Ask the Expert: Jina Sinskey, MD, Associate Chair of Well Being

Jina Sinskey, MD, Associate Chair of Wellbeing

“Individual approaches to well-being are not sufficient; we need a systems approach.”


Jina Sinskey, MD, grew up in Korea and attended high school on the east coast of the US before attending MIT where she earned undergraduate degrees in chemistry and biology. After two years as a management consultant, she moved on to medical school at Tufts, an anesthesia residency at UCSF and a pediatric anesthesia fellowship at Boston Children’s Hospital, before returning to UCSF to join the Department of Anesthesia and Perioperative Care. In November 2020, she was named the department’s associate chair of well being, as well as vice chair of the American Society of Anesthesiologists Committee on Physician Well-Being. This interview took place in May 2021 and has been edited for length and clarity.


What sparked your interest in physician well-being?

I had always considered myself very resilient throughout residency, until the end of my first week of fellowship, when my husband called to say I had been named in a malpractice lawsuit for an incident that occurred during residency. It shook me and I considered quitting anesthesia altogether until I attended a Grand Rounds at Boston Children's on how after a medical error or adverse event, physicians can become the “second victim.” I realized then I was not alone, that mine was a normal reaction to an adverse event and that there were three potential trajectories: quit, survive or thrive. I decided I was resilient enough to thrive and when I returned to UCSF, I was determined to teach resiliency and wellness to residents, so they would have the tools needed to process the emotional turmoil that can happen after these events. 


I began by working with Kevin Thornton (Committee Chair, Residency Well Being Committee) to develop a wellness curriculum for our Anesthesia Education Day that included didactic lectures and breakout sessions for community building. But after a while, I realized that we could only accomplish so much by focusing on residents alone, that we have to take care of faculty well being as well. Well-being efforts should encompass all members of the department. If we take care of our faculty, they are better positioned to take care of patients and trainees. Strengthening the well-being of our faculty will also enhance the well-being of our residents, since faculty and residents work closely together, and residents often model the behaviors of their attendings. What makes UCSF great are the incredible people, and well-being is about supporting our people.


How has the concept of physician well-being evolved over time?

Tait Shanafelt, a Stanford hematologist, began talking about burnout rates and physicians becoming disengaged about a decade ago, one of the first to raise awareness of the need to build resilience in physicians. Ultimately, in 2018, JAMA published a charter on physician well-being, with UCSF hospitalist Larissa Thomas, one of the lead authors. It helped people understand why it matters to commit to well-being on the individual, organizational, and societal levels. The initial focus of well-being was on building individual resilience with strategies like mindfulness, meditation and yoga. That’s important work, but over time people realized it is also the equivalent of putting a gas mask on a canary in a coal mine. The coal mine is still toxic and eventually the gas mask will fail. 


That’s when people began to think about how to fix the whole system so physicians don’t lose the meaning in their work – so physical and emotional exhaustion don’t lead to depersonalization and decreased efficacy. In October 2019, the National Academy of Medicine issued a report on clinician burnout that proposed a systems approach to addressing the problem. 


Of course, this was before COVID, which because of all of its challenges, created a sense of urgency. Physicians were asked to do so much with so little. The PPE shortages, for example, were particularly impactful for anesthesiologists with our exposure to the airways. 


COVID also raised awareness that revealing mental health concerns is not a sign of weakness – and that it can be a source of strength as well. It led to our department creating virtual support sessions for faculty. But that too is complicated, because there is still a stigma around revealing mental health vulnerabilities. There are even some licensing concerns, with different states having different requirements about disclosing mental health issues. Hopefully [New York physician] Lorna Breen’s suicide and the subsequent Lorna Breen Act, which seeks to put resources behind helping physicians admit to and deal with these issues, can bring some change.


Given the shift in focus from the individual to the system, how is the department approaching physician wellness now?

We are definitely looking at ways to drive structural and cultural change, using a design thinking framework – something that my two years as a management consultant helped prepare me for. There are a number of steps in the process: empathize, define (a problem statement), ideate, prototype and test. 


For the empathize step, Dorre Nicholau (Vice Chair of Professionalism and Well Being) organized a series of voluntary fireside chats with [Chair] Michael Gropper and either Dorre or me at Mission Bay and Parnassus. The sessions were designed in a way to ensure psychological safety. Faculty submitted questions ahead of time, which were collated into themes and presented to Michael so he could respond. Later, we sent out a summary of the sessions to the entire faculty. 


The chats led to a series of problem statements and we decided to focus on two initially: scheduling unpredictability and PACU holds, both of which can be incredibly demoralizing. To address the PACU holds, Dorre worked with Medical Center leadership to create more beds for recovery and with the cardiac cath lab to improve flow through the PACU. To help make scheduling more predictable, we created a short shift every day, meaning if it’s your day, you are the first to get relieved and, so, more likely to get out by a certain time. That improves our sense of control over our crazy schedules so we can be more responsive to things like child care or medical appointments. 


Another impact the pandemic has had is that it’s robbed us of our community. Anesthesia can be so lonely anyway. Not being able to gather in break rooms or hold in-person events has really had an impact on our sense of community. We’ve tried to address this in numerous formal and informal ways. One example is that Gerald Dubowitz and Joyce Chang started a sourdough baking group that was so successful they even received a morale grant from UCSF to support updated camera equipment, baskets for bread and other supplies. We also worked with Judith Hellman (Vice Chair of Research) to create a research project list that describes all of the department’s research to help people connect and share resources. It improves meaning and purpose when we connect with people doing similar things. 


We’re also working on empowering faculty around career development through the creation of individual development plans in concert with division chiefs and mentors. Faculty members have told us that to get the support they need, it helps to have the right conversations with the right people. We’ve already piloted this successfully in pediatric and pediatric cardiac anesthesia. 


Finally, we continue to work on individual resilience as well. For example, there is a Medical Center-wide Caring for the Caregiver initiative that provides peer support for which we’ve trained about 40 people in this department. 


How would you assess the progress you’ve made to date, both in the department and across all of health care?


There has been progress, but it’s important to recognize that change happens slowly. Cultural change, especially, takes time. For example, there is growing recognition that unkind behavior is no longer acceptable and that nothing is as contagious as a bad mood. If we can create a culture of kindness in medicine, that would help a lot.


That’s part of the thinking behind a perioperative well-being initiative that we are working on with our operating room (OR) colleagues. We work together clinically in the ORs all day long, but that environment, traditionally, has not always been a kind place. That’s why a surgeon colleague and I reached out to all departments who work in the OR - to the chairs and physician experience council members – to help us understand how to improve the OR work experience.


We are trying to build mutual respect and find connections in our common humanity – to remind each other that the person across the drape is a person too. That’s the thinking behind a universal timeout; it’s a chance for all of us to introduce ourselves and see each other as human beings, with names beyond “anesthesia” or “surgery.” After all, all of us are here for a common goal and if we work as a team, everyone benefits. That includes our patients. A positive work environment can help mitigate burnout. One study showed that if we’re more burned out, we’re less likely to do a machine check or other safety measures, which also undermines patient safety. 


But this will be a process and fixing things requires a top-down and a bottom-up approach. For the top-down approach, we’re lucky to have both department and medical center support; they recognize this is important and they’ve been public about that stance and are putting resources behind it. The bottom-up approach, from people working clinically, will be an ongoing team effort. The more people are willing to share their lived experience, the better chance that these types of human-centered design initiatives can work. 


Article written by Andrew Schwartz