Well-Being in Health Care

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Last updated December 22, 2025

The Power of Providers (POP) partners with behavioral health experts in Washington to support the well-being of health care professionals. POP aims to identify and address challenges that contribute to burnout and promote individual and system level support for health care workers dedicated to improving the health of others. This page is designed to support well-being for health care professionals by offering recommendations, helpful resources, and opportunities for connection.

If you have any feedback or input for our programs, please email: powerofproviders@doh.wa.gov.

Engage

In this space we will be asking questions related to wellbeing and connection. We welcome you to share your honest responses with us. Your answers to the question of the month will be completely anonymous. We will address common themes monthly.

Question of the Month

What are the biggest stressors you are facing right now in your work?

Use this link to answer the question of the month.

Well-Being Champions

Elevate your peers or leaders to be recognized as a well-being champion! Do you know someone that has helped you maintain a healthy state of well-being at work? Use this nomination form to submit a nomination today. We will reach out to the person to ensure they are comfortable being recognized on our page.

Peer Support

Peers can offer a unique form of support. Your peers share the same experiences, challenges and emotions you face daily in health care. This shared understanding can help create a safe space to process feelings together. The isolation you might be feeling can be reduced and resilience can be built by having partnership and mutual empathy from your peers. Additionally, peers can provide immediate support when you need it most.

There are also several peer support resources you can use that are specifically for health care professionals.

Pause

Mindfulness, Meditation, and Journaling

These techniques can help you boost resilience, reduce stress, and improve emotional balance. Mindfulness helps you to stay present, reducing contemplation on past events or worry about the future. The mental shift can lower your stress level, provide emotional regulation and create a sense of clarity even during stressful events or situations.

Mindfulness Practices

Breathing Techniques

Incorporate breathing exercises into your day, your lunch, breaktime, before or after shifts. Taking a few deep breaths can help calm and regulate your mind and body. Focus on your breathing as it flows in and out. To help prevent your mind from wandering, count as you inhale and exhale.

Mindful Walking

A simple form of meditation that can be done during a break. The key to this practice is to slow down, pay close attention to your body and focus on walking. Counting steps, adding a mantra to match your pace, doing a body scan noticing sensations as you move, and walking with intention.

Physical Activity

Journal Prompts

Journaling can help with reducing stress and anxiety, provide a private emotional outlet, improve mood and promote self-awareness. Below are a few prompts to get you started.

  • What are three words to describe how you are feeling right now?
  • What have you noticed about the day(s) that is challenging?
  • What have you done today that made someone smile? Or what is something that someone did for you that made you smile?
  • What is one thing you are grateful for today?
  • Celebrate yourself by starting a journal entry with the sentence, “Today I made a difference in this person’s life by …” (this can be yourself too, like accomplishing a personal goal)

Support

For Leaders

As a leader of health care professionals, recognizing and addressing the mental health and well-being load of your staff is essential to maintaining a healthy workplace and providing exceptional patient care. Implementing support strategies should be rooted in an organizational structure that allows staff to manage workload effectively, prioritize tasks, and maintain a healthy work-life balance. Some key strategies include:

  • Promoting access to mental health care: Facilitate convenient access to mental health resources and professional support tailored to individual needs.
  • Encourage participation in social support networks: foster environments where staff feel connected and seen through peer support groups and team building activities.
  • Support use of paid time off: Promote appropriate staffing levels to ensure employees can take deserved breaks and utilize their paid leave without guilt or fear of work backlog. Utilize flexible scheduling and ensure predictability of schedule.
  • Encourage physical activity and mindfulness: Support initiatives such as mindfulness practices, yoga or physical exercise programs to reduce stress and enhance overall wellbeing.
  • Promote meaning and mattering at work: Create connection points between the importance of their work contributions to personal or organizational missions through recognition and gratitude.

By implementing supportive strategies, your organization can cultivate an environment that helps health care professionals thrive.

More resources for improving workplace well-being:

For more information on the benefits of implementing and supporting mental health programs, expanding access to support services, and maintaining supportive operational practices at the system level, see Addressing Health Care Workers’ Mental Health: A Systematic Review of Evidence-Based Interventions and Current Resources (AJPH,Vol.114,Issue S2), which provides a comprehensive evidence-based overview.

For Team Members

Many organizations have programs that offer support for employees when they are experiencing challenges. Programs like an employee assistance program (EAP) offer confidential services, short term counseling, referrals, and follow up services for employees. These services can start the process of finding longer term support/counseling if that is what you need. Encourage your organization to implement social support systems for you and your colleagues. Seek out resources that you have access to. If you need help finding them, get in touch with your benefits manager, or your human resource office to direct you to the correct person that can help navigate the resources you have.

There are times it might not feel safe to reach out for support. You may worry about how supervisors and peers will see you, or you may simply need more help than is available to you. The services listed below are completely confidential, low cost or no cost, and can connect you with professional support. Additional resources can be found on the National Alliance on Mental Illness website.

