Millennial Doctors and the Next Greatest Generation
Air Date: June 14, 2021
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HEFFNER: I’m Alexander Heffner, your host on The Open Mind. I’m delighted to welcome to our broadcast today Emma Goldberg, she’s a New York Times correspondent who was on the COVID-19 medic beat and author of the new book “Life on the Line: Young Doctors Come of Age in a Pandemic.” Welcome, Emma.
GOLDBERG: Thank you so much for having me on. I’m excited to be here.
HEFFNER: Congratulations on the book. And of course, those of us who were reading COVID coverage over the last two years, or year and a half, read your account of what was transpiring, which was textured and profound and deeply spoke to the horrors and the anxieties and the trepidation that we felt as a country. And that’s what I want to ask you about to start. When did the doctors in general, if not sort of the Gen Y or Gen Z doctors, begin to recognize that what they were facing was at the level of a 9/11 or Pearl Harbor in terms of actual death count?
GOLDBERG: Yeah, well, it was definitely a process I think in terms of really coming to grips with the scale of the crisis that we were facing. And I remember witnessing that sort of firsthand in New York City as the city was in a state of kind of paralysis and shock as the pandemic was first coming toward us, and people were wondering should offices shut down, should schools shut down? Should people be wearing masks? There was not a lot of information and we were all learning in real time. And I think that was one of the most fascinating parts of all of this for the doctors too, is that the young doctors were learning in real time alongside their bosses and alongside hospital leaders. And so I had young doctors telling me that they arrived on the wards and realized that actually they had almost the same level of knowledge about what they were facing as some of the hospital superiors, because they were all learning about the virus in real-time and learning day by day, what COVID care really entailed. So it was a learning curve for absolutely everyone.
HEFFNER: It’s amazing to hear you say that you know, starting on the floor, starting on really from zero and I’m sure it was challenging for these doctors, and I know some began to practice in the wards even before graduating, to not have mentors really with expertise. I mean, it was, it was like we were in a planet without really understanding, you know, the gravity of the situation. And I’m sure that not this must have psychologically and intellectually hampered the beginning of, of treating COVID.
GOLDBERG: Just to, I guess, push back a little bit on the way you put it, I would say they certainly had mentorship and they certainly had leadership. I think more so than ever senior doctors really stepped up just in demonstrating a willingness to dive into whatever kind of work was needed, any sort of tasks that came up, people were there. And I think in some cases there was actually a really welcome shaking up of hierarchy where you had hospital leaders who were changing bedpans or doing the sort of day-to-day tasks that they normally wouldn’t step in and do, because it was an all-hands on deck situation. And you had people from surgery, people from dermatology, people from every single field were just diving in and treating COVID patients. And it was sort of everyone in the trenches together. And I think there was a kind of unity that sparked in a sense of togetherness, that while frightening was also kind of empowering for the young doctors to see, and to learn from.
HEFFNER: That’s on a human level and that’s inspiring, and I’m glad you reframed it in that way for our audience to understand the sense of unity, but just from a factual perspective about what COVID is, and was, and kind of the changing guidance on it, I mean, there are doctors who lost their lives because hospital systems were paralyzed, they were buckling under, they were ill-equipped, they didn’t have the personal protective equipment. And because frankly not just President Trump, but the entire infrastructure, both scientific and administrative, within the medical community was acting like they didn’t know what the hell was going on. I mean, and so you have this great experience and spirit of unity, but at the same time, just getting basic facts like asymptomatic transmission was a reality. It killed a lot of people. And there were leading doctors in New York City and elsewhere who were downplaying that and saying that that wasn’t a factor. You had a governor of New York saying it’s like the flu, basically you’ll be okay, as long as you don’t have a comorbidity. So it was in this universe. And I’m wondering how much of that was just in the political community and how much of that was sort of medical establishment going wrong?
