Mission Over Burnout with Mary Beth Alvarez

What Fundraisers, Donors, and Doctors Can Teach Us About Sustainability, Mental Health, and the Long Game

In this episode of The Brave and Balanced Fundraiser, Erin is joined by Mary Beth Alvarez, a dual-boarded internist and psychiatrist, public health professional, philanthropist, and longtime nonprofit board member.

Together, they explore why burnout isn’t actually solved by self-care alone… how secrecy and discomfort around money create anxiety for fundraisers and donors alike… and why sustainable fundraising depends on connection to mission, clear expectations, and honest conversation.

Drawing from medicine, mental health, philanthropy, and nonprofit leadership, Mary Beth shares why systems shouldn’t rely on burnout or heroics, how direct asks help people feel included rather than pressured, and what it looks like to play the long game with donors, board members, and fundraising teams.

This episode is for fundraisers who feel the weight of the ask, for donors and board members who want to be genuinely engaged, and for anyone who believes mission-driven work should not come at the cost of well-being.

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Transcript

Erin McQuade-Wright 1:33

Welcome to the Brave and Balanced Fundraiser, the podcast I wish I'd had during my 15 years as a professional fundraiser. I'm your host, Erin McQuaid Wright. This is your space to breathe, realign, and reconnect with a part of you that chose this work for a reason. Together we'll explore tools and practices that help you show up less stressed and spread thin and more grounded, brave, and on purpose. I'm so glad you're here. Let's get started. Today's conversation is a special one for me, both personally and professionally. My guest is Mary Beth Alvarez, who is an internist and a psychiatrist, a public health professional, a philanthropist, a board member, and one of my closest friends. Mary Beth has had a front row seat to my life as a fundraiser, including the years when I was deeply anxious over identified with outcomes and quietly burning out while telling myself I just needed to try harder. In this conversation, we explore what happens when mental health is treated as separate from work, money and mission, and what becomes possible when we integrate it instead. We talk about why burnout isn't actually solved by self-care alone. Why secrecy around money and mental health hurts everyone involved, and why sustainable fundraising depends less on pressure and more on connection, clarity and meaning. This episode is for fundraisers who feel the weight of the ask, for board members and donors who wanna be genuinely engaged, and for anyone who believes that mission-driven work should not cost us our wellbeing, let's dive in. Today I'm here with Mary Beth Alvarez. Mary Beth is one of my very close friends. And we met in New Orleans years and years ago, and when I think of mental health, Also, when I think of philanthropy, I think of Mary Beth, but she's coming at it from a very different angle that I really wanted to bring into the conversation, and I think it will be very enlightening for those who are coming in from the fundraising door, or Mary Beth has been a board member and a philanthropist and a doctor, and a fundraiser as well. So I am excited to introduce Mary Beth Alvarez and Mary Beth. Tell us a bit about what you do and why you do it.

Mary Beth Alvarez 4:09

Uh, thank you so much for having me, Erin. I am so excited to be here and share my experiences. So I am a, a dual boarded internist and psychiatrist. So I went to medical school and then did a residency in internal medicine, which is general medicine for adults and psychiatry, which is. Mental healthcare and my whole career, um, uh, up until this point, has been working in lots of different environments, both within healthcare systems, um, in the hospital, in the clinic, as well as outside healthcare systems, in schools, in jails, um, um, working to integrate mental healthcare into the. The medical landscape so that it doesn't really matter where you present for care, whether it's in an emergency room or a clinic in the primary care or in a specialty clinic, or if you're hospitalized, you'll always have access to the same high quality integrated mental health. Care. That is where everybody's a team working together, and that's how I practice medicine. And it's also how I teach medicine is, um, to work in teams with doctors, nurses, therapists, um, social workers, so that we get really good outcomes. And in psychiatry, that is, uh, has been a difficult thing because we like to think about psychiatry as, um. Very hard to measure. Um, it doesn't have the same research behind it that, let's say heart disease has, but, um, just because it's harder to quantify, um, something like depression or anxiety doesn't mean we shouldn't be measuring our impact on patients when we treat them. So, um, I, uh, I'm a pub public health professional as well. I got my master's in public health and, um, think about population health and try to bring that work to what I do with every patient as well as in systems. Um, I used to be academic and, uh, a teacher, and now I am working in the community as a medical director for a federally qualified health center in New Orleans.