  • Therapy Aid Coalition provides pro-bono therapy for frontline health care professionals, including individual and group support.
  • The Emotional PPE Project connects health care professionals with licensed mental health professionals who can help. This service is free and does not require insurance.
  • The Battle Within provides free therapy to medical personnel, first responders and veterans. Private therapists are available to work with individuals in crisis, or who are experiencing grief, anxiety, stress or trauma.
  • 911 At Ease International provides access to free trauma-informed counseling for frontline responders and families, including first responders and emergency medical personnel.
  • For immediate assistance, text “SCRUBS” to 741741 at any time.

Listen

You Matter: Voices in Health Care Podcast

"You Matter: Voices in Health Care" is a podcast produced by the Power of Providers at the Washington State Department of Health (DOH). The show features conversations with health care workers and leaders about resilience, managing stress, preventing burnout, and the systemic changes needed to better support Washington’s health care workforce.

It is hosted by Dr. Anita Chopra, a leading physician at the Long COVID Clinic, and Dr. Carrie Perkins, a medical anthropologist and qualitative research scientist with the DOH’s Center for Access for Whole Person Care.

Episode 1: Secretary of Health Dennis Worsham - "I Had One More Fight in Me"

Secretary of Health Dennis Worsham speaks honestly about the emotional toll of public health work and what it feels like to keep going "when fear is in the system." His story is a reminder that resilience doesn’t come from one person alone. It grows when teams support each other and when leaders and systems care about the people doing the work.

Transcript of Episode 1

Anita Chopra: Hello everyone. Welcome to You Matter Voices in Healthcare, a podcast brought to you by The Power of Providers and Washington State Department of Health. I'm Anita Chopra, I'm a physician and faculty at the University of Washington in Seattle. I'm an internist and one of the lead physicians at the Long Covid clinic.

Dr. Carrie Perkins: And I'm Doctor Carrie Perkins, a medical anthropologist and qualitative researcher with the Washington State Department of Health. Today, we're so glad to be joined by Dennis Worsham, Washington State Secretary of Health, someone whose own story of service and resilience began decades ago on the front lines of the HIV epidemic. Over his more than thirty years in public health, Dennis has led through countless challenges, always centering compassion, collaboration, and a deep belief in community from his early work supporting the LGBTQ+ community during the Aids crisis to leadership roles in King and Snohomish counties, and now at the state level, his work has consistently centered on equity and hope. We're honored to have him here with us today to talk about what it means to lead through change, to care for the people doing this work, and to sustain our sense of purpose in this process. Welcome, Dennis.

Dennis Worsham: Yeah. Thank you so much, both of you.

Dr. Anita Chopra: Dennis. You've had such a long and distinguished career in public health, most recently leading the Snohomish Health District before accepting the role of Washington's secretary of health. It's an honor to have you in that role. What motivated you to take on this role, and how has that shaped the way that you lead?

Dennis Worsham: Yeah, I think thank you so much. Uh, one, thank you so much for inviting me to your space and to giving you a little bit about my own experience and my own journey about, uh, my love and commitment. You know, uh, how many of us in life get to be able to do a job that is actually aligned with our work and our purpose? And I feel so blessed and fortunate to be in this space and to be in this role currently and to kind of carry that work forward. Uh, so yes, I was in Snohomish County. I've been in, uh, as you noted, uh, in the public health system for about thirty two years, the governmental space, uh, and beginning actually that journey in Snohomish County and, um, and what really my degree is actually in health services administration. Thought I was going to go that particular route. Uh, and as I was, uh, wrapping up college, uh, in that degree, I also, um, was working was at Eastern Washington University and, uh, and had helped start their first student health program. It was the only four year university that didn't have student health. And I ran on a platform for student government, uh, to actually start that student health program. And after two years of being student body president and, uh, and getting support to do that from our administration. I was actually hired to stay on and begin that student health program and is still running, uh, today and really addressing, uh, access to student health, uh, in a place where it was much needed. Uh, we had an older age student at the time, and, uh, two things that they needed. Uh, one was, uh, access to healthcare. The second one was childcare. And I had this brilliant idea as a college student is I was going to defund the athletic program, and I was going to fund student health and, uh, and childcare. And you can only imagine how well that, uh, played, uh, with the politics of the university at that time. So what took me to Snohomish County was I was also in the process of coming out as a gay man. And, uh, it was really important at that point for me, uh, to wanting to give back into a community in which I was coming out. And really, uh, we were in the height of the epidemic. Uh, this was in the early nineties. and Snohomish County had a position open as a health educator and a community mobilizer to really work around HIV and Aids. And as we think back to those times, which seems so long ago, is it was a time when the federal government really was standing in a place of not providing the services and or access to care to gay men who were dying. And, uh, and it invoked a passion in me to step into that place and to be a voice from somebody coming out into this space as a gay man and wanting to do something to give back into the community in which I was giving out. And, uh, and that was really, uh, empowering. I always tell the story. We would start every staff meeting on Mondays, uh, with reading the names of the people who died that week in Snohomish County of HIV and every name that was written, uh, and we would place a flower in our atrium of remembrance of that person. Is it just connected me to the purpose of why I wanted to do the work I was doing, and to give back and to save lives? And it just really was, uh, deeply embedded in me of who I am. Uh, and really began my public health journey, as you both know, as physicians and familiar with the public health practice, there is a science and medical model in public health. But there's also equally as important, a community, uh, part of the model. And it was important for me to bring the voice of the community with the science and, and the health, uh, and the medical model, and to really do what we could to really save lives and change the trajectory of that area. Uh, I continued my journey went down to King County, as you mentioned, uh, did a lot of work around equity and other things, but I ended up going back to Snohomish County. Uh, I did, uh, was in a role of leading the Covid response in King County, and, uh, I was burned out. And I know part of this podcast is really addressing some of those areas. But you know, when you're in a place that politically is hard, I know we're going to get to some of these dialogues further. Uh, I was kind of thinking maybe I should just go do something else. And, uh, after I stepped into the interim director role, we hired the new director in King County. And Snohomish County was moving from an independent district into a governmental structure, uh, with the county government. And I was asked if I'd come back and actually be a part of that mission. And kind of like your first date. I fell in love with public health in Snohomish County and wanted to, uh, go back to the place that it actually all started. And what I didn't expect is I really fell in love with public health all over again. Uh, it's, uh, when I left there in two thousand and five, there were, um, over three hundred employees, third largest county in the state of Washington. And before Covid, they were down to one hundred and six employees. They'd lost two thirds of their workforce. And, uh, and here is the county who had our first Covid case in the United States and, uh, combined effort around our first death in King County. And they did a marvelous response, uh, with one hundred and six people to that first response with all national eyes on them. Uh, so I went back up, uh, and led them through that process of getting reintegrated back in understanding morale was low and one coming through Covid, two being, uh, what they felt was a takeover, but it was really the right decision, uh, to come into the county government structure and to really help navigate that system with them and really provide a place of space of leadership. I was going to end my career there, start there, in there, kind of bookended in Snohomish County and, uh, had set a plan to kind of do an early retirement, uh, when I turned sixty two. Um, so, uh, fast forward, governor, uh, gets elected, Governor Ferguson gets elected, and I start getting some phone calls of interest about, do you want this job? And I was pretty clear and adamant that I had a I had a different plan of retirement. But thank you for for thinking of me. And it was an honor, but, uh, no. And I said that no a few times and, uh, and I, uh, was then took a vacation, uh, another podcast. We could do about too much screen time. I was sitting on a beach with my husband celebrating his birthday, uh, on a beach vacation. And I started, uh, watching the executive orders roll out. And, boy.

