Palliative Care Doctor Found Her Voice As Well-being Expert
Dec. 14, 2023, David Mitchell — Family physicians Michelle Owens, D.O., FAAFP, FAAHPM, and Paraag Kumar, M.D., celebrated the birth of their second child in the winter of 2020 and the future looked pretty bright. Kumar was practicing in an urgent care facility and Owens was just a few weeks away from completing her maternity leave and returning to her role as a hospice physician.
“We all know what happened in March of 2020,” she said. “Our worlds were turned upside down. It was a scary time. I had two kids under 2, and I returned to work trying to figure out that elusive balance between having young kids at home and navigating a pandemic while caring for people who were dying.”
In the midst of the chaos, the couple got a flyer in the mail from the AAFP about the Leading Physician Well-being program. This 10-month certificate program is designed to equip family physicians with the knowledge, experience and leadership skills necessary for leading change to improve physician well-being in their practices and organizations.
Kumar encouraged his wife to apply and she was one of 120 family physicians accepted in the first cohort in the fall of 2020.
“I didn’t know how much that was going to ultimately affect my career trajectory, my personal life or my family life, but that program was life-changing,” said Owens, who will serve as core faculty for the program’s fourth cohort in 2024.
Owens, a 2015 residency graduate, said education in self-care was lacking when she was in medical school and residency. Although burnout and well-being had become frequent journal and conference topics before 2020, the toll that COVID-19 had on physicians and other health care professionals made it clear that more needed to be done.
Two Opportunities to Address Self-care
Two free Physician Health First webinars scheduled for early next year are designed to help family physicians address both their mental and physical well-being.
A mental health webinar at noon CT on Jan. 26 will discuss how trauma affects the human brain and its resulting maladaptive behaviors, how to apply self-compassion as a well-being practice to cope with difficult experiences and how to integrate appreciative inquiry as a self-reflection tool.
A physical health webinar at noon CT on Feb. 23 will discuss an anti-inflammatory dietary eating pattern and its potential health benefits, how to apply mindful eating as a self-regulation tool, and integrating regular movement practices to combat stress and optimize sleep.
The speakers for both events have participated in the AAFP’s Leading Physician Well-being program: Michelle Owens, D.O., FAAFP, FAAHPM, is the director of specialty care for Central Health in Austin, Texas. Hani Chaabo, M.D., FAAFP, ABOIM, is medical director of well-being at Ridgecrest Regional Hospital in Ridgecrest, Calif., and runs the hospital’s Stress Reduction Clinic.
“All of a sudden, there were these family physicians who were further along in their career and well respected who were saying, ‘We need to take care of ourselves now more than ever. Otherwise we cannot be sustainable, and we can’t take care of patients,’” Owens said. “It was really powerful to hear that message from experienced physicians who could really speak to this issue.”
Owens said the scholars in the first LPW cohort shared their stories with each other and realized that although their practice settings varied, their experiences were similar.
“It was a cathartic experience to feel validated and that you weren’t alone in what was going on and then be empowered with tools and evidence to be able to go and advocate within your system for yourself and what you needed,” she said. “It was the program I never knew I needed.”
Owens started writing about physician well-being for her county medical society and later had a blog posted on KevinMD. Along the way, she became a frequent speaker at state and national events, including the AAFP’s Family Medicine Experience and the Physician Health and Well-being Conference.
“I found a voice I didn’t know I had in this space,” said Owens, who will be a featured speaker at two free Physician Health First webinars early next year. (See sidebar.)
“I think, most importantly, physicians need to know that we’re not alone,” she said. “We’ve all experienced the pandemic. We’re living in unprecedented times and have been asked to do things in untenable situations. Reaching out for help and looking for connections is paramount. It’s about giving grace and being compassionate with yourself and your peers, and seeking help to process what we’ve been through.”
Addressing physician and staff well-being is just one of Owens’ roles as director of specialty care for Central Health in Austin, Texas.
Central Health is the local county hospital district that provides health care for those living 200% below the federal poverty line. In 2022, Central Health provided access to medical care to more than 150,000 residents with low income. Central Health used funds, primarily from county property taxes, to contract with federally qualified health centers and other specialty providers. It entered into direct patient care in 2022 and expanded access to respite services, post-acute care and specialty care.
Owens has helped Central Health build its multispecialty clinic footprint to expand access to specialty care from the ground up. Her role spans from hiring physicians and nonphysician clinicians across multiple specialties to collaborating closely with key clinic stakeholders to implement an innovative team-based care delivery model that provides wrap-around services for the community.
“It’s been exciting to come in with the holistic, comprehensive approach to medicine that family physicians have,” said Owens, who had previous experience as an associate medical director and hospital section chief for hospice and palliative care services. “We also will integrate palliative care within the clinics. Many of these patients have had limited access to medical care, let alone outpatient palliative care.”
Central Health already opened a multispecialty clinic earlier this year that gave patients expanded access to gastroenterology, pulmonology and podiatry services. A second clinic will open in early 2024 that will offer expanded services for cardiology, nephrology, neurology, infectious disease, medical optimization and palliative care with embedded pharmacy, behavioral health and dietician access.
Owens has been focused on administrative duties since joining Central Health in August, but she will devote 40% of her time to practicing palliative care when the second clinic opens.
Owens didn’t start her career in family medicine. As a third-year medical student at Kansas City University of Medicine & Biosciences, her favorite clinical rotations were family medicine and general surgery. She pursued the latter and matched at a residency in New York.
“When I was a surgery intern, the feedback I got was that I was getting to know my patients too well,” she said.
One patient in particular made Owens reconsider her options halfway through that intern year.
Owens placed a chest tube in a nursing home patient who had developed a hemothorax as a complication of cardiopulmonary resuscitation. That procedure necessitated talking with the patient’s elderly mother.
Owens was asked to see the patient a week later for another surgical procedure, and the conversation with his mother was somber.
“That was my first conversation of delivering difficult news and helping a loved one understand the options for the person they were being the voice for,” she said.
Owens decided surgery was not right for her, reentered the Match and continued her training at the family medicine residency at the University of Texas at Austin Dell Medical School.
During her interview, an attending asked why she was leaving surgery. She told the story of her dying patient and his mother and said those encounters made her realize she missed the continuity she had witnessed during her family medicine clerkship.
The attending then asked if she had considered hospice and palliative medicine. Owens had not, but she later took an elective with the local hospice where she made home visits and spent time in their inpatient hospice unit.
“I heard what those conversations entailed and saw the ways we can meet people who are living with a terminal illness with grace and compassion,” she said. “It was something I was drawn to throughout residency. I leaned into the more difficult conversations and volunteered to take the really sick patients we thought we’d have to have those conversations with.”
Owens completed a fellowship in 2016, and has been focused on hospice and palliative medicine since then. She is an affiliate faculty and fellowship attending for hospice and palliative medicine at the Dell Medical School, and she is a Balint Group facilitator for hospice and palliative medicine fellows.
“Through the AAFP LPW program, I reconnected with Balint Groups, which are utilized in a lot of family medicine residencies,” said Owens, who completed a Balint Group Leader Education Fellowship in 2022. “It’s been a great experience and an opportunity to help to walk these younger physicians through how to navigate the hard things that we see and bear witness to. It’s been a really life-giving space that I don’t think I would have ever gone into if it wasn’t for LPW.”