Erin McQuade-Wright 6:19

Beautiful. And I love how comprehensive you are with. Looking at mental health and entering mental health in the, into the conversation on a broader context, saying this should mental health belongs here and here and here as well. And as a person who started a podcast about the mental health side of fundraising, um, I would say that you are one of the people who had kind of a front row seat to me being an anxious fundraiser. And that was really. Hard on my body and hard on my spirit, and I didn't yet know. I hadn't yet asked myself the crucial question, is this career right for me? I simply had the misunderstanding that I just had to do it better. I just had to keep going because I'd chosen it and that's it. There's no turning back. This is I, I'm too old to have a new career. I just need to make fundraising work and work harder and try harder, and I have no doubt that. As much as I tried to keep that under wraps, well, number one, you saw it because you, you know me and you can see things that other people can't see'cause you look out for things like that. But number two, I think the donors must have felt it as well. I think it's impossible that that anxiety I had. About how I was doing in fundraising didn't seep into the donor conversation, and I'm curious whether you've had experience of that being on the other side of the ask, coming from an anxious fundraiser and what that felt like for you.

Mary Beth Alvarez 8:07

Well, I, I think you're, you're talking about something very important about how we view ourselves. We bring to our work, and I talk to people in mentoring and healthcare all the time about this. There's a lot of discussion about burnout and how, um, if you are work too hard or don't get enough time off, or you don't practice self care, then you will, um. Do a bad job and, and be worthless to your employer, and I really reject that whole concept. Um, I really don't see the answer to burnout is self-care or vacation time. I see the answer to burnout is a sense of mission, and if you cannot connect to a sense of mission, a reason to do the thing, then you cannot find. The way to do it. Um, and I am often reminding learners who are in healthcare, nursing students, medical students, to remember the. The thing they wrote in their essay to get into school.'cause they tried really hard to do this. They've been trying really hard, their whole lives. Trying really hard is not the problem. It's con connecting to. The reason is, is if you feel disconnected from the reason, then you're not gonna find a way to do it. Um, and I always have searched for that in my. Life as a philanthropist, as someone who gives of both time and money. I don't want to give time or money unless there's a reason or unless I'm connected. And I, um, I think I did my best work on boards, um, when I was really connected to the community of it. And this relates a lot to mental health because. We can often put together really good pieces of treatment for someone who is suffering with a mental illness or a physical illness, frankly. We can prescribe medicines, we can do physical therapy. We can. Change diet. Um, we can create a lot of components to treatment, but if the patient doesn't know why they're doing it or doesn't have a community of people who understand what they're going through, they're not gonna be able to connect to the point of it. Um, so I. I work really hard on helping patients see their values and connect their treatment to their values. And I work really hard to have my staff connect to the reason for doing things and why they're there. Um, because there's so many ways to collect a paycheck and there are so many ways to write a check to help a cause. But if you're not gonna have that relationship, then there's really no point.

Erin McQuade-Wright 11:01

Yeah, and I, and I've gotten to witness you with your students, and I've never seen anything like it. You know, I, I didn't come through medical school and I had just observed a really big gap between those who teach and those who learn. That was my experience, you know, all the way, even through grad school and. What I witnessed with you is you used to have this really great party every year for the Oscars, and everybody would come dressed up and your residents were there as well, and I saw you taking them under your wing. And again, this gets back to the word comprehensive, a really comprehensive way. And I saw you including them not only in the work side but also in the recreational side. Uh, you know, to emphasize, I think, um, this is important. And I wonder if you also folded in philanthropy there as well.