Dennis Worsham: It just took me back. It took me back to.

Dennis Worsham: Uh, the very place that I started my public health career. Is the federal government stepping into a place of really denying access? The attacks around Dei, the directive around public health, uh, started to roll, and, uh, and something shifted in me. And it's kind of those moments where it's the fight or flight moment. And I decided I had one more fight in me. And so I had a recruiter call me, and I said, I'm in, and I'm going through the process, and if I'm selected, I'm committed. And, uh, and as we know, uh, because I'm here with you today, uh, I was given the opportunity and I'm really humbled by the opportunity, but it really was stepping back into a place of understanding of thirty two years of being committed to access to care, uh, public health practice and, uh, and the commitment we have to serving people who are furthest from optimal health, uh, was under attack again, just like the federal government was when I first joined public health. So that's what brought me to this this back to this role.

Dr. Anita Chopra: Great. This is such an inspiring story. And, um, I think the highlight of this story is I had one more fight left in me. I love that I love what you said. And I think that, uh, all of us in health care. Somehow, every day we come to work and think, I have this fight in me.

Dennis Worsham: I have this fight in me.

Dr. Anita Chopra: I think, uh, this was very inspiring for me. I hope that, uh, you write a book one day and you inspire younger people who are entering this field. And, uh, you know, there's so much that they can learn from your commitment to public health and just your passion to make a change.

Dennis Worsham: Thank you so much.

Dr. Carrie Perkins: I think it's so deeply relatable about seeing as you were talking about these changes, rolling out changes in federal funding, that people feel that deeply and personally, especially when you've dedicated your life and your career to public health. And you see those changes. And it's just it feels so deeply personal. And I think that response that I'm not just going to leave, I have fight left in me, and I still want to fight for these things that I believe in, I think is so powerful. But I want to go back to something that you said a little bit earlier when you were talking about both low morale and burnout. And we know that many health professionals, in the wake of what's happening federally, but also in the wake of Covid and some of these other emergent issues, um, have have really experienced burnout from things like workload or instances of moral injury, staffing shortages, or even just administrative demands. What are you hearing from providers about these pressures, and how do you think that the Department of Health can play a meaningful role in supporting that workforce?

