuff, and really wanting to make a difference in residence lives and really help people, you know, not go down the road, I went down, and she was just like, why don’t you think about doing this and residencies, and it was like one of those light bulb moments. And I was like, it was like, all the things in one and it just resonated. And so I got into position coaching specifically to coach family medicine residents and their faculty. So that’s how I got to where I am.

Dr. JB  04:10

So you know, I said, we’re gonna circle back around to your burnout story. Well, here’s that time so let’s hear what happened.

Dr. Caylor  04:20

It was before I actually had the terms, right, like I didn’t, I did not know the word burnout. If you would have asked me at the time, I would have told you I was just not a quote, good fit for being in a faculty role. Because especially in academic medicine, and especially in family medicine, you have so many different hats you wear, right? So you’re not just seeing patients. As in the safety net clinic, you’re not just teaching residents on the wards or giving them lectures. You’re also advising and you’re like developing curriculum and you you’re facilitating conversations with the specialists that are going to host your residence. And there are just so many different things. And I loved every single one of them. So much so that when you pair that with a little bit of say unhealthy perfectionism, in the job is there really, I had no understanding that you didn’t get to your to do list done, like I always got my to do list done. When you got that many roles, and you’re trying to do them perfectly, and you can’t get it done, there’s a lot of like, negative self talk that goes on, that inner critic becomes, you know, really amplified. And I also somewhere along the way, lost my ability to be proud of how I was showing up and all became almost like, desperate for external validation, I needed somebody telling me everything I did was good. So those two things, along with probably a million other little things kind of forced my hand. And it was one of those situations where I didn’t recognize, like looking back, I can like, I came home after work, and could not engage with my family. I was very short with my colleagues, I had an agenda and tried to get this done. What I need you to do is do your part and do it now. Right? I had become impatient. I no longer had lunch times where I got to sit with friends and colleagues and chat. I was always working. So I became very disconnected. And then really getting into that, like depersonalization of sitting in a patient room who has so many cards stacked against them and feeling like, what am I actually doing? What What am I actually serving here? So all of that was happening. And it was just like one little hair that broke the camel’s back, right that something happened in a faculty meeting. That caused me internally to overreact. And I walked out. And I called a friend and said, What else can I do outside of this academic world in Anchorage, Alaska? And so that’s when I left, I didn’t want to leave the residency. So they allowed me to stay on is that is that on call faculty. But that’s, that’s kind of now my perspective, looking back over what happened, if that makes a lot of sense.

Dr. JB  07:23

So this all happened when you got to Alaska, you weren’t having any symptoms before Alaska?

Dr. Caylor  07:27

That’s a really interesting question. So, you know, it’s funny, let me start with the Alaska and then I’ll take it back a little further. But probably a year and a half or two years in, we had a faculty retreat, and one of the older, more mature faculty members said, I know, this job is really hard. And I know that it’s hard to have work life balance. And I said, I disagree with that. I feel like I have. I think I have perfect work life balance. And I meant it like I was so much on that high, maybe it’s still the honeymoon period. So it was it was insidious, probably about two to three years, three to four years, just a slow, insidious change that I didn’t even see and recognize. Now, looking back, I will say that one of my first job out of residency, I worked for multi specialty clinic where I was told, you know, I had to have 144 slots per week for patients, and I could design them how I wanted. So I had a little autonomy, which felt good. But I had little early symptoms of you know, those Sunday scaries, they call it where you start dreading Monday on Sunday, and you don’t get to enjoy your Sunday, because you’re dreading Monday. I had hints of that. And I think that I didn’t recognize that, obviously. But I was able to like, pull up my bootstraps and just get through the day and vacations would be restorative for me, right. And so, so nowhere near as severe back then, but I can look back now and start to see some of those little signs So post-residency. But now you work with residents as  Yeah.

Dr. JB  09:18

So what made you decide residents? Was it because you saw signs of burnout in them at that early stage? Or you just like, yeah, students are a combination of both.

