In this episode of the Purpose in Practice podcast, ACU’s Jennifer Dix continues with the second half of a conversation with Dr. Adrian Billings of Texas Tech University Health Sciences Center and Dr. Kyle McDaniel of UNC Chapel Hill. Listen as we chat about the role of mentorship in the healthcare workforce, advice and lessons learned from both mentors and mentees, and the four A’s.

Full Transcript

Jennifer Dix: Welcome to part two of our conversation with Dr. Kyle McDaniel and Dr. Adrian Billings. If you haven’t listened to part one, be sure and check that out. We had a great conversation about the mentor mentee relationship and caring for patients in rural populations. In part two, we talk about the role of mentorship in the healthcare workforce, burnout, lessons learned, and the four A’s. Thanks for joining us.

Dix: I wonder if we could talk a little bit about the healthcare workforce and the role of mentorship in supporting the healthcare workforce or growing it.

Dr. Kyle McDaniel: Yeah, I think mentorship is absolutely vital to see people doing what you see for yourself in the future. Right now, in this moment and succeeding and thriving and being active community members, it does a lot to someone’s future prospects. And not only that, but also providing the assistance because typically your mentor is someone who’s gone down either a very similar path or oftentimes very close to exactly the same path. And so whenever you have someone like that who’s able to provide you guidance, who’s ever to provide resources, all of those things are so important because when we have a healthcare workforce that is not supported in that way, that’s when we lose people due to burnout, due to not seeing themselves reflected in the healthcare system . . .

Dix: Thank you, Dr. McDaniel. . . . and burnout are certainly very important issues when it comes to the workforce. Dr. Billings. I was curious to see if you had any thoughts that you wanted to add to that and what your take was?

Dr. Adrian Billings: I do want to speak to burnout, and I want to say something that perhaps is counterintuitive. First, I don’t think I’ve ever been burnt out. I hope that my colleagues and my family would agree that I don’t think I’ve ever arrived at burnout and counterintuitively what has kept me, I think, from feeling burnt out, has been having this added responsibility, but I would phrase it as a benefit of hosting trainees of mentoring. That has been one of my strategies to try and avoid burnout for all of those reasons that I said that I said previously is I learn from these trainees. I get inspired by them. I become more enthusiastic by hosting trainees. And I’ve probably hosted around 500 trainees in my 17 years of practicing now, and I cannot think of one that was not interested in what we were doing, that I felt like I had to drag them by the hand kicking and screaming and hollering into an exam room or into a labor and delivery room. They were all genuinely interested, and that really invigorated me more.

Dix: Dr. Billings, I’m wondering what your thoughts are as far as what draws medical students to a practice in rural healthcare. Are there things that you’ve noticed that make you think, oh, yes, that person is definitely going to work in a rural area versus an urban one?

Billings: The two biggest predictors of a future rural practice are, number one, somebody who’s from a rural community or has had some sort of significant rural life experience in a rural community. Maybe it’s going summers to their grandparents’ farm or ranch, but the second biggest predictor is having a rural healthcare training experience while you’re in school and or in residency for physicians. And so that is so important that wearing my academic hat now, is that we really need to enable, and in my biased view, we need to make mandatory rural healthcare experiences for our trainees so that they have an idea at least once during their training of what it’s like to practice and experience rural medicine. For those listeners who are listening to try and get you to think about rural healthcare rotations and or future rural practice is, I think there’s really an intimacy about rural healthcare that is a little bit easier enabled because you are, as a clinician, healthcare clinician in a rural community, you’re kind of a big fish in a small pond.

Billings: People know you. It really opens up some additional privilege for you, some incredible benefits to you. But I think also perhaps those of us who are really committed to rural healthcare and remain and feel called into rural healthcare, there’s some significant responsibility that comes with wearing that white coat, having that title of doctor that we really want to contribute and serve our communities. So again, just a shout out to think about rural healthcare rotations and future rural practice. To anyone listening, I would do my career all over again. I would choose family medicine. I’d go back to medical school. I’d choose family medicine. I would choose rural family medicine. I would choose working within a federally qualified health center. I would choose the National Health Service Corps. I wouldn’t change a thing about what I’ve done, and I don’t know that we tell our trainees that enough that we would love what we do and we would do it all over again. That has truly been my story that I can say I would repeat everything if I had to because it’s just been so rewarding of a career for me, and I hope I have 20 to 30 plus more years to go. But that’s saying that from somebody who’s at a mid-career stage.

