How this Johns Hopkins Orthopaedist & Military Colonel Battles Burnout

In celebration of Veteran's Day, we wanted to highlight 30-year military veteran, Colonel James Ficke, MD

Nov 11, 2016 - Guest Author


Colonel James Ficke, M.D., is Robert O. Robinson Professor of Orthopaedic Surgery at the Johns Hopkins School of Medicine and director of the Department of Orthopaedic Surgery. He is also orthopaedist-in-chief of The Johns Hopkins Hospital. During his deployment as deputy commander of clinical services at the 228th Combat Support Hospital in Mosul, Iraq, from 2004 to 2005, he was the senior orthopedic surgeon, treating more than 600 U.S. soldiers and Iraqi patients for war injuries. He is nationally renowned as an expert on the treatment of complex foot and ankle patients, lower extremity trauma patients and amputees. This is how he works.


How has the military shaped your active orthopaedic practice?

To start with, I wouldn’t be an orthopaedic surgeon if it weren’t for the military.

The military created my orthopaedic practice. I joined the Army at West Point and studied engineering then went on to Uniformed Services University for Medical School. Originally, I thought I wanted to do wilderness medicine but was exposed to an Air Force orthopaedic surgeon for a 2 week required rotation, and he was so excited about his practice that I was inspired. His name was “Doug Harryman.” He was a mentor for a short period but had a tremendous impact on me.

Ultimately, I served in the military for 30 years because I came into a position of leadership near the 9/11 events. I was at San Antonio, a level 1 trauma center, where we received many of the casualties from Iraq and Afghanistan and it inspired me to stay on Active Duty. Orthopaedic surgery through the military, research, and service of others has inspired my career in foot and ankle and trauma, which were both areas that were needed in the military.

This is a picture in the olive garden of the Benham Monestary in Nineveh Iraq where we had a Medic Baptized. The caretaker served us olives from the trees behind us.

What is the last book you read for fun?

You’re going to get a kick out of this. I must confess, the last book was A Passion for Leadership, by former Secretary of Defense, Robert Gates. I enjoy reading about other people’s successes. It’s a first hand account of leadership by a highly successful individual and icon for us as leaders in academics and organizations. The book depicts his many trials and tribulations and was a remarkable story about how one person came to a position of leadership - especially with such a humble upbringing.

Where is your favorite place you have visited with the military?

Sigh… that’s a little harder question. I have a hard time with favorites and I’m not avoiding your question. Every day in life there is something incredible.

One of the most exciting places was when I served for 1 year in nothern Iraq. We had a Christian soldier baptized in Benham Monastery built in 400AD – this area had one of the largest libraries outside of Rome at the time.

An Iraqi priest was able to baptize him. This was a man practicing his Catholic faith in 2005 in Iraq in peace. I think the most exciting thing about it was that we were at a place defending the freedom of mostly individuals with Islamic faith but freedom of religion was still permitted.

It was one of the highlights of my life because it signified what we did in the military: Preserve freedom of religion/expression for many of those who may not traditionally have it.

What is the first thing you do when you wake up?

Well, like most people, I guess, I shave – shower – grab a cup of coffee – kiss my wife goodbye and head to work.

After taking care of the ‘mechanics of the morning,’ I arrive ½ hour early at work before anyone is there to plan my day, collect my thoughts, and think about the opportunities in front of me for that day.

What’s your favorite type of exercise?

Running. I try to run 3-4 times per week. It gives me time away from distractions and it’s a known fact that people who incorporate an exercise habit into daily practice are happier. They have better health overall. These days in medicine and specifically for Doximity viewers, the notion of burnout is significant. A recent paper showed that up to 45% of physicians are suffering from burnout. I score very low on the burnout ratings, and I have lots of energy and enthusiasm and attribute much of that to getting outside with my regular exercise. Certainly not everyday, but regularly, and that’s valuable.

How has Doximity influenced your career and practice?

Our Department (Johns Hopkins Orthopaedic Surgery) is partnering with Doximity with the “physician referral network,” which is a pilot right now. I’m not a big social networker, but I know many of my colleagues use that feature to keep up with other professionals. It’s a growing way to have a referral network. And clearly the articles are very valuable.

What’s the most important lesson you learned as an Eagle Scout?

Well, you’ve done some checking. I still have the rank of Eagle Scout on my CV. It’s deeply ingrained in my core values including the Twelve Points of Scout Law: Trustworthy, Loyal, Helpful, Friendly, Courteous, Kind, Obedient, Cheerful, Thrifty, Brave, Clean, and Reverent (And yes, he did name them all).

