The Neurologist Is In, Episode 11, Part 3: Advocacy, Engagement, and Work-Life Integration With Dr Mark J. Milstein

In this episode, Rachel Marie E. Salas, MD, MEd, wraps up her conversation with Mark J. Milstein, MD, FAAN, with details on his advocacy work through the American Medical Association and the American Academy of Neurology, and how neurologists can pursue work-life integration.

Listen to Part 1: The Role of a Neurohospitalist here, and Part 2: How to Pursue an Educator Role here.

Can't get enough of The Neurologist Is In? Make sure you're caught up on all the episodes--find the full catalogue here.

Rachel Marie E. Salas, MD, Med, FAAN, FANA, is a professor in the Department of Neurology at Johns Hopkins Medicine with a joint appointment in the School of Nursing. She is board certified in Sleep Medicine and Neurology. Dr Salas is the Director of Ambulatory Sleep Services at the Johns Hopkins Center for Sleep and Wellness. Dr Salas has been the Director of the Neurology Clerkship for over a decade. She is the Chair of the Undergraduate Education Subcommittee for the American Academy of Neurology and is an appointed member of the Alliance for Clinical Education. She is the director of the Interprofessional Education and Collaborative Practice for the School of Medicine and a Co-Director for Interprofessional Teaming for the High Value Practice Academic Alliance. Dr Salas is also the founder and Co-Director of the Johns Hopkins Osler Apprenticeship Program (in Neurology), a medical education research program for senior medical students and the Johns Hopkins PreDoc Program, a pipeline premedical college program. Dr Salas is a certified strengths coach and uses a strength-based approach and coaching to connect to, support, and develop those involved with her educational mission and clinical practice. Dr Salas is a 2019-21 Josiah Macy Scholar, a 2019-20 AMA Health Systems Science Scholar and a 2021 AΩA Leadership Fellow.

Mark J. Milstein, MD, FAAN, is Director of the Adult Neurology Residency Training Program at Montefiore and Associate Professor of Neurology and Medicine at Albert Einstein College of Medicine. His clinical work focuses primarily on neurohospitalist and neuromuscular medicine / electromyography (EMG), as well as general neurology.

After earning a degree in Biology at the University of Pennsylvania in 1997, Dr. Milstein attended Albert Einstein College of Medicine, where he received his Doctor of Medicine in 2001. Dr. Milstein completed five years of postgraduate training at Montefiore from 2001-2006, including his internship in medicine, residency in neurology and fellowship in clinical neurophysiology. Dr. Milstein was Chief Resident in the final year of his neurology training.

Dr. Milstein’s research focuses on medical education, inpatient neurology and neuromuscular medicine. His work has been published in a number of peer-reviewed journals, and includes original research, review articles, and books. Dr. Milstein has been an invited speaker at a number of national lectures and presentations.

At the 15th Annual Doctors Recognition Day in 2018, Dr. Milstein received the Peer to Peer Excellence in Medicine Award from the Bronx County Medical Society. He is a member of numerous professional societies, including the American Medical Association (AMA), the American Academy of Neurology (AAN) and the New York State Neurological Society. He holds leadership positions in the AAN and the New York County Medical Society (NYCMS).

Read the Transcript:

Dr Rachel Salas: Welcome back everyone, to The Neurologist Is In. I am Dr. Rachel Salas, a sleep neurologist at Johns Hopkins. And I have the pleasure of speaking with Dr. Mark Milstein today. Mark, go ahead and introduce yourself.

Dr Mark Milstein: Thanks so much, Rachel. My name is Mark Milstein. I am an associate professor of neurology and medicine at Montefiore Medical Center in the Bronx, New York. We're affiliated with Albert Einstein College of Medicine. I split my time between clinical work as a neurohospitalist and as a neuromuscular neurologist. And the other hat that I wear is as program director of our adult neurology residency program.

Dr Rachel Salas: As we transition to now talk about your leadership roles not only locally, but nationally, and your work in wellness. When you were talking about work life balance, I've gotten really interested in talking about work life integration, right? Because for me, it's hard to balance things. But if you tell me, here are the things that need to be done, you do it whenever you can. Then I can go take my son to their lacrosse practice and I can go do whatever. And I make it work. I know what needs to be done. And I think there needs to be a lot more of that flexibility in allowing people to do it however they need to, right? So let's talk about that. I know you've done some work with the American Academy of Neurology in wellness, and I definitely want to get you to comment on your role with the [American Medical Association (AMA)]. Because it's not often you see a neurologist really step outside of our field. We tend to stay in our neurology community, and I think it's interesting to find out why and how you got involved with AMA as a neurologist. And I think that's an important perspective I'd like you to share.