Dix: A lot of folks can’t say that they have no regrets and they wouldn’t go back and change anything. So I think that’s really valuable and blessing that you feel that way. So that’s great. I guess I want to turn now to asking you if you have either one of you, any advice or lessons learned for both mentees or mentors?

McDaniel: Well, like I said, I would encourage mentees to first reflect on what they’re looking for in the relationship. And when I reflected on what I wanted from that relationship, I wanted someone who would empower me. I wanted someone who would invest in me and who would expose me to different ideas and different ways of thinking. And I have been incredibly blessed to have gotten all of those things and so much more through Dr. Billings and also in terms of thinking about things in a different perspective. When I was crafting my schedule for my fourth year of medical school, we have the opportunity to go and do visiting rotations at other institutions. And Dr. Billings had mentioned the idea of going and rotating at an Indian Health service site, which is something that I had never thought of, but I ultimately applied and had that experience last year, and it was an incredible experience, and it’s not something that I think I would’ve gotten to do had I not developed this relationship with Dr. Billings and had I not gotten his input. So for mentees, constantly be looking for input from your mentors in terms of things that they liked or I think in this instance, Dr. Billings hadn’t actually done an Indian Health Service rotation, but told me I would’ve loved to have done one of these. So I tried to let him vicariously live through me with that experience, which was an incredible one. So just constantly be looking out for new things and new prospects because that’s ultimately where you’re going to get the best and the most rewarding experience.
Billings: And I think my word of wisdom, if I ever am able to say anything that has any wisdom or philosophy to it is we all need mentoring. Whether you’re at the stage of a trainee or whether you’re mid-career as I am or you’re senior in your career, we all still need mentoring. But I think the other thing to be said is that as a trainee, you can be a mentor. Certainly that’s what I’ve tried to express in our talk today is that even though this is a mentor mentee relationship, it’s really a bi-directional mentoring relationship. So you as a trainee, Kyle, you have been my mentor as much as you have identified me as your mentor, you have also served as a mentor role for me, and there certainly are high school students that look up to you as a medical student wearing a white coat.

Billings: And I know that you recognize this because you have been present in the rural high schools mentoring these rural high school and middle school students. And so at any stage, not only do we need mentoring, but we can also be mentors. No matter where we are in life, there’s always somebody who’s looking up to us that we can give guidance to, that we can enable to have perhaps to find their path and find their mission and find their calling. So in mentoring, I have many mentors who I’ve never met in person. They have been virtual mentors to me. And whether it be via email only or through telephone calls or through zooms, mentoring doesn’t have to be face-to-face. I encourage trainees and junior faculty, if there’s somebody whose work you admire, reach out to them. More often than not, they’re going to take the time to respond to you. And one of my virtual mentors who I call a virtual mentor was Dr. Paul Farmer. I never had the privilege to meet him in person before his passing, but I admired his work from afar. I read the story of Partners in Health. I read his story of Mountains Beyond Mountains, and I never had the luxury to meet him, but I considered him a virtual mentor even though he and I never had any sort of dialogue. That’s another extreme example of mentoring as well.

McDaniel: And just to double back on what Dr. Billings said about mentees, not exclusively inhabiting that role, but also being mentors. That’s how we create this force multiplier within the healthcare system so that we have people across the entire spectrum serving as mentors to those who are coming up and who are rising. That’s ultimately how we propagate and how we fuel this healthcare system that will enable us to better serve rural and underserved. The minute we stop and we think that we don’t need to mentor people, that’s the minute that we lose valuable assets in people in this profession. So always be looking for opportunities to provide whatever insight you have to other individuals so that they can benefit from that, and you may learn something along the way as well.

Dix: I think that’s great insights and advice from both of you. So thanks for sharing that.