Who has influenced you the most?

Well… I mentor people and I think it’s a skill you have to practice. Sir Ernest Shackleton was a tremendous leader. He influenced my life in the way he led his endurance expedition and brought all of his people home. He kept the unruly members close and taught them accountability.

I study biographies. I think any biography you read can really influence your life and how you practice.

One of Dr. Ficke’s former residents whom he mentors, Chad Krueger, and one of his own mentors, Mike Yaszemski

How this Doctor-Turned-Podcaster Manages His Time

Continuing our "How I Work" series, join us as we pick the brain of ObGyn, Dr. Patrick Beeman

Nov 08, 2016 - Guest Author


Patrick Beeman is an ObGyn and writer, and founder of the podcast InsideTheBoards. This is how he works.


Choose one word that best describes your work style:

Collaborative.

What is your device of choice?

My iPhone

Favorite apps & software?

For USMLE/COMLEX preparation, I love telling people about some of the "new kids" in the board-review space: Osmosis, OnlineMedEd and Picmonic. I think these companies approach their business first as servants of the students who use their platform(s) and offer innovative, high quality, and disruptive products that are revolutionizing the way people learn medicine.

For podcasting, I use Audacity for recording software and record interviews with guests via Skype. To keep the quality as high as possible, my home studio includes my iMac, Audio Technica ATR-2100 microphone, an Audio Technica headphone amplifier and pair of ATH MSR-7s cans (headphones) I got while I was on temporary duty in Japan, and a Yamaha MG10XU mixing board.

For daily clinical work, my go to app is Wheel SP, an Ob wheel app that calculates estimated due dates, allows input of fetal biometrics, and other essential stuff for an obstetrician. I use Epocrates and UptoDate a lot on my phone as clinical references. My newest discovery is the social media/secure medical multimedia app Figure 1.

How does Doximity help you in your work as a clinician?

Doximity pushes useful articles, tailored to my specialty to my dashboard. I've also used it to find specialists to whom I might refer patients. Plus, it's helped me connect with influencers to be guests on the InsideTheBoards podcast.

What’s your secret to staying productive?

Setting goals for the day before going to sleep and using the very early morning hours when I'm "fresh" for tasks that require the most creative energy (like working on content for InsideTheBoards or writing an article on bioethics) while saving more time-consuming, but mundane tasks for the evenings when I'm tired (like catching up on email, editing articles or podcast shows).

What do you wish you knew when you were a student?

I wish I had known the "mind hacks" that make undergraduate medical education more efficient, especially studying for board exams. Someone should have told me on day one of first year to do USMLE-style questions. I wrote about the difference that multiple choice questions make in your medical education here. Osmosis, the medical education platform I mentioned above, is doing its best to integrate the best principles of learning discovered in neuroscience into its platform. Things like spaced repetition, memory anchoring, and just doing a bunch of self-assessment questions can drastically increase your retention, efficiency, and long-term memory.

Who is your mentor?

The late Edmund Pellegrino, who has been called the father of bioethics, was my inspiration for becoming a physician. He became my mentor and I've always wanted to model my career after his. One of the best academic experiences I ever had was being his fellow at the Georgetown Center for Clinical Bioethics when I was a medical student.

As an MD-turned-podcaster, do you have advice for other doctors who are interested in alternative ways of using their clinical knowledge?

Many doctors sell themselves short. But a medical education and practice imparts more than just clinical knowledge. There are a bunch of skills a person acquires on the way to becoming a doctor. Besides learning your specialty, you have to be somewhat of a teacher, researcher, communicator, executive, manager, mediator, counselor, scientist, humanist, and writer (although interminable clinical note-writing can have a detrimental effect on one's writing skills) to become a physician. In the first two years of medical school, I was always writing and submitting popular and academic articles on bioethics topics while in class. I wrote boards-style questions during third and fourth year and eventually became the director of content for one of the major Osteopathic question banks. As a resident, I became a MedSchoolCoach.com advisor and have helped premeds perfect their applications to medical school, practice their interviewing skills, etc. I still do a little bit of this work because working with med school hopefuls helps maintain the original idealism that inspired me to pursue medicine as a career.

My dad was in radio broadcasting growing up; I always admired what he did and wanted to emulate it. I was a philosophy and theology major in college and always fancied myself a writer. The result? After becoming a doctor (and during the process, too) I found ways to apply my clinical expertise to writing and media. Clinicians should ask themselves what they think about at work, what they do when they leave the clinic or wards, or what they wish they had more time to do. And then consider ways in which their role as a doctor could be applied to these.