GOLDBERG: Yeah. That’s a good question. I think, I mean, everyone was, I think particularly within hospital leadership, within U.S. healthcare leadership, people were certainly doing their best to get us, gather as much information as they possibly could, and I think in some cases struggling to do so in the context of an administration, a federal administration that wasn’t always supporting them. But I think there, there was a pretty heroic effort on the part of at least healthcare workers and healthcare leadership to try to take stock of the scale of the threat and protect healthcare workers, even as they were doing heroic and, in some cases, self-sacrificing work. But I think one of the miracles we see coming out of this about a little over a year into the crisis is how well the PPE, when it was available, did work. And what I thought was kind of striking is of all the young doctors I followed, none of them got COVID in the hospitals, none of them. And they had the protective equipment they needed. They were able to protect themselves. Those who got COVID actually got it outside the context of the hospital in exposure, in day-to-day situations, but not from their patients. So I think one of the miracles we see coming out of all of this is that when PPE was available, it really worked. And that is a pretty positive takeaway.
HEFFNER: So that is one of the positive takeaways. What about, would you describe you know, in terms of systemic reform or the idea that COVID made us realize the importance of these frontline workers and the unfairness of their treatment in some ways, and that’s something you write about extensively?
GOLDBERG: Yeah, I think this is, certainly the past year has been a reckoning for the importance of mental health in healthcare, the importance of not stigmatizing mental health in particular, because I think one of the biggest questions coming out of this last year is how do we take care of our caretakers? And there has been an emotional exhaustion that’s been created by the last year. I would say every frontline worker I interviewed no matter their level of seniority, they were emotionally depleted by what they saw. They were emotionally depleted by the loss that they witnessed. And in some cases, by being unable to save lives, you know, they went into this work because they want to heal, and they want to save lives. And in the context of COVID, they couldn’t always do that. And that creates a real sense of trauma. And in some cases, a sense of burnout. We see burnout is being reported at astronomically high levels within the healthcare field. So I think the question coming out of all of this that we need to be asking and that healthcare leadership needs to be asking is what does it look like to provide mental health support for people who have been on the front lines? I think that’s a critical question.
HEFFNER: And how does that relate to the overall design of the U.S. health system? I mean, in terms of addressing, not just the mental health question, but in order to address that, some of the systemic inequities, whether it’s public versus privatized health or just frankly, the number of hours you’re expected to work as a resident, you know, in the field, in effect. And the fact that it’s just not really feasible, if you want to preserve your mental health and work, you know, that number of hours?
GOLDBERG: Something interesting that I learned in doing the research for this book is that actually the hours question in terms of the number of hours that residents work is trickier, I think, than a lot of people realize, because you know, you do have these caps on residents working no more than 80 hours a week, and 80 hours a week seems like a lot. But there actually has been research that shows that there’s a trade-off because there is a degree to which if residents work you know, above 80 hours a week, there can be exhaustion. There can be mistakes that get made, and that can be risky for patients, but there’s also a trade-off because when residents pass off patients to one another in between shifts, that’s also a space where a lot of errors get introduced because, you know, you’re passing on the information to a new doctor. You have to remember all the medications, the patient history, there’s so many details that have to be remembered. So that trade-off while residents are going off of their shifts, that is, you know, that also poses a risk to patients. So I think that there’s a level of complexity when we’re talking about capping resident hours and capping resident work weeks. It’s not as straightforward a question as we might think. And I think that’s something that that people in hospital leadership certainly need to keep digging into. I think making sure that there isn’t like a stigma around doctors seeking out mental health care, that’s a critical piece of this, you know. There are like aspects of the system historically that have penalized doctors for seeking out mental health care or even psychiatric help. And I think coming out of this year in particular with all the burnout and the trauma, we’re seeing the consequences of that and the potential risk of stigmatizing it.
And I think lastly, in terms of systemic, what, what like systemic issues come out of this? I think we need to be talking about real systemic ways of prioritizing diversity, diverse recruitment, and retention of diverse doctors in the field. Because over the last year we saw that patients of color were disproportionately affected by the virus. They were, in New York black and Hispanic COVID patients were dying at twice the rate of white New Yorkers in the early weeks of the pandemic. And we have seen that patients of color sometimes get better care, actually, when they’re seen by doctors who look like them. There’s been studies that show that black patients have better health outcomes when they’re seen by black doctors. And so I think when you, when you think about the stakes of diversity in the healthcare workforce, it’s actually, it has to do with people’s health, it has life and death consequences. It’s not just a “nice to have.” So I think thinking at a systemic level about what it will take to introduce diversity to the field is a real important issue coming out of this last year.