Dr. Caylor  09:28

Yeah, we would take these wonderful we get just like amazing residents and we would watch these wonderful human beings, very idealistic, ready to do frontier medicine and learn it all and be out, you know, in rural Alaska, and they’ve just became by the middle of their second year, angry, feeling like a victim not what they signed up for unhappy with everything. And I recognize that even when I was faculty members, but I didn’t I was not whipped with the tools to kind of help them. I remember one of the very first times I was, I think I was precepting procedure clinic when I came back as fill in and I had started to learn some of these tools. And this guy was just such he was like the nicest guy. And he was like the cheerleader his entire intern year. And I hadn’t seen him in a few months, and I was working with him in procedure clinic, and he was just, he was just beaten down. And he was just like, everything he said, was negative. And I was just like, you know, I’m trying to avoid saying, names, but I was just like, What is going on with you? And he just told me, and I said, Let me tell you, let me tell you about where I am at my practice and how I can exercise. He said, Yeah, yeah, no, you have the perfect, you have the perfect client because they set it up to enjoy life and not maximize it, because you’ve heard me say that, right? It’s like, Yeah, but I want to tell you, did you know that our medical assistants are the ones that do our X rays? And he said, Do you know that they don’t actually have the best training? And so I’m constantly having to have them reshoot the X rays? Did you know that? I don’t have epic anymore. And so as much as I used to complain about epic, I can’t run reports, I can’t do anything. I can’t, you know, I can’t look back and search things easily. It’s very frustrating. And then I can’t remember what the third one Oh, and I said, Did you know, we rotate our medical assistants, I don’t get my own medical assistant. And he was like, really? I said yeah, I said, so I can go home every single day, being frustrated. And I said, but decide, I choose to focus on, I get 30 minutes with every single patient. I get to practice medicine the way I want to. It is a wonderful environment where everybody is supportive of each other. The reason that medical assistants can rotate around is everybody’s flexible. Everybody has a growth mindset. And they said, so the truth is, there’s good and bad, and that’s going to be true no matter where you are. So right now, you’re feeling really negative, and what you focus on expands. And he said, so let’s challenge you to start to focus on what what small things are going well. And so that was the first and he just started to open up. And I’m not gonna like tell you he had this like miraculous story. And then life was, you know, Rosie, but he just started to kind of get a foothold, that maybe he could do this career. Maybe he did want to do medicine, because maybe there are some good things. So that’s a long winded answer. And I don’t even know if I answered your question.

Dr. JB  12:41

I mean, I think you got you did, because, you know, you you shared how working with those students, or the residents, right and seeing them come into residency, and there, I am a doctor, you know, call me Doctor literally call me Doctor, not because I have my MD, and how they go from being so excited to so jaded at the end, and how through utilizing the growth mindset that can change. And so I want to explore that topic a little bit if you are open to it. So what exactly do you mean by growth mindset?

Dr. Caylor  13:19

Well, I think if you think of it, compared to a fixed mindset, right, where this is the way it’s supposed to happen, and you have all these preconceived notions, and you’re not opened to seeing other perspectives, right? So that growth mindset, you switch into curiosity, and Hmm, what can I learn from this? Like, none of us practice medicine medicine perfectly, right? So instead of taking that rigid mindset and said, Oh, I failed, I made a mistake and beat yourself up. The growth mindset says, Oh, look at that. That’s good for me to know, right now. I’m glad I learned that now rather than 10 years from now, because now I will approach this situation better. And you start to learn how to learn those lessons to grow into better yourself. And you get out of that kind of all or nothing thinking right? Where you start to see the possibilities in between. So like self care, for instance, which is one of the big things that we talked about, but you know, people will set up this, I’m going to work out five days a week, 30 minutes a day. And if they don’t hit it, then they quit. Right? Whereas the growth mindset would say, this would be my like, stretch goal, and I’m okay, putting my tennis shoes on walking outside for five minutes. And seeing that as a possibility so that it kind of gets you out of that all or nothing mindset and You started to become a little more flexible in your ability to think about things.

Dr. JB  15:06

How do you develop a growth mindset?

Dr. Caylor  15:09

You put your mind to it right? First, you have to know that it’s an option. I mean, I think so many of us grow up, or at least I did, where you just saw things the way you were taught growing up. And that was truth. We never learned to question our own automatic thoughts about things, right? Like, that was like mind blowing to me. You mean, my thoughts are optional? Well, those automatic thoughts aren’t they’re gonna come no matter what, because you’ve been conditioned and socialized. And those are your automatic thoughts, and there’s no judgment. But the fact that you can, like become the observer, and be like, Huh, look what what my brain has offered me. That’s interesting. And what a five to 10 other ways that I could view the situation. Like that was mind blowing to me that I, I actually had some agency in the way I think,

Dr. JB  16:04

That sounds very empowering.

Dr. Caylor  16:06

Yeah, and I, that’s what I want to impart to every physician, because I think, especially now, when there really isn’t as much autonomy, because large healthcare organizations, and insurance companies don’t offer us near as much autonomy as like, say, you know, I have friends that are in some direct primary care practices where they have more of that, right. But when you can’t control circumstances, and we know that the importance of physicians to sustain and like enjoy their careers, they have to have some agency. So if they can’t change the circumstances, they’ve got to take agency wherever they can. And part of that is deciding how they want to see their circumstances, how they want to be a part of that circumstance, or do they want to change the circumstance? That’s where they get to exercise their agency?

