Working the Front Lines: Julie Maggi, COVID-19 Faculty Wellness Coordinator, Faculty of Medicine, U of T

Julie Maggi, mother of Matteo Maggi, Class of 2028, is the of Director of the Postgraduate Wellness Office, Post MD Education, and the COVID-19 Faculty Wellness Coordinator, Faculty of Medicine at the University of Toronto. Her job has taken on new meaning since the COVID outbreak. We had a chance to ask her a few questions about what her job entails these days.
RSGC: Where exactly do you work?
Julie Maggi: Right now, I do a few things. I am a psychiatrist at St. Michael’s Hospital. I am also the Director of the Postgraduate Wellness Office in the Faculty of Medicine at U of T, and as of April 1, I have been tasked with a new role, which is the COVID-19 Faculty Wellness Coordinator in the Faculty of Medicine.
 
RSGC: What is your education background?
JM: I went to McGill University, and then I studied medicine at McMaster University. I did my psychiatry residency training and Master’s degree at U of T. Following that, I spent some time studying in the subspecialty fields of Consultation-Liaison Psychiatry and Administrative Psychiatry at Mt. Sinai School of Medicine and Columbia University in NYC, respectively.
 
RSGC: You mentioned you are taking care of the 3,500 doctors in specialty training to make sure things go well during the COVID outbreak. What exactly does that entail?
 
JM: Yes, at the U of T, we have approximately 3,500 post-graduate trainees in medicine – so residents and fellows. These are individuals doing their specialty training after they finish medical school. (They are the physicians who you usually see first when you go to any of the teaching hospitals in Toronto, and definitely the physicians you see most after the usual daytime hours!) My office at the university addressed the wellness needs of this group, offering leadership around supporting wellness in the training programs, and we also have counsellors if needed. At this time during COVID, we are increasing the capacity of our counsellors to see individuals in need. We are teaching residents and fellows who have leadership roles how they can support the other trainees during the pandemic, and we are helping all the resident doctors who may themselves be at high risk of developing severe COVID due to health vulnerabilities, to determine if and under what circumstances they can work at this time.
 
RSGC: In addition to the physical health dangers of COVID, there must surely be a serious mental health risk for those working the frontlines and even those stuck at home?
 
JM: Healthcare providers dealing with the pandemic are being put into unprecedented situations, making decisions they never thought they would have to make, working under pressure, and working with concerns that they will not have enough personal protective equipment to keep themselves and others safe, and ventilators to keep people alive. These uncertainties and pressures will take a toll as this pandemic progresses. If we do not support people in ways that buffer some of the stresses, the toll will be even higher. We know this from SARS and we know it from the data coming out of Wuhan. We need to proactively take steps to ensure people’s mental and physical wellbeing is attended to, and we need to put things in place to support them at this time when healthcare providers are so busy they may not be attending to their own health. We need to keep healthcare providers healthy, so they can work to take care of the health needs of the population. My task is to lead the coordination of those efforts at the U of T Faculty of Medicine for the doctors in training and for the faculty doctors.
 
We know from data collected during the SARS epidemic that those in quarantine can feel more anxious and down. Being at home can contribute to us feeling isolated. It’s helpful for individuals to keep to a routine, keep in touch with friends, keep active and not to watch the endless COVID coverage.  
 
RSGC: Did you “sign up” for this when you accepted the job? As in, did you ever imagine this is something you would be doing?
JM: Funny you should ask. Just the other day, I was speaking with a colleague and we were talking about our sense of service to the profession and to others, and how despite the long days and challenges right now, this is what we signed up for.
 
I finished my psychiatric training right around the time of SARS and worked at a hospital which was a treatment centre for SARS. Since then, we have had discussions at various times about preparedness for when the next epidemic would happen – Ebola, H1N1, etc. So, in a way, I figured there would eventually be a larger scale infection that we would be dealing with. However, I didn’t imagine it would be quite like this in terms of the impact on life outside of the hospital. Even had I been told this in advance, I’m not sure I could really have appreciated what it now feels like to be in the midst of this.
 
RSGC: How much has your life changed? You said your life is pretty much COVID all the time?
JM: The entire hospital and Faculty of Medicine has transitioned in just a few weeks to be entirely about the response to this pandemic. On the one hand, I am completely amazed at how this happened, how quickly so many resources were mobilized, and how so many people rose to the challenge to manage this in a truly collaborative way. Now more than ever, we are working as a team with a defined purpose. As well, just like RSGC, we have had to transition to the virtual world. For us, that has meant virtual medical care when possible, and all our meetings are all virtual. (I sit in front of the computer for most of the day!) What I struggle with is the fact that everything not related to COVID in the hospital and university has really been put on hold. For physicians, we are having to make very difficult decisions – can this person’s care wait until after the pandemic is over? Should I advocate for them to be cared for now? If I start this treatment, will it be interrupted by my having to be redeployed to another area if patient numbers surge? I was talking to colleagues this week about how we never imagined we would have to make these sorts of decisions. This is tiring, and it keeps us up at night.
 
RSGC: How does it feel to know that you’re making a difference?
JM: It feels very fulfilling – making a difference is why I chose this profession. It’s a privilege to do what I do and I am reminded of that every day when I have the opportunity be with patients, and to contribute and make the decisions I am tasked with.
 
RSGC: Are you working longer hours than usual?
JM: In my clinical practice, the hours are much less right now. In the hospital, we have had to really stop all non-urgent/non-emergency services to make time and space for when the increase in patients will arrive in the coming weeks. My colleagues and I have also decided to work in a model where we alternate coverage of urgent psychiatric services, taking a few weeks at a time each, in order to ensure we always have a cohort of physicians who are healthy to step in if needed. Soon, this may be different as patient volumes will go up.
 
In my university job, I couldn’t be busier. The hours are extremely long right now. We are focused on putting in place supports to help physicians stay healthy during this time. We are working with our partner organizations to ensure that they attend to the things we know will help physicians cope so that we can come to the other end of this crisis unified and healthy.
 
RSGC: Any tips for the general public to “take care of themselves”?
JM: Attend to sleep. Don’t watch too much news about COVID; just update yourself once daily on the evolving public health recommendations from a trusted source like the Medical Officer of Health or the Public Health Officer of Canada. Find ways to stay socially connected even when you have to be physically distant. Find ways to stay active. Be optimistic – we will get through this. Try to find ways to acknowledge those who are working to take care of those affected with COVID and those people doing all the essential services right now from grocery workers, to TTC drivers, to teachers keeping school going – this helps them and helps you to; it’s a win-win.
 
RSGC: Anything else to add?
JM: Please, please stay home, and wash your hands. This is everyone’s way of helping right now. 

Thank you for all that you do, Julie.
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