The Future of Healthcare: “We need to make the prevention of professional burnout a top priority at the systems level” with Shoshana Ungerleider
Bring joy back to the medical profession: Make the prevention of professional burnout a top priority at the systems level, including MDs, nurses and social workers. The wellbeing of our clinical staff directly translates into better health outcomes for patients and families.
As a part of my interview series with leaders in healthcare, I had the pleasure to interview…Shoshana Ungerleider is a physician, founder, philanthropist and speaker who currently is on the internal medicine teaching faculty at Sutter Health CPMC in San Francisco where she also serves on the Executive Board of the Foundation Board of Trustees. The Ungerleider Fund has initiated a comprehensive education program to enhance medical training in palliative care, physician communication and wellness for healthcare providers at Sutter Health’s California Pacific Medical Center. She executive produced Netflix’s End Game, an Academy Award-nominated short documentary. Shoshana was recently highlighted in PBS’ Moment When, named to San Francisco Business Times’ 2018 40 Under 40 class as well as named Woman of the Year by Women Healthcare Executives of Northern California, the short documentary she executive produced, called End Game, was nominated for an Academy Award.
Thank you so much for doing this with us! Can you tell us a story about what brought you to this specific career path?
At age 88, my patient was suffering from end-stage kidney failure. I, fresh out of medical school and ready for action, was on call in the intensive care unit the night his heart stopped beating. My team began doing everything possible to keep him alive. While a code blue alarm wailed in the background, we punctured his paper-thin skin again and again, inserting intravenous lines into his blood vessels, and placing a sturdy breathing tube into his windpipe. I stepped in to do CPR, which is a series of powerful, repeated chest compressions. With that first compression I could hear and feel his ribs snapping. It was horrifying. But I was trained to expect it and to keep going, which I and the rest of the team did. Despite our best efforts, nothing worked.
From a medical perspective, we had done “everything possible” for this ailing man, but he still died — in pain and in a room full of strangers. I quickly learned that our healthcare system is set-up to have a single, default pathway for all medical care: aggressive, invasive treatment, no matter how old you are or how sick you are. The way we treat dying in America today is a public health crisis. Since then, I have committed to ensure people and their families have a say in the care they receive in the moments when it matters most. Here is a quick video to see more: https://youtu.be/ebz4uD9bUUY
Can you share the most interesting story that happened to you since you began leading your company?
Hands down getting the opportunity to partner with Netflix twice on films about the end of life experience. And, having both films nominated for Academy Awards. The first one, Extremis, premiered at Tribeca Film Festival in April 2016 and won Best Documentary Short. It was also nominated for a 2017 Academy Award and two Emmy Awards. The second film I executive produced is a documentary called End Game that premiered in 2018 at Sundance Film Festival and was nominated for a 2019 Academy Award by veteran directors Rob Epstein and Jeffrey Friedman. I have always been interested in finding new ways to empower the public with education about the illness and the end of life so they can make the best decisions for themselves (and their families) in moments when it matters most. Film has proven to be a wonderful way to shine a light in these hidden places and tell these hard stories.
Can you tell our readers a bit about why you are an authority in the healthcare field?
I come at this work from my personal experience as a clinician. Early on in my medical training, I recognized that far too many people receive care at the end of life that they don’t understand and they don’t want. It is also very often not in line with their personal goals and values. I have become an advocate for changing this through writing, public health education, speaking, filmmaking and philanthropy. Three years ago, I founded End Well, an annual interdisciplinary symposium that brings together tech, policy, media, healthcare, patients, artists and design with the goal of transforming the end. My goal is to amplify a cultural shift we need to support new collaborations, systems, protocols and products so that everyone has access to ending well.
What makes your company stand out? Can you share a story?
I had a major a-ha moment at a design conference when I realized that what I was after was fundamentally a conversation about living not dying. I’ve learned from the design community that remaining curious while asking — who, what, why and how — are crucial to problem solving.
I’ve also learned that with health care in general, and end of life in particular, most people are heads down working as hard as they can AND the work is largely siloed. Improving the end of life experience is a challenge that we simply can’t tackle from inside health care. Nor, should we. Ending well is a human issue, not a medical one. I founded End Well as the first cross-disciplinary platform for problem solving to transform perception, policy and care around how our political, social, familial and personal structures can best be advanced to support a person’s goals and values at the end of their life. Our annual convening, End Well, draws sold out crowds, celebrity speakers and cutting edge scientists, designers, entrepreneurs and investors. By inviting new voices to the conversation, we have been able to tap into a growing social movement that envisions the end of life experience be more human-centered for everyone.