Mary Beth Alvarez 12:01

Yes, yes. So I often would bring residents, medical students, um, colleagues with me to events that I was support where I was supporting an organization. And, um, it, people who are new to medicine may come from all kinds of backgrounds, right? Um, they may come from doctors and come from wealth, uh, uh, or they may have really had one of those. Journeys that we really look for in healthcare. People who, um, got to it because of their own sense of mission and commitment to their community, but had no, you know, family resources really to speak of. Um, and so I would often come bring them along and say. Hey, this is what is expected of us as people who are supporting this organization. I'm on the board. I'm bringing you as a support of this organization. I want you to consider what you can do. Um, we're not gonna. Make a big specific ask, but we, we do expect you to give some money and here's the range. And I would give the range of like, people who are new and young are expected to give this range of money and people who are nearing retirement or living off of their retirement are expected to give this much. Or, um, and I said even if you can't give any money, if you buy a season ticket to this theater, um, or if you, um, pledge to come to the next event. Um, or even if you just, um, now talk about this organization to other people, you know, that is giving too. Um, and I can't tell you how many people would come to me and say, thank you for just clueing me in on the culture of what is expected. Because if they didn't grow up doing that, serving in the community, serving on boards or donating money, if their family didn't talk about how they. Gave or donated then they never did know. And I didn't come from money, but my parents were very active in the community and gave a lot of time and they would discuss how they gave any money they did give and why. Um, and so I felt like I had a good upbringing in that. Um, because even though my parents weren't wealthy enough to be Phil philanthropists, they were always giving.

Erin McQuade-Wright 14:20

Yeah. And it sounds like. That's you as a fundraiser, as a volunteer, you found it really important to set the context of what is, what is the playing field that we're entering here? What's the high end, what's the low end? And that education, I think is so helpful. And I wonder if you had experiences where you were interacting with professional fundraisers. And what that felt like on the side of either a board member or a donor, or both.

Mary Beth Alvarez 14:57

I worked in college as a, um, a Phonathon fundraiser for the, oh, for the annual fund? Yeah. So I had this early experience of cold calling alumni with the expectation that they would give something. I was very lucky that I got to see actual printout numbers, you know, I got to see how much they gave last year.

Erin McQuade-Wright 15:18

Nice.

Mary Beth Alvarez 15:18

Um, and what their profession was. And I think that gave me, um, a really good sense of, um, and, and of course it was their graduation year too, so I knew exactly how old they were. Um, and I saw their giving history change over time. And so I, I, um, grew to. Um, really well. I got a lot of training in how to have frank discussions with money, uh, uh, with people about their money. Um, and also I was a link in the chain, right? We, we used students to make these phone calls because it was students who benefited the most from Right. That money, right? And it was, I could give an up to the minute. Accounting of what's going on on campus and how we're using that money. And that, that's probably the most effective ask there is, is to have the people who benefit make the ask. But um, I think it also really just kind of, um, pulled the veil out because really the, a lot of the dancing and secrecy is the most intimidating part. Um, and tell me what you mean

Erin McQuade-Wright 16:17

by that.

Mary Beth Alvarez 16:18

Oh, of the give what you can, I don't know. You decide, um, you know, the, um, the sort of, uh, being coy and, and, and a lot of the, the shame or, or just taboo around money and how much money one makes and how much money, money one spends on things. I think that's not helpful for, um. For us as, as earners. Um, I think it is part of the reason why there's a gender pay gap, and it's also, um, uh, I think one of the reasons why it might be hard for a fundraiser to make an ask because they're afraid of offending or, um, or, um, just digging up something that's taboo. Um, so I way prefer to speak honestly and openly, uh, because really. When you shroud something in secrecy, then you really aren't able to have open conversations about it, which I think probably informs a lot of my mental health work too, about how we're nobody benefits when we keep our diagnoses secret.

