Meet Chesney Fowler 

Dr Chesney Fowler never imagined she'd be treating patients through a computer screen. Yet here she was, a medical director for a telemedicine company, guiding doctors on how to assess shortness of breath without ever touching a stethoscope to a chest. 

How did a emergency department doctor end up here? And why would she trade the adrenaline rush of the ED for a home office? As we sat down to chat, I was eager to uncover the turning points in Chesney's career - decisions that any health professional might face, but whose outcomes can dramatically reshape a career.

Path to Medicine

Chesney's path to medicine wasn't a straight line. "My bachelor's degree was actually in comparative religion and psychology," she explained. "I had two majors and then I had a minor in legal studies." This diverse educational background, while not traditional for a future doctor, would later prove invaluable in her medical career.

But it wasn't until after college that Chesney felt the pull towards medicine.

With characteristic determination, she dove headfirst into a one-year pre-med intensive program, completing all her pre-med coursework in a single calendar year.

As Chesney progressed through medical school in Washington, D.C., she found herself drawn to the fast-paced world of emergency medicine. "I was choosing between OBGYN and emergency medicine." The decision wasn't easy, but the adrenaline rush and procedural nature of emergency medicine ultimately won her over.

Emergency Medicine and Early Career

Reflecting on this pivotal choice, Chesney mused, "It's interesting that people who like OBGYN and emergency medicine are usually very similar. It's a common decision for the two of us because it's very procedurally based and I'm working with my hands."

While sharing how she approached deciding on her specialty for the US right after finishing medical school, Chesney highlights how she wishes it was different. “I wish there was more time to make one of the biggest career decisions of your life. Just a little more time.” In Australia, graduates have a couple of years before deciding and can take longer if needed. 

Chesney's residency in emergency medicine, completed in 2014, was a period of intense learning and personal growth. It was during this time that she also became a mother, adding another layer of complexity to her already demanding career. This new identity would significantly influence her future career decisions.

After completing her residency, Chesney began her career at a suburban emergency department about half an hour from Washington D.C. After a short while, in keeping with her desire for variety, she took her first steps into leadership, reaching out to the department's medical recruitment director with a simple offer: "Hey, if you ever need any help, keep me in mind."

This proactive approach quickly bore fruit when two weeks later he confirmed a need to utilise her assistance. This opportunity allowed her to dip her toes into training and recruitment work while maintaining her clinical role. As I heard this, I couldn't help but reflect on the power of simply asking for opportunities – a lesson that seemed to shape much of Chesney's career trajectory.

Balancing Travel and Family

However, the demands of emergency medicine and a growing interest in diverse experiences led Chesney to her next role within the same company. "I took a position as a regional travelling doctor," she explained. This role involved filling shifts at various hospitals in the region, sometimes driving up to two hours each way or staying in hotels.

While initially exciting, the travel aspect of this job eventually began to wear on Chesney. "When I got my Christmas dinner from the gas station because it was the only thing open, I decided something had to change”, she shared, her tone a mix of humour and resignation.

Chesney's desire for variety extended beyond clinical work. "Emergency medicine is all about variety, but apparently that wasn't enough for me," she reflected. "I really liked counselling new doctors." This interest led her to transition to regional director of recruitment for the same company, which meant fewer clinical shifts. 

Transition to Telemedicine

Eventually, the desire for stability and a more predictable schedule led Chesney to make another significant change. After two and a half years, she left her role and the company altogether, opting for a position as an ED physician at a local hospital. "My commute went from two hours each way to 12 minutes round trip," Chesney said, the relief evident in her voice.

For two years, Chesney enjoyed the stability of this role and the ability to be more present for her family. However, the demanding nature of shift work in emergency medicine began to take its toll. "I wanted to go to my kids' Christmas concert at school and stuff like that," she explained. This desire for a more flexible schedule that would allow her to be more involved in her child's life became a driving force for her next career move.

It was at this point that Chesney made perhaps her most significant transition—leaving traditional emergency medicine for a role in telemedicine. This was four years ago, when telemedicine was exploding, and she had her pick of jobs. "I wanted to explore working from home because then if your kid is sick and can't go to school, okay, that's not fun, but I can still do my job instead of scrambling," she explained.

Adapting to Virtual Care

The move to telemedicine wasn't without its challenges. Chesney had to adapt to an entirely new way of practising medicine. "The biggest thing to learn was how to get that medical information from patients when I couldn't evaluate them," she said. “I couldn't push on their belly to figure out where it hurts. I had to redesign how I asked questions so that I could get the information that I needed."