Billings: Kyle will recognize the story of the three A’s, which has now become the forays because of an astute medical student. Last year when I was a high school student, I was exposed to rabies. I performed a necropsy on an animal, one of my lambs that had passed away, and I was working for veterinarians at the time, and I had assisted him on necropsies. So when I found this animal dead on a Saturday, I performed my own necropsy and I took out my scalpel, my pocket knife, no gloves, rolled up my shirt sleeves, and I made an incision from the neck to the pelvis of this dead lamb. And in a matter of five minutes, I had no idea what this animal had died from. But the county extension agent found out about my necropsy and said, we should probably send the brain of this lamb to the Texas A&M veterinary diagnostic laboratory to make sure the animal did not die of rabies.

Billings: And I did not know the term differential diagnosis at the time, but I was not thinking of rabies when I was performing this non-sterile necropsy. And I’ll never forget the telephone call the next Saturday in the afternoon when the county extension agent called me to tell me that the animal did test positive for rabies. And he suggested that I needed to seek medical care immediately. And I hung up the phone and none of my family is in healthcare. And my parents and I, we really thought I was about to die of rabies. We knew that rabies was bad, and we really all feared that I was about to contract rabies and die. And so I went to the telephone book and I looked up my family doctor Ramon Garcia, and I found his office number in bold, but bolded beneath that was his residence phone number.

Billings: So this was a Saturday afternoon. He was about the age that I am now in his young fifties, and he had two children at home, and I know what he was trying to do on a Saturday afternoon. He was, or Saturday morning, he was trying to just have some quiet family time. And so I didn’t think anything about calling him. I called. He answered the phone. I told him who he knew who I was. I told him very excitedly what had happened and that I feared I was about to die. And in a matter of five minutes, he reassured me that I was going to be okay. And he exhibited the three A’s, or maybe the four A’s at my time of need on a Saturday morning when I really thought I was about to die. He was available to me by printing his home telephone number in the phone book.

Billings: He was accessible to me by answering the telephone. And he was affable at the end of that five minute conversation. He didn’t seem upset. It was just a service that he did. And then the fourth A that a medical student made me think about is he was affordable. He didn’t charge me anything for that. It was just a service that he did. So to honor Dr. Garcia, I’ve also done that for my communities. My home telephone number has been listed in the Alpine phone book for the past 17 years, and it has not been a burden for me or my family. I’ve received zero telephone calls after 10:00 PM which is kind of my pumpkin hour when I go to sleep, usually if I’m not delivering a baby. So again, just an idea to think about being available, accessible, affable, and affordable to our patients both during office hours and probably more importantly after office hours. And I think the most important A of that is that affability being kind and serving to our communities where we live.

Billings: I will use the words of, again, my virtual mentor, Dr. Paul Farmer, and our most significant professional accomplishments in life are done as a team in partnership. And Kyle, I want to thank you for being part of my team and allowing me to be part of your team and for your partnership in this mentoring mentee relationship. Kyle is really a brother from a younger mother for me and Kyle, I love you. I appreciate you, and I’m so proud of you. I look forward to your future successes of what you do, and I look forward to continuing to learn from you throughout your career and the remainder of my career. So thank you.

McDaniel: Well, I love you too, Dr. Billings. I think my life changed whenever I went down to Alpine, and that’s all because you were willing to open not just your exam room doors, but your community, your heart, to accept a student from urban Houston who had no rural experience and impressed upon me all the important things in medicine that have nothing to do with medications, but have everything to do with how we open our hearts to our patients and to our trainees. So thank you for that. And to all the trainees out there and the mentors, really anyone who’s going through the process, look for those experiences that will bring the most impact that will resonate with you throughout your career, and that will ultimately bring you joy. Find those experiences and those people who will enable you to a experience joy and share joy with other people.

Billings: Kyle, I told myself I wasn’t going to cry during this before. I darn it, you made me shed some tears of joy. So thank you for bringing out that emotion. And Jennifer, thank you for what you’ve done to enable this, and I’ve truly enjoyed this, and I hope that this is meaningful for those who may be listening. So thank you again.

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