Dr. JB  17:04

I think, you know, one of the things that you said that is very interesting is looking and realizing what you have control over versus what you can not have control over. And that’s sometimes very challenging.

Dr. Caylor  17:18

Yes, I agree. And it’s really good when you can decide. Number one, I think we have to get an accurate assessment, because many times we think we have no control. And but that might not be the fullness of the truth. Right. So let’s really look at the options. Where do we have control number one, number two, for the things we don’t control? I like to say, accepting them, does not mean endorsing them. Right. So I’ll take it back to insurance companies, I have decided I no longer am giving any emotional capital, to being shocked at the number of hurdles, they’re going to put in my patients way to getting the care they need. I just don’t they’re going to do what they do their insurance agencies, they care about their profits, they care about their bottom line. Of course, they’re going to do that I don’t, I am no longer going to expend that emotional capital. And I’m going to accept the fact that that exists. Now. Does that mean I endorse the way they make us practice medicine? Absolutely not? Is it my, you know, the next question I asked myself is, do I need to be part of that solution? Is that in my lane, sometimes there are things like up here I joined in the fight for changing our licensure about how physicians have to disclose all of their medical issues forever and ever and it becomes public record, right? Like, is that my mind to fight? Yeah, I have plenty of patients who are physicians, I have seen many residents forgo mental health because they’re worried about what will happen to their licensure. That was mine to fight this insurance company. Not mine to fight. But I know that there are people out there that are even minded, very wise, and that have the energy and bandwidth to take that on. And I believe that at some point, we’re going to have to overhaul this healthcare system. In the meantime, I’m taking back my agency of what I can do I actually choose to go to bat for my patients and do the doctor doc, because I choose to do the right thing for my patients. Right. And I can’t control the insurance agency. And so I accept it. Sai Wakeman. She is an author. She’s a therapist, back in the day, but she writes a lot about leadership. But she talks about, you know, if you argue with reality, you’re only going to lose 100% of the time. Right?

Dr. JB  19:57

True. That’s so true. So when you mentioned, at some point or someday we’re going to have to overhaul the healthcare system. What do you mean by that?

Dr. Caylor  20:08

I mean, I can only see things from my perspective, right. And so I do honestly believe that there are a lot of perspectives that I don’t have. But there are a lot of injustices and waste in the system. So you know, personally, I, it doesn’t align with my core values that insurance companies and CEOs of healthcare companies make millions and millions and millions and millions of dollars off the business of physicians and healthcare staff, trying to improve the health of people’s lives. Right. So there’s, that encompasses a lot. So I don’t have the answers. You know what I mean? So I just know that the pandemic highlighted, we’ve known these things for years, but it really brought to the forefront and highlighted many of those issues, access to health care, access to quality health care, team based care where you have the primary care and the subspecialist. involved, you know, you know, I just got a glimpse, we had an issue with my oldest daughter, where she and we ended up taking her to Mayo, Rochester. And it was like, what in the world? Right? Like, they had all these tests, all the specialists had talked to each other, they did all of these things. And we sat down, and we got a full overview of all the ways forward, and it was just like, and, you know, I and I don’t even know that that happens every single time for every patient that may have. But it was just a glimpse of what healthcare could be. From the quality standpoint of it, right. But yeah, so I have a lot, I can see a lot of pieces that are broken, I can see like, I can remember back to dictating notes. In that very first, like 1999, when I finished residency and joined that multi specialty group they had just started was kind of a blend, blended model of EMR and dictation. So we dictated, and we would say dot code, if anything was to go like in the problem list, or my medication list or whatever. But now I’m just talking. And I can talk a whole lot faster than I can enter in something into a data entry base. But like, I can remember how fast my notes were then. Right. So I mean, there are so many hurdles. And I think part of it is losing some of the socialization that has happened over the years in medicine, you know, when the word resident got its word for you actually lived at the hospital when you were in training, right? Like getting back from that. You have dedicated this as your full vocation, you have dedicated your life to it. And I’m not saying that we, we shouldn’t be really having that altruism and love and passion for what we do. But it doesn’t have to be all consuming. And so I think some of that still exist. I think some of the hierarchy and medicine needs to dissipate, at the same time giving respect to experience. Right. So I think there’s a lot of issues that I see are broken, but again, along with it answer to say, I don’t have the answers.

Dr. JB  23:56

You know, but I think that that is just very telling in terms of how connected you are with yourself to be able to say I don’t have the answers, because that’s also one of the limitations that we sometimes have as healthcare professionals as physicians to say, I don’t know, I see this problem. I know it exists, but I honestly don’t know. And that takes a lot of strength to be able to even just say those words.

