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Our Voices

How to End Clinician Burnout

An photo of the change creates change team (four white women) standing in front of a store front.
Change Creates Change, left to right, Andrea Paul, Jillian Walsh, Collette Walsh, and Sierra Pineo.

Burned out and done, dietitian Jillian Walsh needed a change. Seeking to create a better life for herself, her family, colleagues and improve client outcomes, Walsh set out on her own, starting up Change Creates Change (CCC), a series of private care clinics specializing in treating eating disorders with a feminist focus. 

In addition to coping with heightened emotional, social and financial pressures of her own during the peak of the COVID-19 pandemic, Walsh found the public health care system overwhelmed, leaving people struggling with eating disorders to fend for themselves. The system was also unable to meet her own support needs as a professional, partner, and new parent within that system.

Even before the pandemic, eating disorder care has been a female-dominated health care specialty – in Canada, about 95 percent of dieticians identify as women, and about 80 percent do so in the US –with a chronically high burnout rate.  Walsh adds that despite being women-led, the profession offered poor flexibility and low work-life balance, especially for new mothers. The current framework – based on the traditional western medical system, which is rooted in misogyny and patriarchy – simply doesn’t work for many women in the field, herself included. It results in poor mental health, which in turn, negatively impacts the quality and effectiveness of care they can give clients. 

“A lot of the staff at CCC can’t work 9-to-5, Monday to Friday. We can’t put in seven hours straight on, using telehealth or in an office, but those were the demands put on us,” says Walsh. 

Creating a Feminist Enterprise

For Walsh, building a new, more feminist work environment “was about the flexibility and the autonomy to be able to meet our own professional care needs, versus having to assimilate to the traditional culture of the work environment,” noting that this means some of her staff work in the morning or evening, depending on what works best for them.

“A lot of us work with our kids on our laps – I had my five-month-old baby in a carrier all the time. I’d never be able to do that in the public system, but I was able to do it over here (at CCC) and still do the work I want to do.”

Walsh also strives to build an environment where people communicate regularly and feel safe expressing themselves when maxed out. Several times a year, staff are entitled to ‘think weeks’, which are periods when they don’t necessarily have to come into the office or see patients, but they’re doing other things, like catching up on research papers or working on other aspects of their professional life – something significant in her field, she says, because of the ‘emotional toll’ working with people struggling with an eating disorder can take on a professional caregiver. 

“We’re exposed to secondary trauma each and every day, and sometimes we become traumatized ourselves,” says Walsh, noting that awareness of this and making space and time for it was “Something that was really lacking in our past positions and experiences.”

Eating disorders constitute a broad category of diagnosable illnesses, which often require treatment for both physical and mental health. CCC predominantly works with kids and youth up to around 25, says Walsh. This puts most of her company’s clients squarely in the Gen Z demographic – an age range which is the queerest in recent history, with about 20 per cent identifying as members of the LGTBQ+ community and around 15% of those identifying as ‘queer or transgender.’ This is important as queer people – particularly trans and non-binary folks–are at a higher risk of disordered eating and experience it at higher rates than the general population. 

At present, none of the staff at CCC openly identified through the website as anything other than cis, and all are women. A lack of access to trans-informed, gender-affirming care is a recognized barrier to healthcare for gender non-conforming folk.

Likewise, the overwhelming majority of CCC’s staff is white. This is, again, notable, particularly in an industry which has come under criticism for practices which exclude, ignore or vilify non-white body types, diets and experiences. As a result of these ingrained biases, dietetics as a profession hasn’t been traditionally friendly to non-conforming bodies, sexualities or non-white people, and studies show a lack of diversity is a problem among Canadian dieticians in particular. 

Walsh is aware these are problems but notes they aren’t specific to her company; the entire industry struggles with this and its history of practice. “The industry has historically also been ‘shitty’ because what it was traditionally trained its clinicians to do was “to tell people to lose weight” 

To combat this inherited bias, Walsh says her company is offering intern positions to folks from ‘non-dominant systemic identities,’ even if they don’t have the traditional academic training or if they choose not to stay on and work with the company in the future. 