Erin McQuade-Wright 17:24

Hmm. Wow.

Mary Beth Alvarez 17:26

Nobody, Ben, nobody benefits. And I it, especially when you talk about, I, I treat a lot of folks with addiction and of course they don't wanna be going around telling everybody, you know, there's a whole idea about anonymity involved in treatment with for addiction. But if there's a family history of addiction and you keep your diagnosis secret from your kids, you are not preparing them for the likelihood they have to. Encounter this diagnosis in the future. Um, and so I'm constantly telling parents how to talk to their kids about their diagnosis, and I'm, I want there to be more of that. Um, and, and we as a culture have benefited from de-stigmatizing mental illness. Um, but if we are only talking about it in the public sphere of like, okay, here's this suicide hotline. Call these strangers and talk to them about your suicidality. Uh, why can't we talk to the people we know and love about it?

Erin McQuade-Wright 18:25

Hmm. Yeah. I really see how you. Whether or not you intended to, I think you intended to, the, the dots are fully connected between de-stigmatizing mental illness, de-stigmatizing the, the shame about money and making me ask, and just you like a really direct conversation and it seems like, you know, I used to have a, an observation when I was working in philanthropy as a fundraiser. I would say, you know, it's clear to me. I'd say this to myself, we respect our board so much that we don't give them deep things to dig into. We respect our donors so much that we don't ask them to give. Yeah. But once a year, and there's such a perception of cleanliness in that remove, like we respect you so much that we're not gonna give you an amount. And it, and it is. In fact, as you're saying, not helpful because it causes confusion and there's really not a lot of places where this exists in our society today. You know, maybe those who work in the death industry have, have the a little tap dance, soft shoe around end of life stuff, but. We, we really do allow this in the fundraising conversation because there's a fear of offending someone. And what we don't often take into account is what you said, how freeing, how, how much of a gift it is to give someone a direct piece of information, a direct ask, even if it's yes, not something they can do, they can respond to it and say. I, I'm not able to do that. And then the conversation doesn't end there. It can go into different options, but I really hear you saying it's important for fundraisers to be direct about what they're asking.

Mary Beth Alvarez 20:29

Absolutely. And I, I, the people think that the worst case scenario is some, some form of rejection that is a no. Um, but. But really the, the worst case scenario is that you, that person is not engaged and they fall away out of, uh, connection with the organization because they don't feel included. Um, so, um, it's way better to, to make a direct ask and then have the board member or the donor, um. Usually counter. And that's just how finances work and say, I can't do that, but I could do this. Or I am so honored to ask Now is not the right time. Here's how I'm gonna help in some other way. Um, but if you don't, I mean, if you don't create the expectation of, uh, of engagement, then, then you'll lose engagement.

Erin McQuade-Wright 21:24

Yeah. I'm curious about what you've seen. Oh, before I ask you that, I, I, my, I wanna say my whole theory with this podcast, because I see a lot of resources out there about how fundraisers can raise more, how they can do it better with less. Um, my whole point of doing this is to really focus on the inner. Dialogue that the fundraiser is having with themselves about making the ask about what that pressure cooker looks like, and maybe it's easy and they're able to make the ask lightly and respectfully. I was more of an avoidant fundraiser, so I would do anything to not have that conversation until I had to have that conversation then, and then it was stilted and sometimes very successful, but still not the way I wanted to feel in the conversation. But my theory is that there shouldn't be a 16 to 24 month turnover rate for professional fundraisers. On average, it is super high. That churn is costing nonprofits money to train and hire new people. In such a fast turning window and it's costing donor relationships. Like you say that, that thought of, hi, I thought of you. I'm, I'm engaging you with this. Ask we, when the person who's doing the asking keeps changing, we as donors feel disconnected from the organization. And so my theory is that as the donor, as the fundraiser learns to regulate. Her own nervous system and manage her own, do her own emotional mastery work that she will be able to hold a conversation, like a major gift ask without making it mean something about her, how it goes without the result of that conversation, determining her okayness, and that's gonna help donors feel more connected and that's gonna help organizations retain their people. You know? Yes. Instead of this big, huge churn that we're seeing. So I'm curious about how you see, you know, to me that is an example of seeing donors as whole people, not just as ATMs. It's seeing, uh, organizations be employees of organizations as whole people, not just a a person that has to go run and get this money and hand it over. It's more comprehensive than I think we've been in the fundraising sphere. And I wonder how you see that tying in with mental health or changes you've seen over the last decade about how we think about this comprehensive weaving in of mental health.

