Clinical Ethicist — Jennifer Chan

This week’s spotlight is on Jennifer Chan, a non-clinical occupational therapist who is now Clinical Ethicist at Sutter Health!

What is your full name, title, and company name for your current, primary role?

Jennifer Chan, MS, OTR/L, HEC-C — Clinical Ethicist at Sutter Health

Where are you located?

Modesto, California.

Where did you go to OT school, and what year did you graduate?

University at Buffalo, 2018.

What did you do when you first finished school, and for how long?

I was a contract traveler across four states. Then, I transitioned into adolescent mental health before starting the Medical Ethics Fellowship at Northwell Health.

In what setting(s) did you work, and what types of patients did you treat?

I’ve worked in the following settings:

• Skilled nursing facility
• Long-term acute care hospital
• State psychiatric hospitals
• Inpatient child and adolescent mental health
• Inpatient rehab

What did you enjoy about your early roles? What didn’t you enjoy?

I enjoyed exploring new settings and finding practice settings that best fit my personality and interests.

I did not enjoy dictation of patient care by individuals who are not clinically embedded.

When and why did you decide to do something non-clinical?

As a new therapist, I was being heavily influenced by individuals who, whether they had good intentions or not, encouraged me to provide interventions that were clinically and ethically inappropriate.

While dealing with this, I always wondered if there was an unbiased entity I could reach out to to discuss these issues. As a contract traveler, you don’t often stick around facilities long enough to make institutional change.

Therefore, I reached out to individuals in my network to brainstorm ideas on how I could transition my clinical skills into a non-clinical role where I could assist patients and providers on a larger scale.

What are you doing these days?

I am a clinical ethicist for Sutter Health.

Are you still treating patients, or are you solely non-clinical?

I am solely non-clinical for now. However, I would love to continue to work in academia or in mental health if the opportunity were to arise.

How long have you been in your current clinical ethicist role?

The fellowship took one year to transition into this role. I just started this full-time position in September.

What do you wish you would’ve known before going into this role?

This field is highly dominated by professionals with terminal degrees (MD, PhD, JD). Applications often required a terminal degree, and it was extremely difficult to find a position without this requirement.

At the time of application, there were only six embedded clinical ethicist positions in the country.

Did you get any special certifications or training along the way to help you get into your current role?

To transition into this role, I pursued the Medical Ethics Fellowship at Northwell Health located in New Hyde Park, NY.

Because the world of being an embedded clinical ethicist is so new, there isn’t a requirement to be certified. However, I am certified as a Healthcare Ethics Consultant and use the credential acronym, HEC-C.

How did you find your clinical ethicist job? Did you apply or find it through a connection?

I reached out to my mentor, who suggested that I apply to the Medical Ethics Fellowship in NY, as the program was looking to diversify by training non-medical providers. They are one of the few programs in the United States where having a master’s degree was the minimum requirement to apply.

How have people reacted to you leaving patient care?

Reactions have generally been positive, as I still work in healthcare but now focus my efforts in a different way.

What’s a typical day or week in the life like for you? What types of tasks and responsibilities fill your time?

I like to tell people that my role is at the intersection of medicine, human values, and law. My focus is to ensure that the medical team is doing what is medically appropriate and indicated, while keeping the patient’s best interest in mind.

Typically, I start my day on rounds, meeting with different teams. I present education and information that helps providers feel supported to ensure that their medical recommendations are aligned with the patient’s goals of care. I also address any issues that may trigger an ethics consult.

When focusing on an ethics consult, there are several reasons I may be consulted, including:

• Assisting with identifying a surrogate decision maker
• Determining the best course of action for a patient who is unrepresented and lacks capacity to make their own medical decisions
• Assisting in conflict resolution between the patient, family or team
• Reasoning non-beneficial interventions, patient advocacy, and unaligned goals of care

I also ensure that providers feel supported through hospital policy and keep the medical team up to date on state-specific medical laws.

What are some of the rewards of your role? What are the biggest challenges?

The most rewarding aspect of my role is being able to offer a service that I wish I knew existed when I was experiencing moral injury and distress.

The most difficult part is facilitating very difficult conversations with patients and families, specifically regarding end of life care, because the perception of quality of life is extremely subjective.

How did your clinical background prepare you for this role? Which skills transferred?

I haven’t used many hard clinical skills, as I am now non-clinical. However, working in various healthcare settings gave me a foundational understanding of medical terminology and how that plays into the prognosis and recommendations.

Many skills we learn while working directly in patient care transferred to my current role.

Therapeutic listening, rapport building, cultural sensitivity, and de-escalation skills are extremely helpful in working with patients, families and providers.

Roughly speaking, how are the hours and pay compared to patient care?

My salary is slightly above what I made in my contract positions but with much better benefits, work-life balance and PTO.

What type of person do you think would do well in your clinical ethicist role?

Individuals who would be successful in this role are those who are open minded to new ideas, good at building relationships with stakeholders, and are assertive enough to draw boundaries with others.

Do you work remotely or onsite?

My position is on site. However, there are positions at other institutions that are remote or hybrid.

Did you read any books, take any courses, or do anything special overall to get you where you are today?

Yes, my advice is to:

• Get involved with your institution’s ethics committee
• Find an ethics fellowship
• Take a bioethics certification course
• Network with bioethicists and clinical ethicists

What is a typical career path for someone in a clinical ethicist role?

A typical career path for a clinical ethicist could include: management, program development, academia, research, or consulting.

Ready to start your own non-clinical career?

What is next for you as a clinical ethicist? What are your high-level career aspirations?

I am still new to my role. I have been given a lot of autonomy in figuring out how I want to develop the ethics service at my hospital. Eventually, I would like to assist with expanding the service across more settings and bring attention the field of clinical ethics and its value through advocacy.

What would you teach to today’s graduate students in your profession, if you had the opportunity?

I’d like to teach today’s graduate students how to navigate through gray areas that arise in practice.