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Robin Kish (Host): These days, medical school graduates who are training at hospitals in specialized practices are getting the lesson of a lifetime. These doctors also known as residents are on the front lines of COVID-19. Today, we speak with one Family Medicine resident working at a rural Florida hospital about how the pandemic has impacted her, her patients and her career next on this edition of Here For Your Health. Welcome to the Health Care District of Palm Beach County's podcast Here For Your Health. I'm your host Robin Kish. Our guest today is Dr. Nzingha Saunders, a Family Medicine resident at Lakeside Medical Center in Belle Glade, Florida. Thanks for joining us, Dr. Saunders.

Nzingha Saunders, DO (Guest): Thank you for having me, Robin.

Host: Dr. Saunders, as a native of North Carolina, what attracted you to Lakeside Medical Center and it's Family Medicine Residency Program in rural south Florida?

Dr. Saunders: Well, I was actually born in Miami and I still have a lot of family that lives in the area. And I actually grew up in a rural part of North Carolina. So, rural medicine is something that's very close to home for me. And that's something that I wanted to continue, especially at Lakeside in particular, they have a really unique patient population, which I really wanted to get to know and serve.

Host: So, Dr. Saunders, can you describe Lakeside Medical Center's Family Medicine residency program? What's it like?

Dr. Saunders: Sure. So for anybody who's unfamiliar. So a residency resident program is basically it post-graduate training after medical school that all physicians are required to attend in order to practice on their own. And they practice in a supervised area before they end up practicing on their own. And Lakeside in particular is a three-year program. We have five residency positions in each class, and that's a total of 15 positions. Our rotations include emergency medicine, women's health, pediatric, psychiatry, and a lot of other specialties. And we care for patients from birth up until their senior years. This year in 2022, we will celebrate our 10th graduating class.

Host: That's great. And as a part of a family medicine residency program, you must see a lot of different types of patients. Can you describe what conditions you care for and the types of patients you treat?

Dr. Saunders: Sure. So we work in both acute settings in hospitals and also in the outpatient settings as well. And our clinic is actually located right below Lakeside Medical Center. So in the acute setting, we care for all types of conditions. Obviously this year we had a lot of COVID, but we also care for patients with congestive heart failure, COPD, diabetes and any other conditions that you might name in the acute setting. In the clinic, we continue to see those patients so we can manage those conditions and any other conditions that they might have, and also, as I stated earlier, we see patients all the way from newborns to senior citizens and everything in between.

Host: So you may see patients who enter the hospital through the emergency room, and you also may see patients who come for their primary care at the federally qualified health center that is co-located on the Lakeside Medical Center campus called the CL Brumback Primary Care clinics. Is that correct?

Dr. Saunders: That's correct. That's actually our specialty. So we have a lot of our patients who we see in the clinic that end up getting care in the hospital setting. And if we have any body who we see in the hospital setting, a lot of them, come through, don't already have a primary care provider. So we try to see as much as those patients as we can and care for anybody who needs our help.

Host: From a patient's perspective, what are the benefits of being treated at a teaching hospital where residents are involved in patient care?

Dr. Saunders: Sure. There's a lot of benefits to being seen at a teaching hospital. If you're at a place with medical residents, one of the biggest things is that you do get extra time with the doctor. The residents typically come in early in the mornings before the attending physician gets to the facility. And so we essentially, every patient on our service gets seen twice. Also you get an extra pair of eyes as well, because you're also being seen by medical students and also from the attendings and the physicians as well.

Host: So that's good if you get a little bit of extra care from additional trained physicians and also they may be trained with the most advanced information in terms of their preparation, right?

Dr. Saunders: Oh, definitely. We always make sure that we stay up to date on the most current medical information when we're treating patients. That's part of our practice. And of course we have to know that information for any tests that we have to take as well that are essential for our certifications.