HEFFNER: Is that the way you perceive the Millennial, and I know there’s a difference, right. And I want you to talk about the difference between Millennial doctors and gen Z doctors. So why don’t we, why don’t we start there? What, what did you find in terms of the differences between the kind of Millennial outlook and the post-Millennial or Gen Z outlook?
GOLDBERG: Yeah, I mean, the, the doctors I followed for the book were all Millennials. They were all in their mid-twenties. They’re certainly, you know, on, on the younger side of the Millennial spectrum, but no Gen Z doctors who I was in touch with yet, but…
HEFFNER: Theoretically there are probably some hybrids or some who, who are sort of very young. There’ll be the older Gen Z ultimately, right. But you’re saying mostly Millennials. So we’re talking about primarily 30 somethings. But 20 something, you know, late 20 somethings,
GOLDBERG: 20 somethings, exactly.
HEFFNER: You know, and there are, there are Millennials who are, you know, they’re technically by definition Millennials, but they’re like late thirties. I mean, that’s a weird definition.
HEFFNER: The question arises about, you know, whether or not the doctors you spoke to frame it in terms of diversity, like you just did, or whether they talk about the failures of the American healthcare system, and the fact that, you know, basically you were more likely to die if you lived in a certain zip code and that the Affordable Care Act while it provided a platform for public health really did not mitigate any aspect of the COVID disaster, and specifically the disproportionate outcomes in black and brown communities. So, I mean, it’s one thing to talk about in terms of diversity recruitment, either from the medical school perspective or, you know, doctors and practices perspectives, and then to talk about like real political reform. And I’m wondering if any of the people you’ve interviewed and whose stories you told most pointedly, are involved in that grassroots organization to mobilize reform, which they do not believe was achieved, or at least not sufficiently with the Affordable Care Act?
GOLDBERG: That’s a great question. I think you’re certainly seeing among younger doctors, just a lot more openness around issues of equity and inequity and disparities. I think there’s a real language around all of that and a desire to fully confront that head-on and to think about what it will take to bring real equity to the medical field. And I think they have the benefit of there’s more research than ever on racial health disparities on, you know, this field of concordance, which means the health benefits patients might see when they’re seen by doctors who look like them. So there’s just a wealth of new evidence that the new generation of doctors have access to. And I think that you’re also seeing, the pandemic happened alongside the racial reckoning of the last year and a nationwide swell of protests following the killing of George Floyd. So there is more and more openness about racial injustice across fields, and healthcare is certainly no exception. And I think you’re seeing younger doctors talk about that more openly than ever before. And certainly there’s also been older doctors who have put language around that as well. And they’re all you know, jumping into this conversation and in different ways.
HEFFNER: You know, just to go back to the beginning of our conversation, Emma, there really wasn’t resentment towards some of the older doctors or, you know, medical establishment, you know, deans or directors of health, who may not have taken the precautionary measures that were necessary from the outset. I just, you describe the unity inspired in part by mentorship, but I just, I don’t know if you experienced kind of the other side of the coin, which was just this idea that these older folks and establishment medical people, whether they’re doctors or administrators, should’ve been better prepared for this and any resentment from the younger cohort that, you know, they got misleading guidance about COVID, infectious disease people were not outspoken enough at a lot of these institutions to say, you know, we need these separate wards. We need this, you know, from the beginning. And I just wonder if you, at all, chronicle any kind of resentment from this generation about the failures of the older generation.
GOLDBERG: I wouldn’t say I heard a sense of resentment. I would say that the younger generation of doctors actually expressed a level of gratitude for all the structures of support that they had as they were going into this really challenging time. And I also want to be clear, all the young doctors I followed were not you know, conscripted into the fight against COVID. They had the option to graduate early, and the ones I followed chose to graduate early and to start treating COVID patients. And I think, you know, there was also an interesting, I heard comparisons to some of the ways that some of them spoke about having studied the way that doctors approached the AIDS crisis. And during the AIDS crisis, there were a lot of doctors who felt any fear to treat AIDS patients at all.