Dr. Caylor  24:25

Yeah, it’s true. And I you know, giving credit to this generation of residents. I, I’m not going to say all of them, but a bigger percentage than when I was in training, are willing to say that to a patient or a patient family member. And I think that is so wonderful because we’re moving in the direction and they learn to follow up. I don’t know, but I’m going to help you find out. Right, so the patient doesn’t feel abandoned. Right. And so I so appreciate that. At, there are an even early career faculty members that I’ve worked with who have really opened up to that their own strength and being able to say that I really appreciate and I think patients really appreciate that too, because, you know, they can see through through all the stuff, right?

Dr. JB  25:18

Yeah, they can, they can. So it looks like you from when you went through your burnout period, you have really focused on your mindset. Yeah.

Dr. Caylor  25:34

First and foremost, absolutely. That has been over the last five years, that has taken a huge shift, and really, into all, you know, categories of my life right now, not just work, not just my business, but also with relationships and family members and friends and community. So much needed, I still have much growth to go. But I am learning to do that from a self compassion place, rather than a judgmental place.

Dr. JB  26:14

So self compassion, can we talk about that a little bit. I love that word. And I love utilizing that but tell me what what, how do you define self compassion?

Dr. Caylor  26:25

I, I would say it’s different from self pity. Where are you just miserable. And you know, just like wallowing in all this, the unfairness, their sadness, or, you know, whatever, whereas self compassion is really having that empathy for yourself, for the fact like, you are part of the human race. And you also talking to myself, you also deserve empathy and compassion, because all of these things that, you know, I’m still peeling back the onion layers, right? Of all the things that I was socialized with, like, I can have a lot of judgment around that, or I can be like, Oh, well, it turns out that I’m human. And this is just this is what humans do when they’re in this setting. And mean, like, of course it is. So it’s just understanding and meeting myself where I am, right. Instead of, I think, like, how many of us got through medical school and residency by using a whip on ourselves, got to do better, you’re failing, you’ve got to prove yourself. And, you know, that works for an extent, you know, we can muster up some willpower and just suck it up. But like, realizing the fact that if you do that from a compassionate place, I think the fear for me when I first started doing this was like, Oh, my gosh, if I have self compassion, am I just gonna, like, not care? And I’m gonna give up and I’m gonna become this mediocre, you know, person. But no, actually, it actually frees you to move forward and grow even more. And I mean, I have to credit Kristin Neff, and many other people who have taught me things out of her research. So

Dr. JB  28:17

Because you’re not spending time beating yourself up, because it’s not like, Oh, you say one negative thing. And that’s the ends. No you just keep harping at it, right?

Dr. Caylor  28:27

Yea, and it doesn’t mean you can’t see room for growth. You can like I can assess and like, wow, next time, I would like not to say those words, that didn’t come across the way I intended. Right. But beating myself up and ruminating perseverating on it. All it does is like make me more miserable. It doesn’t help me get to the next level of okay, how can I say that in a way that is heard better? Right?

Dr. JB  28:53

That’s absolutely right. So I see how your experience working with that physician coach completely changed your life.

Dr. Caylor  29:03

Yes, absolutely. She was a huge part of what I believe is my ordained, like journey, right? Like, right place right time. And helped me to kind of get clarity on a lot of things. So, yeah.

Dr. JB  29:22

So if my listener wanted to find out more about you and what you do, how can they get in touch with you?

Dr. Caylor  29:30

They could go to my website. It’s www.joyinfamilymedicine.com. Also, I have a blog on there. So if they’re not necessarily looking to have a coach, but they just want to kind of read more about mindset and everything. They blogs on my website. So and Yeah.

Dr. JB  29:52

And do you have any final pearls of wisdom for my listener?

Dr. Caylor  29:56

I would say you one of the big things I love to encourage physicians, no matter if you’re in training, or you know, 20 years out of training is to look at three areas of decreasing unnecessary suffering. Number one, self care is not selfish, what do you need to give yourself, because by giving it to yourself, you’re going to be able to show up better for your patients, you’re gonna be more efficient and present.  Two is, look where you’re confusing altruism with people pleasing or a toxic part of that, you know, really serving people from a place that feels good. It energizes you and people pleasing leads to resentment. So look where you’re confusing those two and give yourself permission to stop people pleasing. And the third is the concept of that mindset of looking where you can take back some emotional control where you can get to have emotional independence, rather than riding the waves of all the circumstances around you, or what people did around you. Like, look for ways that you can start thinking of things differently. So you can take back a little bit of your emotional control control.

Dr. JB  31:19

Yeah, who says a doc can’t rap? DOCTOR JB.  The greatest doctor to ever touch the mic. The greatest podcast ever broadcasted or pre-recorded. Come learn some. Each one teach one. I’m done.