Dr Mark Milstein: Sure. Just commenting a little bit on what you said about getting all your responsibilities done, integrating work and life--I really actually like that phrase. And I think that is something that I have taken out of the last two years, right? There are parts of our job that are fixed and scheduled, right? You have clinical sessions, you have weekly meetings, whether administrative or educational that you know are going to happen. And you build a schedule around that, but there are lots of other pieces. Whether it's working on a research project, whether it's putting together new curriculum, whether it's engaging with medical students on career development, whether it's being involved in advocacy at the AMA. Where those things are less in the eight to five, eight to six daily schedule. They can happen during those hours, but sometimes they happen outside of those hours. I think that's been a very important lesson for me to learn, is knowing what I have to get done. And as long as it gets done in the same quality that it would've gotten done in previously, it's okay if something that I might have normally done between six and 7:00 PM, I now do between three and 4:00 PM. And it's a life activity, whether it's going to a doctor's appointment or running a couple of errands. And knowing, because I'm going to come back after that and add that hour on later, working on that project later, I think that is important. It's not flexibility that our trainees get as much, but it's something that we can talk to them about and help them realize for the future. There are fixed time responsibilities and not fixed time responsibilities, and integrating that is an important task. So I really like that phrase.

The other thing that's been important for me is engagement. Engagement is what keeps me excited. It's what keeps me active. It's what keeps me wanting to develop more. And the two organizations that have allowed me the most engagement are the American Medical Association and the American Academy of Neurology. I agree with you that as a community, neurologists like to hang out with their own. We feel like we're the only ones who understand the language we're speaking to each other. And I guess if I had come to the AMA later, I'm not sure that would've been the advocacy job that I would've been interested in because the academy has such an amazing advocacy arm and it's been fun for me to combine those two activities.

I started with the AMA when I was in medical school. And I am always very honest with people why I initially thought about doing work with the AMA. The medical students who were a couple of years in front of me said, "Hey, come join our local AMA chapter. You'll get to work on problems that are important to our patients and to medical students and residents and attending physicians. And also, the meeting's going to be in Hawaii next year." And I said, oh, okay. Well, this sounds like something I should take a better look at. Fortunately, there was a lot more to the organization than just Hawaii, because that would've lost its luster pretty quickly. The meetings are very busy. The AMA is a huge organization. It is not perhaps as representative as it was 50 years ago, but we still represent about 30% of all physicians in the country. And while that is not a majority of physicians, it still means that we are the largest advocacy group for physicians in the country. And so it's important, I think to know what the loudest voice at the table is doing. And it's a big organization with diverse members and diverse opinions and robust opportunities to make change. You go to these meetings--and I'm actually very excited. We're going back to live meetings for the first time in two years, this June. I'm excited to see my colleagues again and work on these things in person. But you get to these meetings and you realize, and I think this is a good thing, that not everybody agrees with your opinion about how patient care should be provided. About how physicians should be regulated, about how physicians should be compensated. About how residency training should occur about how medical schools should be developing new programs. And that conversation, that debate, that's where the excitement comes in. We have physicians from all over the nation. And so we represent the opinion spectrums and political spectrums that our nation represents. I joke that we're a little bit like Congress, except we actually pass things. So, that's good.

Dr Mark Milstein: The organization as a whole falls somewhere, I think in the center of the spectrum. And it's not because it's a moderate organization, but it's because it's the balance between all of the different opinions. And that's been very, both fun for me and educational and invigorating. How exciting it was for me then, when I started to get involved in the academy, to realize the academy had its own advocacy arm. Again, looking at things that are important to all physicians and our patients, but really with a neurology focus. How can we make sure that our older patients have access to care? How can we make sure that patients can have insurance cover all of these new medications and developments that we have come up with? It's great to have a new treatment, but if it costs $500,000 a year and no insurance company will cover it, then it might as well not exist to begin with, right? And so being able to combine those two organizations has really been thrilling for me. And I was lucky enough to rise into the position of being the chair of the academy's delegation to the AMA. So I'm getting to keep my advocacy hats on in both organizations and really keep that involvement, and that's been fun.