Dennis Worsham: Yeah, I think thank you so much, Carrie. Yes. So, as you know, I've been, um, on a listening tour, uh, listening, learning. And then we're going to lead tours, and this is coming up everywhere. Uh, uh, is, you know, I think as both the healthcare system and the public health system, uh, that we, we, we really gave everything that was in our souls, uh, to this Covid response. And we wanted to assure, uh, just as I did in early in my career around the HIV pieces, that everybody had the access that we needed to get, the service they needed, everybody would have access to that prevention that they needed around vaccines and education, and we wanted to make sure that we could interrupt this transmission and people dying. And we it was tough. And, um, I saw, you know, during the Covid response, I was over the infectious disease program in King County, and then for a year and a half of my time during Covid, uh, stepped into the director role, and I saw our team work endless hours and I saw the healthcare side work endless hours. And I also saw the toll that took on people, uh, people who were physically tired, people who started to manifest their own health concerns physically and mentally saw depression, uh, and all kinds of things really play into our, our workforce. And, uh, it meant a lot to me as how do you rebuild? How do you really support people where you're at? Um, in the healthcare system, it's the same thing. And I think what made it even more difficult is it became polarized through some of the politics that all of a sudden health and public health, uh, really started getting politically, uh, in the center of the Covid response. And that also had a huge impact, uh, because it isn't something we have experienced to that level, uh, in my career. Anyway, uh, to really filling that. And I think that that also really played into people's moral health. One of the things I have been saying to people as we've been out and about in our role is one is, uh, and I know we're going to do a rapid round at the end about things that inspire us. But I one thing to know about me is I generally have a theme song that I kind of have, and sometimes they last for weeks, sometimes they last for months. And uh, one of those, uh, when I moved from, um, the role of over the infectious disease program into the director role. Extremely tired. Uh, a year into the process of Covid and my song became Andre Day's Rise Up. And she says, I'm tired. I'm beaten up. I'm. You know, where I'm at. And, uh, one of her lines in there is she says, you know, I, we have hope because we have each other. And it really was important to me to understand, uh, that, uh, in my own journey of getting back to this place, of taking care of my own health and the health of my team, was that we always had to lead with hope and, uh, that this would pass, we would get through this, and we were doing the right things for the right purposes. And our jobs were actually the work of what was importance at the time. And I think it's important for us to be connected to that. Why? And to keep hope into those conversations of where we need to continue to move. I also say to people, having watched it firsthand within the public health system, is there are there's so much stigma around mental health. And when you are in a service created environment like public health and healthcare is, we're even more sensitive to say, I need to take a break, I need to take care of myself. It feels selfish and, uh, and it's hard to step back and to make sure our own health is in good place before we lift others in that good place of health. So I really want to always put that emphasis out. There is sometimes encouraging people to step back. If you need to step back and take care of yourself. Uh, I think about the game that you play as a kid. Maybe you guys played. It was called tug. It was called, you know, Red Rover, Red Rover. Right. And you would have, uh, everybody embrace their arms and they would call the person over and they would try to break the line of where we need to go. And I think about that image of holding hands and holding arms to hold the line as best we can. And, uh, and so my message to people are is, if you're tired, take care of yourself. We're going to hold the line, uh, until you can come back and join us. And once you can hold that line, once you want to come back and hold the line with us, come back and we'll fight with you for what we need to do and bring the morale where we need to go. But we're trying to bring hope to this conversation. We're trying to get people connected back to why we're in this work to begin with. Reassure people this will pass and there's hope beyond this. And to not get so caught up in what's going on in the microcosm, but to really keep the macro of where we're going and our our role in this society is really important. And people who have the poorest health outcomes need us more now than ever, because those disparities of health are only going to get greater if we don't hold the line. So, um, so keeping that vision is really important.

Dr. Carrie Perkins: Yeah. Thank you. That's a really powerful visual, I think, of us linking arms. Right. And then creating that, that net that tension that is going to hopefully keep us together. And I also like what you said about community. And I think it's important for us to be visible to each other, that you see that strength, that we see each other, that we are all working towards the same goal. And that visibility kind of reinforces, I think, that strength and that resilience as well. Yeah.

Dr. Anita Chopra: It's so important to hold the line together. I think that's the essence of, you know, the community that we are because, you know, we have each other to lean on as well in these difficult times. And it is um, I really feel that, um, in my own practice, I constantly lean on my colleagues, I lean on my medical assistants, my clinic manager, my, uh, you know, chief, uh, of the clinic. I think that having those relationships is extremely important for us to, to to feel inspired and to feel, um, like we are making a difference. It just it's like a sense of validation. I think that's very important.

Dennis Worsham: Thank you so much.

Dr. Anita Chopra: And, Dennis, I want to change tracks a little bit and.

Dennis Worsham: Absolutely.

Dr. Anita Chopra: Talk about slowing down. You've emphasized slowing down, explaining the why behind decisions, and rebuilding trust in public health. How do you see healthcare providers contributing to that process? How can we help and what steps can d.o.h. Take to strengthen trust with communities in partnership with them?