Host: Now you talked about Lakeside Medical Center serving a rural area. It's an agricultural region known as the Glades and Lakeside Medical Center is a public teaching hospital owned and operated by the Health Care District of Palm Beach County. It's the only acute care facility within approximately 30 miles and many Glades residents, we know are uninsured or under-insured and have complex chronic conditions like you mentioned, diabetes. How were family medicine physicians well-suited to care for such a primarily underserved population?

Dr. Saunders: Well, as I mentioned earlier, family medicine physicians get trained in all areas of medicine. This includes, you know, endocrinology, cardiology, nephrology, and pediatrics, adult medicine, every, pretty much everything. We really strive to be generalists, especially all of the residents and myself here that are providing care for the patients here in the Glades.

We essentially, you know, we want to be, much as we can, to kind of one stop shop for everything to kind of direct their care for everything else. Also with a lot of our particular patients in this area, a lot of them have trouble a lot of time with transport and as you mentioned, a lot of these patients are also uninsured or underinsured, so they may not have, you know, the means to go see a specialist.

So, with that, we try to take care of as many chronic conditions as we can.

Host: Now with COVID-19 pandemic has taken a toll on residents in the Glades communities. And this area was known as a hotspot for the virus in early 2021. And then a summer surge flooded the hospital's ICU with COVID patients. Healthcare leaders sounded the alarm for help when no hospitals in the county or elsewhere in the state had the capacity to accept transfers of the few COVID patients who needed a higher level of care. Can you describe what it's been like for you at the hospital, during the pandemic, in terms of your experience and your training?

Dr. Saunders: Sure. So it was definitely a interesting experience. Myself, since this was my first time as a practicing physician, I was not able to compare it to anything else. So, basically when I first came in COVID was all that I knew. During that time, most of our patient load was in fact, COVID. We had some very sick patients as well. And it got to a point where there were so many patients as, particularly with COVID, needing hospitalization,

of course, with this increased workload it also affected our training in the ways that unfortunately not all of our rotations were available.

For instance, we weren't as able to complete as many deliveries during the COVID pandemic because the hospital at which we complete the deliveries wanted to really minimize the risks to the mothers and the babies. So essentially, unfortunately, the residents kind of got a cut out of that experience with that.

Host: So, how did working during the pandemic affect your mental health and how did you deal with the stress? It must have been overwhelming at times.

Dr. Saunders: It was definitely overwhelming. As any new resident can tell you it's, it's definitely overwhelming enough to try to learn the ropes and learn how to practice physician and cumulate all this knowledge that you gained during the practice. But to do it with such a high volume of patients is another challenge that is added to it. Unfortunately we also, with COVID, everyone knows COVID had unfortunately had a very high death rate as well. So, that definitely takes a toll on your mental health because you really, as, as much as you want to try to save every single patient and for everybody to get home safely, that wasn't the case for a lot of patients.

Unfortunately. And that takes a toll after a while especially because you spend a lot of time wondering what you might have done differently, if anything. The best way that I found to deal with it was talking to people who were in similar situations. That would include my co-residents other staff members as well.

I also have other friends from medical school who were going through the same thing. They were also interns and doing their first year of residency during this pandemic and just staying connected with them virtually, essentially, made all the difference. It was nice to be able to voice our frustrations and our concerns with them.

Host: What are the factors Dr. Saunders that played a role in who among your COVID patients became the sickest?

Dr. Saunders: Definitely. When we noticed the first, the second wave that came out, it was the people who are the unvaccinated. Essentially, anybody who was vaccinated, a lot of them were discharged directly from the emergency department and didn't get hospitalized. But continually when we had patients that needed to be hospitalized for COVID, we, as part of our workup, we would ask them if they had received one or both doses of the vaccine at the time or no doses and the people who had received no doses continually had the the biggest complications during COVID. And unfortunately those made up the vast majority of the patients who ended up passing away after the vaccine had been released.

Host: Dr. Saunders, in terms of your comfort level, do you feel equally comfortable caring for COVID patients as you do for non COVID patients?