What’s the first thing you do when you wake up?

I try to get in some quiet time/religious devotion and/or exercise.

What’s the last thing you do before you go to sleep?

It's a bad habit, but I'm usually checking my social media feeds for news (and opportunities to troll my friends' by antagonizing—I mean commenting on—their profiles).

How do you decompress?

Working out or writing.

I can’t live without...

My family. I'm in the military and stationed nine hours from three of my kids, who live in Cleveland with their mom, and five hours from my wife (who is a psychiatry resident) and newborn, who live in Cincinnati.

What are you currently reading?

Faulkner's The Sound and the Fury.

Do you have a favorite song?

So glad you asked this. I love music. It's a little-known secret that part of the reason I'm doing the InsideTheBoards podcast is to connect with some of my favorite artists and share some of the songs I love with a wider audience. My favorite song is by a little-known artist, Rich Mullins, "We Are Not As Strong As We Think We Are" which, I think, captures the agony of loss better than anything I've ever heard: "I tremble like a hill on a fault line just at the thought of how I lost you."

What’s the best advice you’ve ever received?

From my mom and dad: stop living so far in the future.


Patrick Beeman is an Ob/Gyn and writer. He worked on the Case Files series and has written practice questions for four question banks including USMLE-Rx. Most recently he was the director of content for a leading board-preparation question bank until founding InsideTheBoards to teach students the principles board exam question writers use to construct test items in order to help them reduce stress, improve efficiency in studying, and to help them achieve the scores they deserve. Listen to the InsideTheBoards Podcast for the USMLE, COMLEX, and Medical School tips.

Doctors Love the iPhone 7. Even More Than You Do.

How physicians are using smartphones today

Oct 27, 2016 - Doximity Blog


Whether it’s the iPhone 7 flying off the shelves, or the Samsung Galaxy 7 being put on the No-Fly List, our favorite hand-held device has been making the rounds in recent news stories. Apple, in particular, has been front and center - and with their announcement of a revamped MacBook Pro at today’s Apple October 27th event, they seem to be headlining the news every week.

Our researchers at Doximity started wondering: exactly how are physicians are currently using smartphones? With over 60% of all U.S. physicians on the Doximity network, our member data provides an unparalleled wealth of information on physician technology habits and implementation to get the most accurate look at device trends in medicine.

Physicians adopted the iPhone 7 faster than the rest of the population

When it comes to new technology updates, physicians are often at the top of the curve. In the first two weeks after the release of the iPhone 7, 3.7% of the general population updated to the new device. However, 4.1% of physicians adopted the iPhone 7 in this same time period - proving once again that those in the medical field are tuned in with tech.

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Overwhelmingly, the iPhone 6 holds the first place spot - with over 80% of Apple-using physicians in tow. The standard iPhone 6 (not iPhone 6s or 6 Plus) was the most commonly used of all the iPhone 6 versions, by 45% of all physicians using iPhone 6 versions. The iPhone 5 and 7 claim the second and third places respectively, but at 11% and a little over 7% each, the iPhone 6 is most popular by a large margin. (Did you know that we predicted the iPhone 6’s popularity among physicians before its release, in 2014?)

After the initial wave, is it possible iPhone 7 adoption will slow with doctors? It could, given that the iPhone 7 doesn’t have ‘enough’ features for people to make the change. There’s a better camera, better speakers, and no headphone jack (which some would count as a negative feature), which are all new features, but nothing as exciting and noteworthy as the changes from the iPhone 5 to the iPhone 6.

Perhaps it’s not that the iPhone 7 is underwhelming, but rather that the iPhone 6 has enough features to keep customers, and physicians, happy.

How quickly did physicians upgrade to the iPhone 7?

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Our findings showed that certain iPhone users were much quicker than others to adopt the iPhone 7. Those physicians with the iPhone 4 were the group that most quickly adopted the iPhone 7 upon its release.

After that group, physicians with the iPhone 6 were second most likely to make the upgrade to the iPhone 7.

From our sample, around 3% of total Doximity physicians made the switch to the iPhone 7 in the first month of its release. After the first month, the adoption rate of the iPhone 7 doubled to over 7%.

In past releases, the iPhone 5 and iPhone 6 have been adopted much quicker in the first month, at rates up to 37% in the month of the initial release.

Code Red! How many physicians are carrying the flammable Samsung Galaxy 7?