Dennis Worsham: Yeah, yeah. You know, I've thought a lot about this, uh, a lot, uh, over the last little bit. And, uh, you know, there is so much misinformation that's out there. And I do think we have lost some trust, uh, through the Covid response, uh, and part of it becoming politicized, uh, is what has reinstated that with the misinformation that's out there and available. And I think that, um, when I think about our Covid response as a system and I mean that as the public health and the health care system working side by side is we just had to move, right? We had information. We had to make decisions quickly. Do how are we going to interrupt this transmission? How are we going to curb death? And do we need to close down schools? Do we need to close down work environments. What do we need to do that's going to protect the area? And we were making decisions very fast in order to be able to save people's lives, literally, and to interrupt transmission of of disease. And I think about prior to Covid that we as a public health system and a healthcare system, uh, oftentimes people would say, you know, um, let's, let's apply a public health approach. It didn't matter if it was around transportation or incarceration. People started using this terminology, even outside of the public health world, about a public health approach, because it was such a trusted community and process in which we did our work. And now we're on the other side of Covid, and now there's this sense of not trusting who we are and the work that we do. And I think, again, part of that is, you know, the politicization, misinformation that's out there. And I do think we have to slow down a bit. I think about in our public health practice, if you look from the nineteen twenties to currently, right, is we have made over twenty years of progress, of life expectancy, and that has really come through really strong medical and public health interventions, from vaccines to injury and violence prevention to sanitary to clean water. A whole bunch of public health practice is where we gained that trust. And I think we're going to have to slow that down and really remind people of what we do in public health and the outcomes of what we've done in public health. And I think we're going to also have to slow down and say why we're doing what we're doing currently. If when we just did the West Coast Health Alliance. It was really important for me to be in front of the media and to say, we're doing this because. And, uh, and really tie it back to science, to our medical community, to. Academy of Pediatrics, Acog, all those really strong medical communities of really around where the science was and getting people clear. When we did the standing order, it was really important to say a standing order is a prescription. That's all we're doing. We're writing a prescription. So you have access in your pharmacies without having to go to your doctors to get a vaccine. That's why we're doing the standing order. If you're still not sure, talk to your doctor, have a conversation. And I think we're going to have to have those kind of intentional, slower conversations and allow some dialogue in those places in order to rebuild trust. And our outcomes will get us there, because they always have. In public health, we deliver, uh, good, uh, practice. We intervene. We we make our communities healthier. We just have to have rebuild those conversations and they'll start, you know, at a relational level through dialogue.

Dr. Anita Chopra: You know, this is so important, what you said about trust. I think for patients, it is an opportunity to deliver or get better health care, and physicians can deliver better health care if there is trust. And then patients can feel more empowered and aware and their ability to assimilate the correct scientific information increases. And they can dispel myths. They can tell the untruths. What? What is the truth? What is and what is not. The you know what is not the truth, but for the other side, for physicians, I think it helps us, uh, build our own professional identity when we establish that connection of trust. I often have my students, you know, with me in clinic or even during our community outreach efforts and what I can see firsthand is their professional identity being developed. They're out in the community as they are building trust.

Dennis Worsham: Yeah. If I could just say one thing on the medical side, and I think that this is an important part of us on the public health side as well is, you know, I, I choose my provider by somebody I feel comfortable with. And that comfort comes from me sitting in space with that provider and having that provider see me for who I am and what my values are and what I have. And we have that dialogue one on one, and that's how that relationship starts, and that's how the trust then unfolds going forward. And I think what I'm trying to do is take that model in the public health side. And it starts at a relational level, right? When I show up in eastern Washington, where I was born and raised, in the small town of Othello in Adams County, and I show up and I say, I get it. I grew up here. I understand I'm one of you. And let me tell you about my own journey, is that trust happens because there's a relationship. And just like in the provider relationship, public health is going to have to get back in and get to that relational level that we are going to really change things in the long term.

Dr. Carrie Perkins: I agree, it's so important to meet people where they're at, I think, and showing up and actually making, um, you know, making that commitment is deeply symbolic. And it says a lot about, you know, the commitment to doing this work. Yeah. Um, I wanted to go back a little bit. We mentioned your listening tour, and you talked a little bit about some of the themes that were coming out of that tour, being related to burnout and how people are managing that. Are there other themes or stories that you're hearing from healthcare workers during that listening tour?