Dr. Saunders: I do now, now, I am six months into my second year of residency and as everybody knows, there's less COVID now. It's become less prevalent and we're having fewer hospitalizations on the floor for COVID. So, now I'm getting a bigger variety of, of different types of patients. But before that, I didn't. I felt like most of I felt very comfortable taking care of COVID patients, but not as comfortable taking care of patients with other run of the mill, more common chronic conditions. But like I said, now, after not having to take care of many COVID patients, I definitely feel more comfortable and I feel equally comfortable caring for both COVID and non COVID patients.

Host: Dr. Saunders, you mentioned being able to reach out and talk to other residents and physicians. What effect, if any, has the pandemic had on those relationships with your co-residents and other staff?

Dr. Saunders: If anything, I would think it's made as closer. You definitely, like I said, it helps to talk to people who are in a similar situation and some of my co-residents and people, other workers on the front lines, such as a physical therapist, respiratory therapist, you know, case management and other disciplines. They are some of the other only people that can understand this experience. And not only, I feel like it's brought us closer together, but it's definitely given me a newfound respect for everybody's role and has shown me how truly essential every single person's role within the hospital is from nursing to housekeeping staff, to the dietary staff and everyone in between.

It's essential that we all worked together and everybody played a crucial role in caring for all of these COVID patients. And I definitely have a new found respect and gratefulness to my coworkers.

Host: Did you and your fellow residents play other roles within the hospital, such as assisting with COVID-19 testing, vaccination efforts and community education.

Dr. Saunders: We did. So when I first arrived at Lakeside, we had the testing center, which was operational until, by the residents and other staff that are part of the CL Brumback clinic that was operational until I think, May of this year. And so we actually participated in testing. I know a lot of other co-residents and other staff had participated in giving out vaccines as well. And of course we all participated in community education by educating our patients anytime that they asked us any question. I'm a huge proponent with health literacy and patient education. So anytime that my patients have any questions about anything, not just limited to COVID, but in COVID, especially, I encourage them to ask me any questions, especially if they were reluctant to get the vaccine.

Host: What's been the most rewarding part of your job during the pandemic and what's presented the most challenges?

Dr. Saunders: I would say the most rewarding part of my job was definitely seeing patients get better, especially ones that had more grim prognoses that you could see and looked like maybe they weren't going to do so well. When I got to safely discharge them to home or to a rehab center, that was always, you know, a really heartwarming moment, especially because there were so many patients that I had that didn't get to go home and definitely I would say the most challenging has been, the most challenging think has been essentially dealing with unfortunately so much deaths round. That was a really hard part. And with anything else, you do get used to it and you do learn to cope with it and you get better at dealing with it. But there's never a part of you that, that, where it becomes completely comfortable, it never quite goes away and you never quite become comfortable with it. It's always, you know, a sad thing when somebody passes and you try not to take those things home with you. So that way you can really focus on work and it doesn't affect your mental health too much, but there are some times when there's particular cases that hit home when maybe the patient is close in your age, or maybe it was somebody that you knew from the community, that definitely makes it a little bit more challenging.

Host: Yeah, that grieving process continues, I think for so many healthcare heroes like yourself and families. What would you say is the most important lesson that you've learned from working as a Family Medicine physician during the pandemic?

Dr. Saunders: I would say the most important lesson that I've learned and what I've tried to live by now is that life is very short. I know that a lot of people, myself included, you know, didn't see this pandemic coming and thought that maybe they might've had more time to accomplish certain goals in their life or to whether it was to go on a certain vacation or complete school or to visit a certain family member or friend.

I know myself, I always thought that I had so much more time. And of course, with having to do so much extensive schooling and training, I had to put off a lot of things in order to complete my medical training and medical schooling. So the thing that I've really taken is that life is short and that we should really cherish each moment that we get.

So I would encourage everybody to, you know, not delay accomplishing any goals that you have set out and to cherish your family while they are here. Make sure that you call them, make sure that you're enjoying your life. And that there's at least a little bit of, you know, something that you can cherish, moments that you can cherish every day. And that you take the time to appreciate them.