By our standards, thankfully not too many! Our researchers found that less than 1% of physicians on Doximity were using the fiery phone. This is good news. If you think a phone catching fire on an airplane is bad, imagine it happening in a hospital surrounded by oxygen tanks.

Are you a reporter interested in more data from Doximity's research team? Email today.

How this Ochsner Physician Executive is Transforming Healthcare Through Technology

In another 'How I Work,' article, we feature technology evangelist and cardiologist, Dr. Richard Milani.

Oct 20, 2016 - Guest Author


Dr. Richard Milani currently serves as Chief Clinical Transformation Officer and Vice-Chairman of the Department of Cardiology for Ochsner Health System. This is how he works.


Choose one word that best describes your work style:

Nonstop.

What is your device of choice?

My new iPhone 7. I even got the shiny black color, Matrix-style.

Favorite apps & software?

It changes every day. In the last 24 hours, I’ve been really into iBooks. I have all my books, PDFs and keynotes in there, just stored in the Cloud! It’s crazy.

How does Doximity help you in your work as a clinician?

Right now, it’s in the Colleague Connect Platform, where we’ve been able to generate information about Ochsner as a tertiary center for potential referring doctors and have them better understand what we do, in an easy-to-digest way.

What’s your secret to staying productive?

Never taking no for an answer. You find a way to make things happen that need to happen -- I guess I’m just pushy (smiles).

What do you wish you knew when you were a student?

You sort of divide medicine into two parts: science and healthcare. You can learn the science in school, but then there’s the healthcare side, which is really how it works - workflows and the business of medicine. That’s the part you learn over time, but don’t learn in school. I wish I knew more about that as a student.

Who is your mentor?

Today, there isn’t one, but I’ve had various mentors along the way. Dr. Alex Leaf, who was Chief of Medicine at Massachusetts General Hospital, stands out as a mentor in my life.

You’ve worked with Apple extensively in the past, utilizing technology to enhance patient care. How has this transformed the patient experience at Ochsner?

The transformation has been dramatic. Let’s take a step back: what healthcare needs to do is identify the issues that the population you are surrounded by face - and match those. What is the epidemic of our time? Chronic diseases. 86% of all dollars spent in the United States - 2.86 trillion dollars, is spent on chronic diseases. We do a lousy job of managing it, and we’re not doing anything different to change that. In contrast, if you were running a business, wouldn’t you look at inventory on a daily basis or sales on a daily basis? You’d be evaluating all these variables hourly or daily - you’re constantly monitoring to match supply and demand. In healthcare, we say “you have diabetes, it changes by the hour or the day, and we’ll see you in 6 months.” Then in 6 months you’ll be fine, or in 2 months you’ll be crashing. With chronic diseases, we need a different model of delivery with multiple streams of data between physician and patient.

For example, patients who have been enrolled in a digital health program in managing hypertension will work with their internal medicine doctor to measure readings wirelessly, right from their home. In addition, we have multiple “O Bars” in our primary care centers to help patients seamlessly manage their health. Now patients don’t have to call their son or daughter for technical assistance - we have a full-time technology specialist behind the bar to help if they have any issues. This way, patients have tools that empower them to stay healthy.

This week we rolled out Connected Mom, a program to promote a healthy pregnancy. Pregnancy is very scripted within health systems, usually 14 visits for the average expectant mother. At some of these visits, all that takes place is ensuring that the woman is gaining the appropriate amount of weight and her blood pressure is within normal range. Some visits would be unnecessary if everything is going well. With Connected Mom, women can go to the O Bar to receive a wireless scale and a blood pressure cuff. The program also gives women tips throughout their pregnancy, including milestones, and what to expect next. The value is that women can skip unnecessary visits, and doctors can fill that appointment slot with patients who need to be seen.

How do you decompress?

Exercise. I’ll do whatever my body will allow me to do - yoga and weights, in particular.

Do you have a favorite song?

Whatever my wife and kids are listening to.

What’s the best advice you’ve ever received?

The dean of students at my medical school told me this: it’s just as important to know what you don’t know, as it is to know what you know.

How an MD turned CDC Injury Center Director Juggles It All

In the next edition of our 'How I Work' series, we feature Dr. Debra Houry, Director of the National Center for Injury Prevention and Control (NCIPC) at the CDC

Oct 14, 2016 - Guest Author


Debra Houry, MD is the CDC's Director of the National Center for Injury Prevention and Control. This is how she works.


What words best describes your work style:

Collaborative, innovative, dedicated

What is your device of choice?