Dennis Worsham: Yes. Uh, you know, in the listening tour, you know, when you're a newly appointed position like my the one I've stepped into, you know, the first question out the door is what are your priorities. And, uh. And what I have learned, you know, and, uh, in my own journey. Right. I came in at a front door, entry level position in public health, and, uh, and I what I learned, uh, through my journey is the importance of taking time and listening with people who are closest to the work and what they're experiencing. Uh, before you make any decisions about where you're going to go. So it was important for me to set a framework in the framework that I have set in this listening tour are four areas of focus that I'm trying to get input on. And one is how do we strengthen the governmental public health system? And when I talk about the governmental public health system, it's really local public health, it's state public health, it's tribal health, and it's the state Board of health. That's the governmental public health system. And when I talk about then the other, uh, area of focus is how do we strengthen the health care system. And that is also tribal health. That's, uh, hospitals, that's clinics, that's behavioral health, that's, uh, whole person health, in those particular spaces, and what can we do to strengthen that system? Because public health has two pillars is we have our traditional public health side, but we also have uh, on our other pillar is really around healthcare. And if I were to say our pillar is about protection, promotion and prevention and public health, on the healthcare side, it's really about quality. It's about access and it's about affordability. And the other part of this work is in the listening tour is then how do we work together across those two systems to improve health equity, or what I'm calling health justice. And the other one is how do we then work with our team, which we've addressed here around burnout and supporting our workforce through this really difficult time? The thing I'm hearing is there is so much fear in the system right now. Uh, we're seeing funding cuts. We're seeing Medicaid cuts that have already passed. Uh, we expect two hundred and fifty thousand people are going to lose access to their, uh, Medicaid. Another one hundred and fifty thousand are going to be priced out. We're talking four hundred thousand people. I said in critical access hospitals in eastern Washington, where over sixty percent of their payer mix is for Medicaid, and they're like, what's going to happen? What's going to happen about aging in place, serving the communities where we're at? What are we going to do? So I'm hearing a lot of fear, the public health side. Same thing. We see this dismantling of the public health system from data to infrastructures of funding. And what do we really do in this particular area. And I think it's the call to action. Going back to this visual of of the holding the line is how do we come together to really think about are there opportunities in this place to really do some innovative good work that we need to do? And I think that's going to move us to the action plan. But there is a hunger and a need for people not to feel isolated in their professions and thinking about how we build the momentum and if we can bring tribal health, uh, physical health, behavioral health, public health. And, uh, for me, also equally as important, people who we serve people in the community to the table to think about how we're going to move through this time is going to be really, really critical in what we need to do. I'm hearing things from data integrity. Uh, and where is data going to come from that really drives what we do. And that's both on the health care and public health side I've heard about how do we, uh, around vaccines, uh, vaccine preventable diseases, uh, as this war on vaccines and integrity of vaccines is starting to health care providers are asking for help because if we, for example, start seeing which we have already, uh, in the within the last year, is that as people aren't getting their Covid vaccines or aren't getting their flu vaccines or their measles vaccines, is it puts greater pressure on the systems of the healthcare response. If people lose their health care and don't have a primary care doctor and they're using emergency rooms for their primary care, is putting more stress on the system. So the question is, on this continuum, from community to tribes to public health to healthcare, is what is each of our role and where can we really support each other in really getting through where we're at? So we're going to be developing kind of an action plan based on several of these things coming through. And how do we strengthen these systems individually but also collectively.

Dr. Carrie Perkins: And I'll just add in, you know, over the past couple of months, I've been interviewing sites that host our caravan mobile clinics. I've been talking to working groups that work with people with lived experiences of homelessness. And I'm hearing very, very similar concerns of uncertainty, of worrying about vaccine availability, what this is actually going to do to communities when they don't have access to these services. And so I would really, you know, just reinforce what you've said is that I think that these themes are absolutely real.

Dennis Worsham: Yeah.

Dr. Anita Chopra: And I also liked the fact that your commitment and the commitment to inclusion, you talked about tribal health. I think that is so very important for all of us to be together, to be inclusive and to not leave any groups behind. We have to be mindful of all these different groups. And, you know, I think that when all of us are safe, then each one of us is safe. Uh, then it's across your career. You've had to make hard decisions under pressure. And I don't really envy your job, especially during, you know, public health emergencies like infectious disease outbreaks. Health care workers face similar pressures every day at the bedside and in their communities. From your perspective, your experiences, what helps people stay grounded keep their sense of purpose in those high stress moments and also keep their motivation, not give up.

Dennis Worsham: Yeah. Yeah. You know.

Dennis Worsham: As we talked about a little bit earlier, you know, I'm a big believer of getting connected to why we're in the field to begin with. Uh, is certainly an important part of that. I also think it's important in this space is not to get isolated, uh, from, uh, being away from the people that we actually serve. And, uh, that is a motivator for me is, you know, it's easy for us in our public health world or in our Department of Health world is to become insular, and we start working only with other people in public health or the health care system, and we get further removed from the people we're actually serving. And I find that if we can stay connected to the people who need us the most and understand what their needs are, it's a motivation for us. But there's also a a Reaffirming, uh, the services that we are providing, how important it is for people who are receiving those particular areas. I'll give you one example. And it's kind of it's kind of insular, but not, uh, is, uh, when we made the decision around the standing order. Right. It was uh, it was quickly we had to make it quickly. Uh, and we made the decision based on FDA, with the Covid vaccine coming out, that it was only going to be available. Their recommendation was for sixty five and older, which takes anybody who's under sixty five off label. And when you're off label, uh, then it takes that prescription in order to be able to get that. And we know in the state of Washington, uh, we have, uh, nearly sixty percent of people who are getting RSV, flu and Covid vaccines are for pharmacists. And taking that access away was really important. Uh, to address really immediately. So we did this prescription standing order approach. I heard from one of our own staff members, uh, who has a special needs child, uh, who has some healthcare issues, uh, and, uh, and family members who live with this, this child in this, in this ecosystem of of family dynamics. Uh, they live in Idaho, and they were not able to get a vaccine for the rest of the family to protect the health of this kid. Uh, the kid could get a vaccine, but the rest of the family wasn't eligible for a vaccine. And she had to load up her family, drive to Washington, to a pharmacist able to get their whole family vaccinated to protect their kid that they couldn't do in their own community in Idaho. And it's just a good reminder that we made that decision quickly for important reasons. And as soon as you hear that story come forward of a family that benefited from that, it then motivates you to say, we're doing the right thing. We got to keep doing no matter what the pressures are, no matter what the rhetoric is out there, people are benefited by the decisions we make for their family and for individuals. And that's always a good motivator for me.