As Chesney described this learning process, she shared an example of how she assesses shortness of breath in a virtual setting: "If a patient tells me 'I'm short of breath,' they're probably not going to be able to tell me what their oxygen level is, but I could say, 'Can you carry on a conversation with me over the phone and walk up a flight of stairs at the same time?'"

This creative problem-solving approach has become a hallmark of Chesney's work in telemedicine. She explained that much of her work involves "designing protocols and best practices to get the information that a clinician needs to make the right decision when we don't have any of our usual measuring tools."

Leadership in Telemedicine

In her telemedicine role, Chesney's leadership skills once again came to the forefront. She quickly moved from being a clinician to taking on management responsibilities. "That started when the company was growing. So we had a lot of new clinicians that needed to be trained and mentored," she explained. "I raised my hand to say that it was something that I wanted to do and it kind of grew organically from there."

This willingness to take on new challenges led to her first role as an assistant director and then to her current role as medical director at the telemedicine startup. In this position, Chesney oversees clinical operations and innovations, develops protocols for virtual care, and trains other physicians in virtual patient assessment and communication.

As Chesney described her current role, I could see how it combined all of her previous experiences – her clinical expertise, her interest in education and mentoring, and her ability to adapt to new technologies and ways of practising medicine. "We all understand what it's like to go to a doctor's office, have a visit, and then go to the lab and the pharmacy to get your medicine. But when we can't touch our patients or measure their oxygen level or breathing rate, we have to figure out ways to assess that without having the number."

Navigating the Startup Environment

However, the transition to a startup environment brought its own set of challenges.

 She found herself needing to learn new skills, from creating spreadsheets to understanding business terminology.

"I remember the first time I was tasked with making a spreadsheet," she recalled. "I went to my husband, who has an MBA. ‘I've never made a spreadsheet’. He's like, 'What do you mean you've never made a spreadsheet?' You don't need them in medical school and definitely not for a Psychology major."

These experiences taught Chesney the importance of asking questions and being willing to learn new skills. "I've gotten more comfortable looking in those executive business meetings from 'I don't even know what these acronyms are'...to just be like, 'Sorry, layman's terms over here,'" she explained. This openness to learning has not only helped Chesney in her role but has also fostered a culture of open communication within her team.

Work-Life Balance in Remote Jobs

Throughout our conversation, Chesney repeatedly mentioned her reflections on work-life balance and the importance of setting boundaries. "I really struggled, and still do, with turning off at the end of the workday," she admitted. "Because I could just finish one more email, or I just have two more slides left."

To combat this tendency, Chesney has developed strategies to maintain boundaries between her work and personal life.

Chesney also shared some of the unique challenges of working from home full-time. "Sometimes the only time I leave is to take my son to the school bus and pick him up," she explained. "And then by Friday, I'm kind of a caged animal and I want to paint all of the walls because I'm like, I have to look at another gray wall for another minute, I'm gonna go insane."

Chesney was refreshingly candid as we discussed the financial implications of her career transitions. "It was a significant change," she admitted about the move to telemedicine. "It did go down about 15%. But I realised it didn't alter my lifestyle because I still drive a nine-year-old car. We live a very frugal kind of boring lifestyle."

Addressing Burnout in Healthcare

Chesney acknowledges that burnout is a significant issue in healthcare, whether in-person or virtual.

This pressure leads to a relentless pace of seeing patients as quickly as possible, contributing to widespread burnout among healthcare providers. In virtual care specifically, Chesney notes a unique challenge: "The downside of virtual work versus in-person work, especially in the ER where you do have such variety, is that virtual is a little bit smaller. It's more repetitive; you see the same types of things."

Chesney focuses on education and support to combat burnout among her clinicians.

This approach involves training clinicians to navigate the unique challenges of virtual care, such as assessing patients without physical contact and managing the repetitive nature of typical virtual visits. By equipping her team with effective strategies for virtual patient care and fostering a supportive environment, Chesney aims to improve job satisfaction and reduce burnout among her clinicians.

We end our time together with Chesney’s strategy for crafting healthy work-life coherence:

A good reminder for us all.

Chesney’s Wisdom:

• Be proactive in seeking leadership opportunities or additional responsibilities at work

• Establish a clear boundary between work and personal life, especially when working from home

• Prioritize personal relationships and life outside of work, recognising that professional achievements alone don't define one's legacy