This post was updated Sept. 16 at 1:38 p.m.

Dr. Joshua Khalili, an internal medicine physician for the UCLA Health Extensivist Program, sat down with Daily Bruin contributor Catherine Wang to discuss his plans after being appointed as director of physician wellness and associate chief wellness officer for the UCLA Department of Medicine.

Khalili received his medical degree from the UCLA David Geffen School of Medicine In his new position, he aims to reduce burnout among UCLA physicians by facilitating interventions such as personal coaching.

This interview has been edited for length and clarity.

Daily Bruin: How did you come to specialize in internal medicine at UCLA?

Joshua Khalili: When I was nine, my mom donated a kidney to my dad, who was suffering from renal failure from a history of hypertension and diabetes. I saw the impact that their doctor had on the whole process. I was only nine, but I think it was a formative moment in my childhood, in my interest in medicine in general.

I went to UCLA and studied psychobiology. I took a gap year after college. I did HIV and STI prevention work at a nonprofit through AmeriCorps. I’m also very interested in LGBTQ+ health and sexual health, and through my own process of coming out in college, my doctor ended up being like a mentor for me.

After residency, I did a chief year in internal medicine and the primary care track, and then I started as an attending (physician) in 2019 through the Extensivist Program. We specifically work with patients who are particularly admitted in the hospital with complex medical needs and also psychosocial barriers to health. We try to help with a multidisciplinary team to help address those barriers to help deliver coordinated medical care. My boss, Dr. Sun Yoo started the wellness committee with the onset of the pandemic. Then, she appointed me and I came on as the associate chief wellness officer, or director of physician wellness.

DB: What does it mean to be director of physician wellness and what are your responsibilities?

JK: Our role is to develop initiatives and better understand where we’re at in terms of our well-being and burnout. So it’s multifaceted in our approach in assessment of burnout and well-being, really determining what is it that contributes to the barriers and achieving wellness in every day. It’s different for everyone, and that’s what makes it challenging. The main issue is the structural barriers and systemic kind of issues in the medical system that contribute to burnout. My role, along with Dr. Yoo, is to really get a better understanding. We’re doing focus sessions across all divisions. There’s over 1000 faculty in our Department of Medicine. We’re the biggest department at UCLA Health.

We’ve been doing burnout assessments for the last three years and a lot of our docs actually participate in these evaluations. We’ve seen burnout has decreased slightly from its peak around the pandemic.

An inpatient doctor, a hospitalist, is going to have a much different set of barriers and needs than an outpatient doctor. I’m an outpatient doctor. One of the biggest barriers for ambulatory outpatient doctors is the in-basket, and that’s where we get messages and requests. The average primary care doc in the country has around 2000 patients. So when you look at that and you see you have a full day of clinic, but then you’re inundated with messages and results and requests, the workload becomes extremely overwhelming. Our role isn’t necessarily like starting all the initiatives, but teaming with our leadership to advocate for our doctors and make sure that we get things done to really help with that workload and well-being in general. My role is really to be an advocate for our doctors, understand what are the contributions to burnout and wellness, and to develop initiatives and work together with our leadership in creating policies to help with decreasing burnout and improving well-being.

My role is to be an advocate for our doctors, understand what are the contributions to burnout and wellness, and to develop initiatives and work together with our leadership in creating policies to help with decreasing burnout and improving well-being.

DB: As a physician yourself, what are some misconceptions about physician wellness and burnout?

JK: Something that people easily get led to is trying to develop things that you try to put in one type of policy or initiative, but you really have to understand the needs of every different type of doctor. We have less support, I would say, as doctors in general than people believe.

Developing an infrastructure to supporting doctors is still something we’re figuring out in our healthcare system. I think we have amazing staff, and I think that’s really important in that a lot of times we’re focusing on physician wellness, which is really great, but our wellness is also reliant upon the wellness of our coworkers and our staff. The patient experience is everything. It’s from the front desk to the checkout, to the person who calls, to the nurse who helps administer a vaccine. I think it’s a misconception that doctors are the only ones who are burnt out. Advocating for change can be a little bit more challenging when you’re not the ones who are really interfacing with their leadership on a frequent basis and that’s a part of what we needed to do.

