Finding Balance on the Precipice of Change

Cleveland Clinic has appointed Karen Murray, MD, as its new Chair of the Pediatric Institute, Physician-in-Chief of Cleveland Clinic Children’s and President of Cleveland Clinic Children’s Hospital for Rehabilitation.

Dr. Murray joins Cleveland Clinic from the University of Washington School of Medicine in Seattle, where she served as Vice Chair of Clinical Affairs for the Department of Pediatrics and Professor and Chief of the Division of Gastroenterology and Hepatology. Recently, she has also served as Interim Chair of the Department of Pediatrics and Pediatrician-in-Chief of Seattle Children’s Hospital.

Her clinical interests are primarily in medical hepatology, and her research is focused on the treatment and pathogenesis of childhood liver diseases such as hepatitis B and C viral infections, non-alcoholic fatty liver disease, and cholestatic liver diseases. She has spearheaded efforts to eliminate pediatric hepatitis C by bringing two highly effective adult drugs to infected children.

In her new role, Dr. Murray will lead a group of more than 300 pediatric specialists who are leaders in research for cardiac care, neurological conditions, digestive diseases and other conditions. Cleveland Clinic Children’s is consistently rated among the “Best Children’s Hospitals.”

Recently, Consult QD had the opportunity to get to know this internationally recognized physician leader. Dr. Murray shared her views on mentoring and burnout, as well as her vision for Cleveland Clinic Children’s.

Given your passion for mentoring residents, I wonder: who your own mentors have been and what you learnt from them?

Dr. Murray: I have many mentors for the different domains of my life, and who have played varying roles over time.

One individual who has been a mentor for decades—and is also now a friend—is a gentleman who was Division Chief in Pediatric Gastroenterology at Johns Hopkins when I was a medical student. He recognized my abilities and gave me responsibilities early on, which built my confidence. He also included me in social events so that I might develop relationships with other physicians and get to know the subspecialty better. We have remained in touch over the years, and still have dinner together from time to time when in the same town; I can always call him for advice or to just catch up. He now serves as president of a university. He tells me about his challenges and opportunities, is in turn interested in mine, he inspires me and I have been excited to watch his career trajectory over time.

Other mentors have guided my research, administrative challenges, clinical practice and aspects of my personal life; I admire them, learn from them, and am inspired by them.

As relates to my own mentoring, very little gives me more thrill than to watch a mentee’s career develop, to think I might have had some influence on them, and then to be able to watch them go into the world and succeed.

What are your thoughts on burnout? How will you assess for and address burnout in the physicians at Cleveland Clinic Children’s?

Dr. Murray: Burnout is a very serious issue in pediatric medicine. According to the most recent Medscape National Physician Burnout, Depression and Suicide Report, 41% of pediatricians reported burnout. Essentially, burnout is a situation in which physicians become emotionally fatigued and lose their passion.

Many people blame burnout on the electronic health record or other bureaucratic tasks that take a lot of time without being value-additive for the provider. As physicians, we face a variety of demands on our time and energy, compounded by the needs for high-utilization of our clinics, patient access, and of course quality and safety, while sometimes practicing with suboptimal support. Inefficiencies detract from the physician’s ability to spend the time desired actually seeing patients, providing the best care they can, fulfilling their educational mission, or conducting the research they are dedicated to and passionate about. In the academic world, the biggest driver of burnout is when a provider is unable to spend time in activities they value the most due to these time inefficiencies or administrative tasks that erode time.

I want to assure that, culturally and operationally, physicians have the ability to optimize the time spent in the various aspects of their professional lives, and can protect their non-clinical time as intentionally as they should be focusing their clinical work. At Cleveland Clinic Children’s, I hope to support academic productivity, safeguarding administrative, research and teaching time, and encourage a culture in which these activities are valued and celebrated as much as excellence in clinical care.

What do you consider to be the most exciting areas of opportunity in pediatrics in the next 5-10 years?

Dr. Murray: Innovations in therapeutics—I think we are on the precipice of changes that can really benefit children, such as immunotherapies, gene therapy, and the creation of medications to reverse physiological challenges. Take muscular dystrophy, for example—children suffer and ultimately succumb to many of these illnesses. With the new therapies, we can replace missing proteins, prevent further muscle degeneration, and in turn reduce suffering and perhaps even reverse the course of the disease.

What is your vision for Cleveland Clinic Children’s?

Dr. Murray: Cleveland Clinic Children’s is an amazingly dedicated group of medical providers at a world class institution. There’s more going on than the world knows about. My vision for Cleveland Clinic Children’s is that we continue to provide and improve upon the world-class medicine and innovation that are already occurring here, while working to expand academic pursuits and enhance our national reputation.

Will you continue to provide patient care in your new role?

Dr. Murray: Yes. It makes me happy to be in the clinic; I love developing relationships with my patients and their families, and doing what I can to better their lives. Additionally, I think being active in clinical care keeps me grounded and provides insights into the operational side of healthcare and into the levels of support our physicians need.