You know, there was so there was not a lot of information about how that virus was transmitted and doctors were in a lot of cases, scared to treat patients, thinking they could get infected themselves. And I think the doctors who were working during the COVID crisis felt, you know, a sense of they were doing right by their patients. They were surrounded by systems of support and older doctors who were right alongside them in the fight. And I think that there was a real sense of unity in the field. And I think you even saw the outpouring of that in the daily 7:00 PM applause, you know, people were leaning out their windows, applauding the healthcare workers. And I think the healthcare workers felt this sense of togetherness in New York City with the older doctors. And certainly I think there might have been different degrees of frustration with the federal response or lack of communication coming out of Washington. But, for the most part, what I was hearing was the sense of gratitude of being together in the fight with their superiors in New York City.
HEFFNER: Yeah, well, it’s really amazing that they were able to tune out what you would perceive as maybe the political nonsense. And it wasn’t just federal. I mean, I can remember the ousted health commissioner, she’s not the current New York City health commissioner, saying to New Yorkers, you know, basically we are not aware of asymptomatic transmission, in one of these daily press conferences. I mean, the political cohort was getting something wrong every day, for many days, until the city was silent, you know, because people weren’t going out anymore. And it was, it was an eerie experience, but it’s, it’s really extraordinary to hear about the resilience of these doctors, who they just did their job, and, you know, they were aware probably, and maybe you could testify to this a little bit, that there was a lot of nonsense going on politically, a lot of, you know, from the idea that you could inject yourself with Lysol or Clorox to, you know, other nonsense about, you know, treatments that were not actually legitimate. But there is the psychological element of just the daily death count and not being able to treat patients because they’re dying. And then, there would have been the psychological element of like our country is failing us. This is like our homegrown Vietnam and, you know, and I guess they just tuned it out, I mean, or, or…
GOLDBERG: I… Sorry, I don’t think that’s fair to say. I will just say that the substance of my conversations with them was focused on their care for patients. So we were just talking about clinically what they were seeing, medically what they were seeing…
HEFFNER: Right. Is there anything from the book that you could, that you could comment on sort of environmentally on how they dealt, because I know someone like Craig Spencer at Columbia who, you know, was an Ebola survivor and a very active Tweeter on COVID, you know, Dr. Spencer you know, he would correct a lot of the dis and misinformation and I just wonder how much, you know, that was, was of relevance to doctors, the sort of wanting to correct things that are going on in the environment, on the outside that, that need to be corrected.
GOLDBERG: Certainly I think there was a lot of frustration with people who weren’t wearing masks and people who weren’t taking the precautions. I think that felt really personal for healthcare workers because they were on the front lines, risking their lives. And so to see other people, you know, not taking all the necessary precautions, that is painful to a certain degree. I will just say the substance of my conversations with the doctors, we were focused more on the kind of changing nature of the patient-doctor relationship, the changing of clinical norms. So our conversations weren’t as focused on the broader, that broader ecosystem you are talking about.
HEFFNER: I hear you. It does sound like the, this generation is much more prepared to take on a political role though, in fostering equity, either internally within health systems, or maybe even as candidates for Congress in the future. It sounds like you’re saying that, you know, there is more of an acceptance of the doctor who, I don’t want to say a political doctor, but the doctor who views himself or herself as a citizen and someone who can take positions on public policy and can fight for equity and for his or her neighbors.
GOLDBERG: Yeah, I actually wrote an article last May about a wave of doctors who were running for office. And I think you’re certainly starting to see more and more doctors jumping into the political arena. And they’re seeing the intersection between medicine and our political system and government more and more in the context of the pandemic. And I profiled a number of doctors across the country who made the decision to run for office in the context of the COVID-19 crisis, realizing that their medical skills were not separate from policymaking skills. And so I think that that does touch on, that does speak to the trend you’re discussing in which we’re seeing more and more how medical voices can be amplified in the political and policy making arena.