Host: Great advice. Looking toward the future, when people ask you about your experience being a medical resident during the COVID-19 pandemic, what do you think you'll tell them?

Dr. Saunders: That's a great question. I think I will tell them that it was a tough time. That it was a unique experience, but that in a way, it kind of brought us all together. There was times when it was, you know, very isolating because we had to social distance and I, myself, wasn't able to see my family as much being from out of state. Not seeing my immediate family rather, because they're back home in North Carolina and other places in the United States. But. I think this was something that really kind of humanity had to suffer through it together. I think it really kind of brought all of us together. And I think that they would tell, I will tell them that while it was a hard time, that there were some bright points that that came out of it. And I think I'm most looking forward to telling them that we made it. And that's the biggest thing that the pandemic happened and that the world survived and moved on from it.

Host: Yeah, nice. If it's in the rear view mirror. Last year, the Association of American Medical Colleges released a study with a dire prediction, finding that by the year 2033, the United States would face a shortage of as many as 54,000 to 139,000 physicians. What do you think of that data in light of our aging population and any future pandemics similar to COVID? Hopefully not, but.

Dr. Saunders: Well, I'm hoping that we don't suffer any more pandemics, especially in my lifetime. I wasn't essentially prepared to handle one. So another one would be interesting to say the least and not the most desired, but obviously with that data we need to encourage more people to become physicians.

I think it's going to be very essential. I know that it is becoming increasingly more popular for people to pursue the route of becoming nurse practitioners or PAs or, other types of healthcare workers. And while those are essential as well, we're definitely still going to need physicians. Physicians go through a lot of training and we go through that training so that way we can become essentially experts in our field and be trusted to making the right decisions for patients and their families and to be able to guide them in the right position. And I think that it's essential that we still have people to continue that tradition and to pursue that level of education. So that way we can continue to have people that are leading the way essentially in that realm, especially because we're going to have like an aging population and we're going to need doctors to take care of them.

Host: Dr. Saunders, is there anything you'd like to add in closing, maybe for those who are considering a career as a family medicine doctor?

Dr. Saunders: Yeah, sure. I would say that if you, first of all, like we said anybody that wants to ,join the medical workforce, I would strongly encourage you to do so. It's, while it's very hard work, it's very rewarding. And there's not a lot of jobs that I think people can truly say at the end of the day that I really made a difference, but I feel like I can do that with my line of work.

And as far as becoming a family medicine physician in particular, I would say that it's a great field. I chose this field because I really like all areas of medicine and I wanted to be able to become proficient in providing cares for a vast areas of concentration for patients, a vast number of ages, vast number of conditions.

And I wanted to essentially be in essentially independent and be able to provide care for patients, especially in rural areas where people have less access. So, family medicine is a great opportunity. It's really accumulation of all the fields and it is what you make it. So even if there's something that you're particularly interested in, you can also study that as well while you're in your training. So I would definitely consider it. I've I consider it to be the best field, but I might be a little biased.

Host: Well, we wish you all the best with your medical training and your career. We thank you, Dr. Saunders for sharing your residency experience with us. And we thank all of the medical residents at Lakeside Medical Center for their commitment to the health of the Glades community.

Dr. Saunders: Thank you so much. I appreciate you having me.

Host: Sure. If you find this podcast helpful, please share it on your social channel and check out our full podcast library for topics of interest to you at healthcaredistrictpodcasts.org. Let us know what you think. Your review helps us reach more people just like you. Today's podcast is brought to you by the Healthcare District of Palm Beach County.

The Healthcare District is a unique safety net healthcare system located in south Florida and provides county residents access to primary care, skilled nursing and hospital care, registered nurses in nearly all of the county's public schools and oversight of the county's trauma system, which includes operating two life-saving trauma Hawk, air ambulances.

Learn more by visiting hcdpbc.org and our hospital's website at lakesidemedical.org.