“We want to train these folks because we want to hire them, but (at the moment) we have nobody to hire (in these demographics) because either they don’t feel safe to apply or they haven’t had the opportunities within dietetics yet,” says Walsh. “There’s been a big movement in the past five years… calling out white women in dietetics for taking up too much space– and we are taking up too much space.”

“We don’t need more white women as interns. We need to do our part in diversifying dietetics.” 

Eating Disorders Are Rising

The pandemic has fueled a documented rise in eating disorder diagnoses and relapses. Walsh thinks part of this is that parents have been home with their kids more and therefore more able to notice – and be alarmed by – unhealthy behaviours. 

“Before COVID-19, the wait times for eating disorder care within the public system was anywhere from three months to 12 months–and when we talk about the nature of an eating disorder, time is of the essence, because the longer it goes untreated, the harder it is to treat, the more difficult it is to overcome and actually the more damage it does to the body. Unfortunately with COVID-19, a lot of the public eating disorder programs got shut down and their staff were redeployed to vaccine clinics, to be the people at the door checking temperatures and stuff, so the virus) created a significant backlog where wait times were either doubled, tripled, quadrupled or just closed altogether,” says Walsh.

“Parents were in a lot of distress because they were noticing that their kids were extremely sick. They were going to the doctor and the doctor was like “Yep, this looks like an eating disorder – go over to the public system.” And the public system is like “Yep, absolutely. We’ll see you in 12 to 24 months.’”

As a result, the need for care for eating disorders has ballooned, putting even more stress on an already strained arm of the healthcare system, and creating more demand for private care clinics like CCC–care which costs around $150 an hour. 

From a feminist perspective, a private care clinic model poses a problem. Can a health care business that provides essential, potentially life-saving medical services only to those who can afford to pay for it, either out of pocket or by insurance – the demographic which, by Walsh’s admission, makes up the majority of CCC’s clients – really be said to be feminist? 

Walsh admits that, yes, the private health care model does pose a problem from this angle – one she hopes to address in the future. 

“We’re only in month 18 of operations. We’re only now being able to find our feet underneath us to start to put more time and energy into the equity pricing models so that we can actually offer services to everyone, not just folks that are privileged.”

That might include something like a sliding scale or pay-what-you-can model, says Walsh, or a fund where wealthier patients can donate cash to help pay for clients who can’t afford it. She notes that the company isn’t tied to the ‘for profit model’ and moving to a not-for-profit model is something she might consider in the future. 

“We’re very new and just trying to see what governance model we need to fall under to be as sustainable as possible. “We’re trying to flip that model because the goal is not actually to develop a profit – it’s just to create sustainable employment for women in eating disorder care.” 

Publishers Note: Change Creates Change participated in the Fifth Wave  Initiative, a year-round program offered by CFC Media Lab and its partners to support the growth and development of women entrepreneurs in the digital media sector in southern Ontario. All enterprise founders in the Fifth Wave community are selected for both their potential and commitment toward weaving intersectional feminist ideals of equity and fairness into sustainable and scalable business growth strategies. Fifth Wave Initiative is committed to minimum of 50% participation per cohort by members of underrepresented groups. The Fifth Wave is a LiisBeth ally sponsor at the Lighthouse levelApplications for Cohort 5 are open August 25. Apply here

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Our Voices

A Feminist Entrepreneur’s To Do List

Image of protestors with sign that reads Capitalism depends on unpaid care work. No more Work for Free.
Image by Dante Busquets | Shutterstock

With the new year and a vaccine on the horizon, many entrepreneurs are crawling from the wreckage known as 2020, dusting off, and thinking, what next?

In the past, mainstream entrepreneurship has focused on opportunity and extraction: find a market gap or problem, figure out how to exploit it, and then work to extract as much wealth and power for yourself and investors as possible. Meanwhile, social entrepreneurs sought to find the harm caused by Big C Capitalist pursuits; figure out how to fix the mess; then set to work abiding by capitalist light rules.

Neither one of these models make sense for the ground that has shifted beneath our feet this past year and for what’s coming next. The very purpose of entrepreneurship, attendant policies, and the way we do business must undergo a profound revolution.