Dr Rachel Salas:

That's amazing, Mark. I'm so grateful to have you as a colleague to advocate for not only other neurologists, but our patients through the AMA, and then your leadership and your work at the American Academy of Neurology as well. So thank you for doing that. And I think that this, as we get close to the end here, circles back. And when you talked about earlier about burnout and wellness, I think the studies at this point show that if we are committing and doing meaningful work, right? We may even be working more than we were. But if you are doing things that are in line with your values and you are really passionate, which, clearly you are. That really is the biggest remedy that we all can have in terms of wellness. And so, any comments for that? But then I also want to transition into, what do you do for your own wellness?

Dr Mark Milstein: So I really like the way that you talk about that, Rachel. The first lesson we had to learn is that wellness is not just about resilience, right? Resilience is important, but it can't be the only thing in your toolbox. You need other things, and for me, engagement has been one of the biggest tools in my toolbox that I can use to keep myself happy and satisfied. Most people will tell you it is not about how hard they are working, it is about what the hard work is getting, right? If somebody works really hard and then their patient has an incredible outcome, they are generally going to feel good about that and not say, ugh. I just, I can't do that again. That was terrible. They're going to feel great about that, right? But if you spend an hour and a half waiting on hold to do a peer-to-peer for prior authorization, even if you get that prior auth at the end, which you were pretty sure you were going to get when you picked up the phone, that's not meaningful work.

I think there's a combination of things that we need to work on right now. As individuals, we need to look for the meaning in work and find out the things at work that are making us excited, and hone in on those things. And sometimes it's internally, at our own place of employment, and sometimes it's looking out to local and maybe state or national organizations to find some of that engagement. We do need to continue working, both as a field and as a profession, on the things that are challenging, meaning for all of our colleagues and peers. And so I think that that advocacy piece is important. Not everybody has to be directly involved. I will tell, certainly for all of the neurologists listening, donating to an advocacy committee is great. The American Academy of Neurology has BrainPAC. Dollars do speak volume when it comes to making change at the government level. And so I'd encourage everybody, even donating a couple of dollars a month does make a big change over the long run. And people who are more interested in being directly involved, I think there are opportunities there to be directly involved.

So I think those things are important. There are changes that need to be made, but I think if as individuals we can focus on what makes us happy at work? What keeps us engaged at work? What keeps us satisfied at work? Most people have the skills to find the balance they need to have a really rewarding and fulfilling career in neurology.

Dr Rachel Salas: Yeah, well said. And so as we end here, tell me what you do? When you're not in the office, when you're not teaching, what are you doing for fun?

Dr Mark Milstein: So I've been a city boy for a long time, and I admit that. I'm a born and raised New Yorker. I do like taking advantage of everything New York has to offer. I'm very excited as things have started to safely open back up that I can go back to checking out the many cuisines and restaurants of New York City. I freely admit that after chocolate, I don't have a favorite food. So if it's something new to try, I'm going to be excited to try it. I do like food experiences where a chef is trying something new. Of course, going to the theater as often as I can and looking for exciting opportunities there. But then taking advantage of the things that New York has to offer that don't cost a lot of money. I'm a pretty avid runner, and there are just miles and miles and miles of really exciting paths to run in New York City. In parks, around parks, on the water, through the city. We are an urban jungle, but we are also an urban playground, and taking advantage of those things has been very exciting. I moved from one side of town to the other side of town last year, and I moved my running path from one body of water to another body of water. It's my happy place. It helps me disconnect from the noise of life, and really recenter me. So I've had a lot of fun doing that.

Dr Rachel Salas: Well, there you have it. Dr. Milstein, it's been just awesome to connect with you and to learn and hear about just the work you're doing and the passion you have for your patients and your residents and the students. And I'm just, again, grateful to know you and I'm so happy that you're a neurologist and really advocating for the field and our patients. So thank you so much for taking the time out of your very busy schedule to share a little bit about your perspective.

Dr Mark Milstein: I thank you for the opportunity. This has been a lot of fun. I love talking neurology, I love talking education, so time well spent.

Dr Rachel Salas: All right. Well, thank you so much. And we'll see everyone next time.