Smartphone: for better or worse, so I can keep up with emails at all hours. I also like the apps for directions, social media, and keeping my child occupied at times in the car or at restaurants with educational games and reading apps.
Laptop: I still like to use a computer for writing papers, longer emails, and working on presentations.

Favorite apps & software?

Twitter and LinkedIn for social media, One Note to keep track of to-do’s and keep notes in one place, and I can’t function without Outlook Calendar.

How does Doximity help you in your work as a clinician?

I like reading the articles on topics relevant to my work that may not be in journals or media outlets I subscribe to or read regularly.

Want to receive specialty-specific news? Update your settings here.

What’s your secret to staying productive?

I’ve always loved the quote “well behaved women seldom make history." For me, it means you cannot be a silent bystander in life - when you see something you can do to make a difference in the world, you need to step up. Taking care of patients in underserved “safety net” emergency departments, coming up with innovative programs to prevent violence and injury, and making the world a better place for my daughter and her peers is what drives me.

Describe your journey to medicine/when you realized you wanted to be a physician.

I had a calling very early on. No one in my family was in medicine, but I volunteered in hospitals in high school and really loved science. During my undergraduate studies, I continued to volunteer in hospitals in various capacities and found that I always left inspired and wanting to learn and do more for the patients I interacted with. I pursued a joint MD/MPH degree so that I could focus on treating individual patients and have impact at the population level through prevention work. During my residency training, I realized there were so many injuries I saw that could be prevented and knew that I can balance all of this in the emergency department by working on the front line of the health care system and working with the community on injury prevention.

Who is your hero?

Several come to mind. President Carter for his work in recent years through the Carter Center to improve the health and well being of others globally; C. Everett Koop and David Satcher for some of the work they did as Surgeon General - taking on tough issues because it was the right thing to do; and my dad- who came from an immigrant family, worked his way through engineering and then law school, and has been a role model and mentor to so many. My boss, CDC Director Dr. Tom Frieden, inspires me to focus on using the data we have to compel action and to ensure that what we do has impact to improve the health of others.

What is the biggest challenge for women in medicine right now?

I think there are several issues that impact women in medicine. One is balancing work and family, and it’s certainly not just women who face this - it’s tough to do and I don’t think you can ever “balance,” but rather shift the imbalance as needed. Sometimes family needs more focus, and other times a work project may require added attention. And, although women have become more represented in leadership positions and academic rank over the past decade, there are still significant differences in the number of male and female chairs, deans, and full professors.

You’re currently the Director of the National Center for Injury Prevention and Control (NCIPC) at the CDC. What was the path like to this role, and any advice for clinicians looking to work in a similar capacity?

Over the past 15 years, I’ve balanced clinical work in the emergency department with a dual appointment in the School of Public Health. I conducted research on intimate partner violence and sexual violence prevention, taught classes in injury and violence prevention, and was president of two national organizations (Society for Academic Emergency Medicine and the Society for Advancement of Violence and Injury Research). My experiences in the emergency department treating patients after an injury and those experiencing ongoing violence, studying interventions to prevent violence, and leading diverse organizations fueled my passion for injury prevention and I wanted to have impact at the national level. I can’t say I planned the path to this role, but my various experiences gave me the balance of skills and knowledge needed for the job. I think my emergency medicine training has been really helpful for this job - I can triage what needs to be taken care of immediately vs. later, make decisions based on the data at hand and revise actions if needed when I have new information, and understand firsthand how our work impacts the patient, clinician and community. I’m lucky - I love this job, and I now get to practice medicine at the population level to help people live healthier lives through the work we are doing at CDC.

How do you decompress?

It can be as simple as reading a good book or spending some time with my family away from work. A trip to the beach where I can walk in the sand is always great when I have a few days to spend some downtime.

Do you have a favorite song?

Zac Brown Band's Homegrown and Toes. It reminds you to keep things in perspective, take things one day at a time, and be happy and thankful for what you have.

What’s the best advice you’ve ever received?

The “can you sleep at night” rule. It comes down to doing the right thing at the time based on what you know at that moment. As I’ve always said, if you’re worried that you could you have done something different for a patient when you go home and sleep, then you need to do what you believe is right for the patient now. The same is true with other types of work and interactions: if you know you did the right thing, involved others when needed, and can stand by your actions, then you can sleep at night.


Debra Houry, MD is the CDC's Director of the National Center for Injury Prevention and Control. Dr. Houry leads innovative research and science-based programs to prevent injury and violence and to reduce their consequences. She brings frontline experience of preventing injuries and violence as an emergency room physician and researcher.