Mary Beth Alvarez 24:18

I, you know, there's so much there about, um, sustainability and, um, thinking about the long, the long game. And I tell that to people all the time that, that, that, uh, that we gotta play the long game or you're never gonna see success. You can have, um. You know, uh, one very good meeting. But until you do all the follow-up discussions and you actually see change happening, um, then you're really not. You are really not gonna see, and that it is helpful to me. My brain works more in long term now at this age than it did in short term, and that, that may be one of our issues is that we, if we don't let, allow people to mature in this career, then we'll only see the version of. Of them that shows up right when they're hired, um, without that institutional wisdom. But the other thing is that you have to be able to see changes happen over time to know how to invest in what? Um, and I. I just, there's so much that has happened in healthcare since I became a physician that if I didn't change and adapt and, and wasn't in it for the long term, then I would get left behind. I mean, when I went to medical school, I learned how to take care of patients with a binder and paper and a pen, and if I hadn't, you know. Learn, and I've learned at this point 11 electronic medical records. If I haven't, hadn't done all those trainings and done all the investment in that, I'd be left behind. And there are doctors who are retiring because they can't adapt to electronic medical records. And I think that, you know, think same thing is true about diagnoses. I mean, uh, there are diagnoses I'm treating now that didn't exist 20 years ago. Um, uh, if COVID has taught us anything, we, we, we now know that there are mental health. Uh, health consequences from an acute episode of inflammation that we have to care for. And, and of course we knew about it before, but we didn't pay attention to it or know how to treat it. Now we understand it because of this, this rapid evolution that's happened, and if we don't adapt, will. Fall away and, and lose relevance. But um, I think the other thing too is when I started medical school, um, we were expected, this is funny now to think about, but it's not really that, that it was. They had just implemented an 80 hour work week in, in residency that you could not work more than 30 hours straight or 80 hours in a week, which is insane. Wow. And, and that window is now moved so that it's, it's, it's actually very difficult now to find a residency that it will do that, that will work someone 80 hours. But, um, some rotations still do. Um, it isn't part of the culture anymore, but the cultural expectation was that we were called residents because we lived at the hospital, and that's just not the culture anymore. And in fact, it's tipped so much in the other direction where, you know, I'm working with a bunch of residents and they're saying I'm timing out. I said, but there's still work to, to do. They're like, well, that's it. My clock is up. Uh, which I is just a, a totally different culture. So I think we have to think about. How to, to learn lifelong. We can't cram it all into residency'cause there's just not enough hours that we're at the hospital anymore. And so we have to keep learning. And the same is true about, you know, let's say you get a young fundraiser into the organization, you cannot depend on them to be the workhorse and, and work tirelessly without the developing skills over time. Um, and we've gotta. Mean, think about ourselves as, um, the slow cooker function on the Instant Pot instead of the high pressure function on the Instant Pot. Um, and um, and we always constantly talk about this is that we're not gonna ever get success from a superhero with a cape making a rescue because you don't wanna have crises all the time that require rescues. You need systems where people, it doesn't depend on people being a superhero to get things done.

