The Mary O’Flaherty Horn Scholars in General Internal Medicine Program was created in 2000 in Dr. Horn’s honor. Prior to her passing in 1998 of amyotrophic lateral sclerosis, Dr. Horn was a master clinician-educator devoted to caring for underserved populations at St. Mary Medical Center, a University of California, Los Angeles (UCLA) Affiliated Internal Medicine Residency. Dr. Horn was the first internist at UCLA to split a full-time faculty position with another like-minded physician, Dr. Carole Warde. Both were able to be devoted to their families and their careers without the constant struggle of needing to be in two places at once.

The Horn Scholars Program was endowed by Dr. Horn’s family and friends to allow other physicians to find a satisfying balance. This career development award for clinician educators supports work-life balance, which Dr. Horn exemplified, by supporting those desiring to work less than full time and providing protected scholarly time. Since 2000, there have been seven Horn Scholars.

The Horn Award is a transformative experience for recipients. We are excited to announce that starting in 2023, a Horn Scholar will be named every year instead of every three years. The desire to support SGIM members, especially in the wake of the COVID 19 pandemic and the coincident growth of the Horn endowment, have led SGIM leaders to this program expansion.

We sat down with the current Horn Scholar, Dr. Tyra Fainstad, 2020-23 Mary O’Flaherty Horn Scholar, to learn about her experiences.

Please describe your life before the Horn Award and what prompted you to apply for this award.

I was working as a primary care doctor and clinical faculty at the University of Washington. Like many junior faculty, I was an “approval addict.” Medical training culture left me with the idea that “life will be better once I…”. Despite this arrival fallacy, I loved my job, especially teaching. Drawn to feedback reception, mindset theory and psychological safety, I had dreams of reinventing the learning environment, but quickly learned that protected time and funding was necessary to innovate, study, and disseminate ideas. I ended up doing scholarship without protected time or funding, mostly on my own time. Simultaneously, I was given an abundance of well-intentioned offers and advice: “Please create this 2-day workshop”, “We are happy to have you to serve on this committee!”, “Would you mentor a few medical students?”, “Remember to attend and speak at all the big conferences”, “The Sub-I curriculum could benefit from your eyes”, etc.

I had two children after residency, and parenting was not what I expected. The harder I tried to “do it right” the further away I got. As an only child with two ill parents, I found myself in the “sandwich generation” trying to keep the balls in the air, constantly prioritizing what felt most urgent. This was a losing game. I felt exhausted in a life I didn’t expect or create. Don’t get me wrong: I deeply appreciated and loved my position at UW. I did have a half day a week of protected time and the relationships I made in my clinic were pivotal for my development.

However, I was lost in a culture that taught me to value my worth by my external assessments. A culture that taught me that to be happy, I had to sacrifice my current self for my future self. A culture that whispered that my physical and mental health came second.

I decided to move home to Colorado to be closer to family. I was recruited to the University of Colorado by my medical school mentor, Dr. Mark Earnest, who would be my future division head. Before I left Washington, Dr. Earnest passed along the Horn Award call. I remember opening the e-mail on a cold Seattle afternoon thinking “is this for real?” The award felt like a beacon of light from someone who saw that I was barely keeping my head above water. Someone who knew I had been unable to even consider the big ideas I once had with my miniscule amount of protected full-time equivalent (FTE). I knew then that this award was a game changer.

The application for the Horn Scholars Award involves not only the applicant but also the GIM Division Chief, the Chief of Medicine and two Mentors. Can you share a bit about the experience of putting together this application?

I had a unique experience in that I was applying while planning to transition institutions. I had gone to medical school at University of Colorado and was fortunate to have continued relationships with Dr. Earnest and another mentor Dr. Karen Chacko, who introduced me to the team that now supports my career. This feeling of support from a group that didn’t even know me was perhaps the first example of my external approval addiction shifting to a healthier source of internal validation. Even though they had never worked with me, they believed that I deserved the support anyway. In a culture that teaches us to prove ourselves first and then be gifted with resources, this was a welcome and important shift. I will be grateful to my team at Colorado forever.

Describe your life now, after receiving the Horn Award.

It is not an exaggeration to say it is night and day. The award allowed me to become certified through the Life Coach School and to build something that I am proud of and eternally excited about. It also gave me the space to breathe when I needed it most. I worked with a physician coach in 2020 and defined my purpose, values, and vision statement. I identified areas where I was holding myself to unhelpful standards that ironically got in my way. I began to think big, question norms and decide what to create from a place of abundance, rather than the scarcity (we are expected to do more with less) that is so tightly woven into academia today.

I feel centered, excited, and proud. The Horn Award gave me the protected time and, more importantly, the belief that I “deserved” the time. This was the beginning of an important mindset change for me.

Tell us about your scholarly focus and how you have used your protected scholarly time.

I teamed up with a colleague, Dr. Adrienne Mann at CU, also a certified coach and who shares my passion for physician burnout mitigation. In 2020, we created Better Together Physician Coaching: a six-month online, group life coaching program crafted specifically for issues women residents face including confidence, imposter syndrome, feedback, career decisions, and micro/macroaggressions at work.

We piloted Better Together in a randomized control trial in 2021 with 101 women-identifying residents across specialties and were thrilled to find improvements in burnout, self-compassion, and imposter phenomenon in intervention participants. We are planning to expand the program nationally in 2022. Our findings support what we already know to be true about coaching: normalizing emotions, holding a compassionate space for authenticity, and using metacognition to nonjudgmentally look at self-sabotaging patterns WORKS.

What has surprised you most about this experience?

The Horn application was the first time I had written about my successes with candor and honesty. That process eased my fears about being seen as arrogant if I had something to say. I am still surprised when someone refers to me as an expert in physician wellness and coaching, but now am quicker to reframe my self-deprecating responses into a simple “thank you.”

I am also surprised by my own productivity. A commonly held belief is that if we give ourselves a break, we might become lazy, unproductive, or worse, forgetful, and harmful to patients. What I know from positive psychology and self-compassion literature is that the opposite is true. The most productive year of my life was the first year of my Horn Award. Taking the time to define and create my own future gave my actions laser-like focus. I have stopped saying yes to everything, and even more importantly, dropped the attached guilt.

What recommendations do you have for anyone who is interested in applying for the Horn Award?

Do it! The application process alone was so beneficial. I have a few colleagues who applied for the award and didn’t get it. They ended up turning their application into a proposal that their institutions ultimately supported. I have used questions from the application with mentees. No bad can come from writing your dreams, fears, and core-whys on paper and then from sharing that with a team of mentors.

What are your plans post Horn Award?

Now that I have successfully learned to carve out healthy personal development time, I will continue this habit indefinitely. I know that the sacrifice of my personal time for work not only feels terrible, but also does not benefit my career in the long run. It’s a lose-lose that I refuse to engage in again.

In terms of career—I’m going big! Dr. Mann and I are building a team of coaches and creating a model for institutional support of physician coaching. We ultimately hope to offer our coaching program to everyone that wants it at all levels of training, career stages and intersections. Stay tuned!

For questions, please contact the authors: https://www.sgim.org/career-center/awards-and-grants/grant-awards/horn-scholarship.