Dr. Carrie Perkins: Yeah, absolutely. I mean, it's just understanding there are real people behind these headlines, behind these numbers, and it affects people on such a granular level. Yes. Um, so when you look back over your career, also kind of thinking about how your career has spanned over three decades now, um, is there a moment that really stays with you when you thought like, this is why we do this work, this is why this is important? Or is there a time when you saw public health or healthcare make that real sort of impact?

Dennis Worsham: Yeah. You know. I, um, I've had many of those moments, you know, to be honest. Uh, of course, we've talked about my HIV journey, which probably made it most real for me, uh, because, uh, you know, I saw so many people die, and, uh, and to know that we were helping people, uh, who were Scared, confused, and, uh, and, you know, it's weird. Uh, and and hard coming out as a gay man. Right? I was in my late twenties, early thirties, and I started even believing myself that if I make it to fifty, it will be a miracle. Like to have that become a community norm, uh, around people you die is really impactful. And to be able to change that narrative and to support people through that process and give them hope, uh, and the tools that they need to have the best health they have. I think about, you know, the time when, uh, this is, you know, again, a different population, but a similar thing that is also just gave me like, pride in the work we were doing. I became a program manager for TB and serving, uh, people with tuberculosis. And generally those are foreign born people who come from high endemic areas that were able to really help provide services to. But in my role there, we had a major outbreak in our homeless population. And again, a population that has historically marginalized, uh, and we oftentimes don't even make eye contact with when we're out on the streets ourself and how, uh, we needed to change the outcomes of getting people the treatment that they needed to be able to do. And I remember a really sweet moment where we decided, based on my HIV experience, we were going to bring people who were living unhoused out to dinner. We had a white tablecloth dinner, and we set our homeless populations who had been impacted by TB and wanted to hear from them directly about what they needed and what services they needed in order to stay compliant to the medication. Because, as you know, as a doctor, uh, that's a long journey through that medication process. And they gave us clear things. And one of them was that getting to Harborview up the hill was a was a really challenge when at that time, the free bus zone, uh, didn't take you all the way up to Harborview. And so, uh, so we ended up setting up a clinic downtown in one of our homeless shelters. And actually we're able to provide those services. And I was like, this is what public health does, right? We listen, we learn, and we provide services to the people and meet them where they're at. You know, Carrie, you made that very comment earlier and it was a good moment. And I think about those opportunities where we have brought people in, uh, who, uh, were struggling in other topic areas, and we listened to them and we really create systems. And I'm just like, every time those moments happen where you talk to a person who's behind that challenge of, of illness or disease is coming up with a solution that is co-created with community and people who are most impacted. Reminds me of like, these are cool moments and this is what public health does.

Dr. Carrie Perkins: I could not have said it better. I'm so am in agreement with you about this co-creation of knowledge and bringing people to the table to have that conversation. I read this book over the summer that was called When We Walk By, and it was by a guy named Kevin Adler, and he's talking about, you know, this, this aspect of our culture that doesn't even allow us that, where we often don't make that eye contact, right when we are just ignoring these systemic problems because it makes us uncomfortable. And it was about confronting the things that make us feel uncomfortable is the only way to actually implement systemic change that's sustainable. And it's such an important, you know, it's such an important conversation to have. And so I thank you for verbalizing that in such an eloquent way. Um, if you can believe it, we're actually close to the end of our questions before we get to our fun ones. But I thought we'd give you an opportunity. Um, if there's something, um, one piece of advice or, um, a message that you might want to say to the people that are doing this type of work every day, is there a message or a reminder that you hope that they carry with them when things get hard?

Dennis Worsham: Yeah. Well, I was just this.

Dennis Worsham: Just comes from my own spiritual values of who I am as a person. And I say one of the most important things we can do is live in a place of gratitude, that there is something to be grateful for every day. And we need we need to find it and look for it. And if we're struggling with that, I always say start a gratitude journal. It's just name five things every day that you're grateful for. And what it does is it starts to shift your perception to the good things that are happening around us. And I think it's important in this time where we feel so much despair around us is getting reconnected to gratitude. And I there are there are good things happening and we can't lose track of that. Uh, the other thing I would say is stay hopeful and, uh, that everything is a time and a season and it will pass. And, um, and, you know, I'm kind of a spiritual woo woo guy. Uh, Eckhart Tolle is a couple of books I've read of his that I really like, and one of them was The New Earth, and I read it many years ago, uh, and I read it again during Covid and, uh, and it was an interesting read the second time under something that was so difficult going on and I watched an interview with him in, in in the concept of New Earth. It's really that we're evolving as a society and as a people to something better. And I was like, are we are we? It doesn't always.

Dr. Carrie Perkins: Feel like it.