So, in addition to all the things we normally think about—launching,  pivoting, downsizing, upsizing, going digital, managing growth (some enterprises are thriving!), getting through the next lockdown, making payroll—there is this to consider: how to build a truly accountable enterprise that models an inclusive, restorative, and generative future versus perpetuating the rapacious systems, standing behind decorative diversity mission statements and operating with the fear-based mindset of the now.

Of course, no one knows the answer to that big question, but here are some things to kickstart the process of getting there:

  1. Stop perpetuating systemic oppression: Take a hard look at your culture, policies, pay scales, processes and practices. Centre the word ‘care,’ and start rooting out anything that enables oppression—whether racism, anti-black racism, white supremacy, colonialism. Let’s turn the page on the way we lead, communicate, operate, and design products and services.
  2. Advance critical consciousness: Do action work. Participate in and encourage difficult, uncomfortable conversations that lead to personal growth, political awareness, and systems thinking mindsets for staff, customers and suppliers. Everyone, not just the founder, must evolve and reckon with internalized oppression as well as external. We learn best in community with others. Seek out expertise and communities that facilitate growth and help sustain them in return.
  3. Take stock of whose work and ideas you amplify: What stories do you tell on your company blog? Whose ideas do you advance on social media? What art do you hang on your workspace walls? Looking at who and what you focus on can also tell you who and what you’re not supporting—and should.
  4. Re-write your procurement policy: Make a commitment to sign up to WEP and direct 30 per cent or more of your procurement spend to enterprises owned by women, BIPOC, trans or gender-expansive folk. These directories can help you find the services or products you need:  Black, Women’s or LGBTQ Chamber of Commerce, The Native Women’s Association, Immigrant Women in Business, Feminist Founders, WEKH Ask and Give app, WeConnect and Femmbought—to name just a few. Follow our stories about services offered by feminist founders on and in our newsletter. We have profiled over 183 feminist identified, progressive enterprises that are all looking for customers and a shot at new generative collaborations.
  5. Get Political and connect with other aligned social movements: Social change is collective work—not hero work. And the best and freshest thinking today is generated by BIPOC, women-led, grassroots, activist groups, not large, corporatized institutions. Engage with BLMCda, BLM USA, the LEAP, DIEM25, Pace e Bene, Salmon Nation, and other generative movements that embrace social justice, feminism, and environmentalism. Sign up for their newsletters. Donate. Invite their speakers to talk to your stakeholder group. Invite an activist to sit on your advisory or fiduciary board.  Answer their calls to action. It has to be a give and take.
  6. Diversify your media spend and attention: Spend at least 50 per cent of your annual media budget on indie outlets to diversify your listening power. Consider indie outlets such as, APTN (Indigenous) Yes Magazine, Herizons, Peeps Magazine and, of course,
  7. Ask who’s in the room? Who’s not? And consider why? Over 54 per cent of all businesses in Canada have one to four employees (considered micro companies by StatsCan) often including the founder and co-founder.  This presents an obvious challenge when it comes to advancing inclusion: your company may just be a close-knit founding team of three cis-het white women with no plan or money to hire. And that’s OK. But there are countless ways micro companies like this can engage with the 30 per cent of the Canadian population that is BIPOC identified. Make that engagement a priority as it will inform and strengthen your work. Need advice? Join the Feminist Enterprise Commons community (FEC).
  8. Trailblaze like a trailblazer: Like Bloom + Brilliance, a women-owned website and branding company, be transparent about your intersectional feminist values on your business website. Integrate the use of pronouns in your staff directory and website. Radically change your bylaws to strengthen accountability. Consider implementing a barter pay system in addition to trading in cash (because a lot of folks will have a lot less of it next year).

As brutal as the year was, 2020 delivered a gift: it has unveiled what needs fixing in ways that not even mainstream folks can continue to ignore.  We cannot turn away from it or all the suffering will have been for nothing, all the pain and carnage will continue. I suggest we heed the words of Audre Lorde: It is time for us all to be “deliberate and afraid of nothing.”

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