DB: How do you define physician wellness and how do you know once it’s been successfully achieved?

JK: Burnout is a clinical work-related syndrome and it’s associated with emotional exhaustion, having a loss of energy, feeling fatigued from work itself.

We think of depersonalization as a contributor to burnout – that’s feeling like you have a lack of agency. The opposite of that would be being invested and engaged in your work. The last component of burnout we think about is decreased personal accomplishment, and that’s not feeling like you have a say in things. A big protector of burnout is having autonomy.

We have initiatives where it’s like, ‘Okay, how are we using augmented or artificial intelligence to help?’ So whether it’s responding to messages from patients for us, or whether it’s a scribe, those are things that are happening and will happen very quickly, so we’re excited about that.

Getting help from nurse practitioners or physician assistants to see patients can help with access. When you do that, you feel like you have more agency. I honestly didn’t get all this training to determine that someone needs a Tdap (Tetanus, Diphtheria, Pertussis) vaccination booster.

DB: You’re the principal investigator of a randomized controlled trial that examines how professional coaching alleviates physician burnout among Department of Medicine faculty. How do you plan to apply that work to this new role?

JK: Professional coaching has evidence that it helps reduce burnout for doctors. It is based in positive psychology – that means prioritizing what’s important to you in your life outside of work and also what’s important for you in your work. I think everybody needs some kind of refresher. You can get jaded over time.

UCLA Health did a pilot of 10 docs three years ago. I was in that pilot and was paired with a professional coach. It was wonderful. I was going through a really hard time. I had just lost my father suddenly and I was about to get married, so it was a very challenging time mentally for me.

I went toward leadership with help from Dr. Yoo. I was like, ‘Hey, can we do a pilot and randomize it and maybe not just one-on-one coaching, but can we do small group coaching where you have three physicians and one coach in groups in a way to help scale the intervention so it’s not as expensive?’ We saw significant reductions in burnout after just six sessions, up to 30%.

Specifically in our department, women physicians who are in research, have significant rates of burnout and they also have voiced that they would like coaching. The next step is providing coaching for them.

DB: How exactly does coaching help with burnout?

JK: Each of the six sessions had some type of structure and they’ll go over certain activities. The first meeting, everybody does this “Wheel of Life” activity, and in these different areas of our life what’s highest in the priority, or what do we score ourselves as? Like, getting on that, whether it’s physical health, your mental health, your you know, if you have a spouse, like the relationship health, relationships with family, and then work and leadership and where you’re at with that. And so that’s an example, like an activity that you’ll do, and you’ll grade where you’re at in those things.

It’s really hard for me to separate my work from my life. Even when I was on the breaks in between the run, I would go to my phone and I would open my patient chart app. We worked on identifying why I was doing that. They’re not therapists, and that’s definitely not what they’re trying to do, but some of the things that they do and some of the activities you’re doing are based in cognitive behavioral kind of based activities and techniques.

In the groups, I think it was a unique experience where doctors got to share with each other what they were going through. From what I’ve heard from qualitative responses, it was really nice to be able to share because a lot of times you feel alone. I think, one, even just that’s one solution to being able to just communicate about it.

DB: What advice would you give to medical students and young professionals about maintaining their well-being throughout their careers?

JK: At UCLA, it’s hard. It can be exhausting. I think even in med school, it’s like another level. It was like, I was studying every single day. Making time to do things that you enjoy is really incredible. For me, exercise is a priority. A lot of times we get stressed and we feel like we have to be working 24/7. But you can’t be your top performer self unless you’re taking care of yourself. That’s part of the individual-based things that I think are important, and also the system, I think it’s advocating for yourself when you see something that you feel like is a major barrier to your well-being. You know, finding out who’s the person that you can reach out to your mentors. Finding mentorship, I think, is critical in being well and in guiding through college and through med school. And I was really lucky that I had that.

Reaching out to people is such an important way that I deal with stress. I think in college and in med school, it’s finding out what works for you, because that helps me feel supported and confident that I can move forward. And I think again, for everybody, it’s different. So it’s really being aware of that, though, and trying different things. Try different ways to study, try different ways, try meeting new people – that is such a key part of college, and I think in med school that will really help achieve your goals.