Can you share with our readers about the innovations that you are bringing to and/or see in the healthcare industry? How do you envision that this might disrupt the status quo? Which “pain point” is this trying to address?
In my role as founder of End Well, a non-profit media platform and annual convening, I have the privilege of connecting with incredible entrepreneurs, payors and VCs regularly who are innovating in the aging and end of life space. Anyone interested in a venture in this space should sign up to learn more here.
The biggest pain point continues to be payment models. Few have been able to find a way to pay for upstream, high-quality care along with other services and products for the seriously ill that allows people to have the care they want in the place they want it.
What are your “5 Things I Wish Someone Told Me Before I Started” and why. (Please share a story or example for each.)
Listen first: Within the first 60 seconds of meeting a new patient, I can often learn more by simply listening than by talking. For patients to be engaged in their own health, they must understand their diagnosis, treatment and potential outcomes. This starts with listening and learning about them first.
Be open to opportunities: I never imagined I’d end up running a foundation, executive producing films, speaking across the country and starting international conferences. The opportunity to be part of the films was unexpected and it’s because I remain open and curious about how new opportunities play into advocating the work I’m doing.
You don’t have to be an expert in everything: As a doctor, I am very highly trained in medicine. When I moved into founding a non-profit (I operate End Well as a start-up), it was scary. My daily tasks were things I had never done before and hadn’t been trained to do. I learned that it’s ok to learn as you go, fail fast, learn from it and move on!
Meet people where they are: Not everyone is interested in thinking about their own mortality, and that’s ok. Sometimes, you have to get creative when addressing difficult, but important topics like end of life. I shared more in a recent article on the importance of preparing for the end of life as part of living a holistic lifestyle.
Focus, focus, focus: One of the things that my husband (the CEO of a tech company) has instilled in me is being very goal-oriented. I’m hyper-focused around palliative care, hospice, end-of-life — that is all that I do. My mission is to have conversations about mortality be so commonplace that I don’t need to do this work anymore, that palliative care can go away as a field because all medicine practiced is good medicine. That is my end goal and with everything I do — I ask myself: is this getting me closer to my goal?
Let’s jump to the main focus of our interview. According to this study cited by Newsweek, the US healthcare system is ranked as the worst among high income nations. This seems shocking. Can you share with us 3–5 reasons why you think the US is ranked so poorly?
We are a “sick-care” system. We wait until someone gets ill to become involved in their lives because of this, the per capita cost of healthcare in the US is extremely high. We also aren’t incentivized to improve the health of the entire population by focus on prevention of illness and we are only just now recognizing the importance of improving the patient (and family) experience of care.
You are a “healthcare insider”. If you had the power to make a change, can you share 5 changes that need to be made to improve the overall US healthcare system? Please share a story or example for each.
1). Prevention of illness is vital: If we can shift our focus to provide high-quality community-based primary care as a public service, this would be a game-changer
2). Interoperability of the EHR: There is an extraordinary amount of waste in the system that occurs due to redundant testing. A single, central electronic health record built for patient care (not billing) would markedly reduce this
3). Expand telehealth options: This is a safe, cost-effective means to expand capacity within health systems that have specialty shortages and geographic disparities which deserves more paths to insurance reimbursement
4). Move out of fee for service medicine — we are slowly moving toward a model that incentivizes volume to one that rewards value. This is key!
5). Bring joy back to the medical profession: Make the prevention of professional burnout a top priority at the systems level, including MDs, nurses and social workers. The wellbeing of our clinical staff directly translates into better health outcomes for patients and families.
Thank you! It’s great to suggest changes, but what specific steps would need to be taken to implement your ideas? What can individuals, corporations, communities and leaders do to help?
It starts with all of us. It’s about making high quality, affordable healthcare a part of the conversation in your home, your company and your community. We must all demand that our legislators focus on healthcare as a key issue. Don’t forget, we have the power to make a change with our vote!
What are your favorite books, podcasts, or resources that inspire you to be a better healthcare leader? Can you explain why you like them?
My favorites are the ones that include a mixture of evidence and personal narrative. The Nocturnists Podcast (a podcast of healthcare professionals sharing person stories); I just read Sunita Puri’s That Good Night: Life and Medicine in the Eleventh Hour which is a phenomenal book about medical education, palliative care and the importance of language in our culture when we talk about illness and death. ZDoggMD is wonderful and always makes me laugh. I also love (and am continually inspired by) our End Well resource page. As an advocate on various topics impacting physicians and our patients, I have been featured in Forbes, CBS News, PBS and Vox, read more here.
How can our readers follow you on social media?
Thank you so much for these insights! This was so inspiring!