The Yale School of Medicine community gathered at Harkness Auditorium on September 9 to listen to Vice Admiral Vivek H. Murthy, MD ’03, MBA ’03, United States Surgeon General, Department of Health and Human Services, speak at the 24th Annual Samuel O. Thier Lecture in Health Care Policy.
The Medical Grand Rounds session, “A Conversation with the Surgeon General of the United States,” was hosted by Gary V. Désir, MD, chair of the department of internal medicine, and was moderated by Marcella Nunez-Smith, MD, MHS, associate dean for health equity research, C.N.H. Long Professor of Internal Medicine (General Medicine), and professor of epidemiology (chronic disease) and of public health (social and behavioral sciences). Murthy and Nunez-Smith, long-time colleagues going back to their medical residencies, chatted about Murthy’s journey to medicine, health care worker burnout, and his thoughts on the future of the medical field.
“[Murthy’s] work has provided clear, consistent, and equitable guidance and resources for the public,” said Nancy J. Brown, MD, Jean and David W. Wallace Dean of the Yale School of Medicine and C.N.H. Long Professor of Internal Medicine. “His work has focused on major public issues, including the proliferation of health misinformation as a real problem in the last couple of years, the ongoing youth mental health crisis, and well-being burnout in health care workers.”
“It was a great privilege to work with Dr. Murthy during the transition and first year of the [Biden] Administration on the federal response to COVID-19 and on advancing health equity broadly,” says Nunez-Smith. “I am so grateful he was able to join us in conversation to highlight the critical work of the Office of the Surgeon General and to bring an inspiring perspective to the next generation of health care workers and leaders. He is a national treasure.”
A Non-Linear Journey to Medicine
Murthy’s inspiration to become a doctor stemmed from his parents, who ran a medical clinic in Miami. But his path was not linear. While an undergraduate at Harvard University, he pursued his interests in history, economics, and literature, but was eventually drawn back to the world of health when studying HIV and feeling the same sense of inspiration he felt as a child watching his parents in the clinic.
Murthy would go on to obtain his MD at Yale School of Medicine. However, by the end of his residency in internal medicine at Brigham and Women’s Hospital, he realized that he didn’t know what he wanted to do. He decided to take a part time job as a hospitalist while he tried to figure it out his next steps. He kept a yellow pad of paper with him for keeping track of his ideas—many of which ended up in a trash can. He says it was “a challenging, confusing, and lonely time.”
“I was really lost. Everyone else had it figured out—they were going to apply for this fellowship, or this primary care job,” he said. “I was one of those people who hadn’t.”
Finally, in 2007, he felt his passion reignite. As presidential candidates began gearing up for the following year’s election, both sides were actively having conversations about health care. Although he lacked a background in health policy, he saw firsthand as a doctor the burnout and cynicism many of his colleagues felt toward the health care system. He grew interested in becoming part of the ongoing conversations and working to make things better for health workers.
Upon reflection on his journey, Murthy imparted several pieces of advice. First, he said, was to take risks—we often tend to miscalculate risk as bigger than it is. His second piece of advice was to think short-term rather than long-term. While it may seem wise to have a five- or ten-year strategy, he explained, most successful people end up straying away from their initial plans. And last, he advised audience members to hold onto their anchors.
“None of us can navigate these paths alone,” he said. “We all have moments of uncertainty and doubt. And it’s in those moments that we need other people who can be mirrors for us and remind us of who we really are and what our values are.”
Addressing Health Care Worker Burnout
In May, Murthy issued a Surgeon General Advisory calling attention to health care worker burnout. He hoped to lay out a pathway through which his team could tackle this issue and help the public understand the gravity of the crisis. “We got here through a series of policies, institutional practices, and cultural elements that have all contributed to where we are,” he said. “But we all do have a part here [in addressing burnout].”
Murthy hopes to alleviate some of the burden through working to change the culture of medicine in a way that redefines strength. Traditionally, many health care workers have felt pressure to hide their struggles and feelings of uncertainty. He foresees the world of medicine shifting to a culture of compassion, in which institutions value how providers care for patients and their families over how many hours they can work.
“Our promotion systems are based primarily on publications and grants, and far less so on compassion, kindness, and care at the bedside,” he said. “That is not a culture that supports the well-being of clinicians, and it certainly doesn’t help patients. So we have to take a hard look at the culture within our training programs and health systems and make sure it reflects the kind of culture what will suit our clinicians and the work that they do.”
Reflections on the Future of Medicine
It is not an easy time to be a clinician. As crisis after crisis infiltrates media headlines, it may be easy to feel discouraged. But the people Murthy works with keep him hopeful about the future of medicine. “The reason I feel optimistic is that our true nature is not to be fighting with each other,” he said. “All across America, I see people who are waking up each day asking to be a part of making things better.”
He felt especially inspired by the many medical school students who stepped up at the onset of the COVID-19 pandemic eager to come up with solutions. It’s this leadership and commitment to making a difference that the United States needs, he said, to tackle the issues it faces, including climate change, poverty, and racial inequality. He hopes to see more health care workers at the forefront of conversations about these pressing societal problems, raising their voices with “strength, confidence, clarity, and compassion.”
“Whether or not the world changes in the future for the better is dependent on how brightly your light shines,” he said. “And that depends on how much we help one another.”