HEFFNER: You know, we talked about hours, but are, were there specific ideas that those candidates had or any folks you’ve interviewed, you know, that they, that I mentioned the Affordable Care Act, that discrepancy between public and private health systems. Were there specific things outside of pandemic preparedness and protective equipment that, you know, these folks running for Congress or running for office wanted to champion?
GOLDBERG: You know, there’s, there’s more and more mobilization around the shortage of residency positions in the U.S. and there is congressional legislation that touches on that right now, that’s being considered. The number of federally, federally funded residency positions is capped. And that’s a more and more contentious issue. And you’re just seeing more and more conversation around the need to place science and public health at the center of policymaking in all different ways, whether that’s in government approaches to lock downs or to have vaccination rollout, to all those different issues. So there’s a wide range of issues that doctors and scientists are placing forward and in policymaking spaces. And I think we’re going to start to see more and more of that coming out of this crisis.
HEFFNER: And final question on vaccines and vaccination, you said there might’ve been some resentment, not towards other doctors, but towards lay people, not masking, not taking necessary precautions with respect to vaccine hesitancy or resistance, however you want to classify it, you know, from the doctors that you’ve spoken with, what has been maybe the most effective approach they’ve employed to respond to the hesitancy or resistance?
GOLDBERG: It sounds like from what I’ve, what I’ve heard from a lot of frontline providers is just conversation directly with people, that it’s, it’s all just that one-on-one interaction and building trust that allows people to ask, to that allows doctors to ask people what’s forming their hesitancy, you know, where their worries about the vaccine are coming from, and the more you engage in conversation, return to certain communities, make it super accessible and, you know, even go knocking door to door, that all those kinds of things really help to build trust and to address some of the hesitancy coming out of very, you know, real fears and a sense of historic distrust in certain communities.
HEFFNER: And was there any discussion as it relates to this pandemic? You know, I related it to 9/11 or Pearl Harbor, but, you know, did these doctors think about it in the sense at all about sort of a once in a lifetime battle?
GOLDBERG: Yeah, I think that particularly young doctors who started their careers on the front lines have a sense that this is a pretty, a pretty unprecedented or once in a generation type crisis. And I think they’re grateful to have been able to play an important role in serving their communities. I think that they realize that what they did was incredibly courageous and just a remarkable decision to place their own bodies on the line to help their community and to help their city in their patients. And I think that there’s a sense of pride and gratitude in all of that.
HEFFNER: You probably think I’m just so pessimistic or negative, but I just, on the flip side of this, just in addition to the patriotism and feeling proud of what they accomplished, I mean, some of them might be concerned about not just the potential for another pandemic, but, you know, really getting out of this pandemic. Like if people talk about a sense of normalcy, or whether we’re there yet with half of the country vaccinated, we’re obviously not there yet, but were there any, any specific insights you wanted to share about kind of the post-COVID, the post-COVID outlook or when these doctors want to feel as though we are beyond COVID, because people have different opinions, both medically and scientifically on when we will not be in a pandemic anymore. And as far as we can tell, you know, internationally, we most certainly are going to be in this thing for years and in the U.S., did they have a sense of kind of when, if, and when there’s a closing chapter, more that we’re like we’re living with sort of pandemic conditions for a while, as long as something like COVID-19 is still in the air?
GOLDBERG: You know, I think it’s changing day by day as more scientific information comes out. And I think there’s just a desire to look to the experts and let them guide, you know, epidemiologists in conversation with physicians and policymakers and let them guide when is the appropriate time to start lifting various restrictions, particularly as the pandemic continues to rage in most parts of the world.
HEFFNER: Emma, I want to thank you for being so positive reading you, you know, over these months and in some heart, gut-wrenching material, you know, it’s, but that doesn’t mean we can’t be positive and admire the courage. And I really appreciate that you’ve stayed so positive amid covering all of this. And of course, the doctors who you chronicle. Emma Goldberg, author of the new book “Life on the Line: Young Doctors Come of Age in a Pandemic.” Thank you for your story and for your insights today.
GOLDBERG: Thank you so much for having me.
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