Dennis Worsham: You know, and he had a comment that I stuck with me. And it's a nice visual for me. And he, he gave the, uh, the visual of being at the ocean. And sometimes there are undercurrents that pull us back. And we're in a time where I feel there's this undercurrent that we're fighting against, and it's pulling everything it can back. But that momentum of pulling back also projects that wave to go further when it hits the shore the next time around. And I want to tell people that we're we are feeling that undercurrent right now, and we're fighting against that current because we don't want any harm to be done to the people we care about, to the communities we serve and the people that we are locked arms with to hold the line. But I believe this undercurrent is going to give us momentum, and we're going to come back better, stronger on the other side of this. And we got to keep that vision of what we want to see. Uh, the new world to look like, uh, and as we evolve to that's that's the message I really want people is something good is going to come from all of this angst.

Dr. Carrie Perkins: Excellent. Thank you so much. All right. We're going to move to a quick lightning round. On a lighter note, um, is there any TV show that you're into right now or a book or a podcast that you'd like to recommend to our listeners, or what's helping you recharge these days?

Dennis Worsham: Yeah. Uh. Let's see. Well, you know, I'm a big Brene Brown fan. I think you probably know that from your time at the Department of Health. And she's just come out with a new book. I've just started it. So, uh, I love Brene Brown. I think it talks about our vulnerabilities and leaning in and not armoring up. And I think it's really, really important messages right now is not to get armored up and to stay in a place of curiosity and, uh, and to really continue to ask the whys and understand that and kind of move in a good place. I just started I'm only a couple of episodes into it, but the new show, boots, uh, is really, uh, interesting. And, you know, of course it's got a gay character in it, and it's about the military. Uh, my husband is retired military and, uh, and certainly is, uh, it's fun watching it with him and kind of having those experiences, but, uh, enjoying that show. And it's kind of a fun watch. There's a little bit of drama in it, a little, uh, challenges, but it's, uh, but it's a good escape and a good watch. And the song right now, as I mentioned earlier, is have a song. Uh, and I'm trying to find my why in this work. And, uh, David Archuleta, it's although it's a Christmas song. It's not really a Christmas song, but it's called, um, glorious. Okay. And in the song, glorious, uh, he talks about the symphony, and he says, we all play a part and there is music that we are all playing, whether it's in the healthcare system and the public health system or the varieties of system. We all have music that we're playing, and the idea is figuring out what our part is and bringing that music together to really create this glorious symphony. And I'm it's I'm holding that space is in this listening time is what is the opportunity of creating a symphony that really is about bringing people together, creating the harmonies and really creating this beautiful music together that is really going to serve our populations in the best way possible. So that's the song I'm holding right now is kind of my theme song is leading towards something glorious.

Dr. Carrie Perkins: Great. I'm making notes for my Spotify list or my SoundCloud these days. Great. Thank you. Um, I've also added boots. I grew up on military bases. My dad was career military, and so I've also got a little bit of that context. Um, have you seen The Pit at all? That's been.

Dennis Worsham: I haven't.

Dr. Carrie Perkins: That one's been popular with my healthcare colleagues. It's like a yeah, it's called The Pit. It's on HBO, but it's a okay, the entire series is like twenty four hours in an emergency room in the U.S.

Dennis Worsham: I have heard about this.

Dr. Carrie Perkins: Yeah, it's pretty good to binge watch. I'll.

Dennis Worsham: I'll check it out.

Dr. Carrie Perkins: So if you weren't working in public health, uh, what other career could you imagine for yourself? What would you be doing if it wasn't this?

Dennis Worsham: If I wasn't doing this? Um, I think I really, you know, my early years in public health, being a health educator, uh, I loved. And so I would probably do something in the area of education. And based on what my experience is now, I'd love to be like a leadership coach and or leadership development, uh, and really help, uh, that, uh, people who are in those places is to be able to connect to their own power and help them find their strengths and their magic and bring that forth and, uh, really help change systems, because I think sometimes our systems are challenging and good leaders can navigate those and break those down and bring people along. So I probably would do leadership coaching or leadership development.

Dr. Carrie Perkins: That sounds like a good fit. Yeah. And so last question. What's one piece of advice you have for our future healthcare leaders, future physicians that might be in the thick of med school, grad school right now. Do you have a piece of advice that you would give them as they're entering the field?

Dennis Worsham: Yes. Uh, my bit of advice is, uh, you've chosen your right field and, uh, that, you know, I have to say, and I did this. I did some coaching with a one of my staff, uh, in a former place. And you know what? This is? My truth is that I was. I'm so lucky to have found a career path that is more than a job that I really feel. It's my work, and I feel that I get to give back in some way every day. Uh, to not only the people I work with and have the opportunity to serve in this role, but also, and more importantly, to the communities in which really need a voice, uh, to make sure they have the access and the the chance of well-being that we all do. And, uh, and so you've hang in there because it's more than a job. It really becomes your work and your purpose. And what we know about social determinants of health is being connected to your purpose is really one thing that really gives us longevity and good health. So get connected to your work. And I think this is a really good path.

Dr. Carrie Perkins: Excellent. Dennis, thank you so much for taking the time to talk with us today and for sharing your story, your perspective, and your heart for this work. It's been such a meaningful conversation, and I know that our listeners are really going to take a lot of inspiration from it. And to everyone who's tuning in, thank you so much for joining us. Until next time, take care of yourselves and each other.

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