Erin McQuade-Wright 28:24

Yeah. I love that. And I, I think it actually maps on nicely to the different generations of donors. And I don't know if you are aware of this, um, this sort of grouping of donors by generation, you're shaking your head yes. I think about how the greatest generation is the, the example that we all go to first. How they would just write a check and say, do good with it. I don't care. I don't wanna know, I don't wanna look under the hood. And we're now kind of at the opposite end of the spectrum where we want the, as a potential donor, I wanna be able to go on your website and see all the things that you see who's on your board. And I wanna understand what, uh, what makes your business tick. I wanna see financials if possible, and. I think that

Mary Beth Alvarez 29:10

may even see, wanna see metrics, see outcomes. Yeah. And how each dollar goes to each, um, you know, each mission. Mm-hmm.

Erin McQuade-Wright 29:17

Right. And so I think what you were describing, the slow cooker setting on the Instapot, taking the long view really aligns well. With the greatest generation's way of giving, and I think we've moved away from that and we've lost some things. Now I understand why we've moved away from that, because scandals that have happened can be contagious and we can see what one organization did with a misappropriation of funds and that can have an effect on our organization because people are suddenly suspicious more than they had been in the great greatest generation of. You know, the ask and how the money was being used. So we got here, uh, for a reason. But it really strikes me that when we look at it from the aspect of board members, and I don't know if you're currently serving on a board, but there's been a trend moving away from the long game, which I would call planned gifts and major gifts. It's to more transactional. We wanna see that ROI, you know, we've got more, in some cases, we've got more business influence on our nonprofits that they should be run more like businesses. And there becomes, you know, there become questions about how are, how much are we getting out of this investment in a high paid fundraiser? And if you're looking at planned gifts, major gifts. You know, I was, when I exited the career, doing the end of life gift planning, it's highly niche. That's an expensive role to fill, and we've seen these positions get cut because there's less of an appetite for the longer instapot, you know, slow cooker setting when it comes to these conversations. And I think. That's a real loss for our nonprofit communities and for our donors because what you've cut out when you're looking for that quick return is real relationship building over time.

Mary Beth Alvarez 31:25

Yes. I, I, I don't really think, I mean, we, I have heard that discussion too about, um, you know, finding the whales, the people who will do a, a very large gift of the, the trust or the end of life. And, um, and, uh, I understand where that comes from, that kind of, um, need to fill a budget gap or need to hit dollar metrics. But really every, um, organization that I've been a part of that has, um. Power, I guess. Um, power doesn't come from a big lump sum of money. It comes from, uh, building your group of sustaining members of people who are consistently engaged. Right? And, and I think, you know, I think about alumni groups as being incredibly powerful. You get a steady drumbeat of people coming every year, graduating every year, and you need to include a higher and higher percentage of those as sustained givers in order to survive. Um. Church membership, same thing. It's not, you don't want one member giving all the money for the, for the budget. You want growing membership and, and a not-for-profit should be viewed the same way. It's not necessarily a membership, but it should be. Um. Uh, a sustained community. Um, so, um, when I was on a board of an art artistic organization, it, it wasn't so much as, I mean, we always wanted a balanced budget, but it was that we wanted, um, also people engaged in the work of, of putting on the art and, um, and appreciating the art. We wanted audience members. Um, and that that matters as much. And so we were constantly pushing network building, which I think is a, a much more important, um, way of operating than, um, expecting a big check or a big payoff. Once you want sustained giving, which means sustained engagement.

Erin McQuade-Wright 33:21

Beautiful.

Mary Beth Alvarez 33:23

And, and that's why I'm, that's why I'm in outpatient medicine now is'cause I'm, uh, it's very satisfying to watch somebody go from an acute presentation and, and, you know, we discharge'em from the hospital and they're so much better. But I prefer to work in that space where I'm creating a relationship with the patient and seeing their health improve over time. It's way more satisfying to me.

Erin McQuade-Wright 33:44

Well, I love that, and I think that's a beautiful place to bring our conversation to a close. And I love on just on behalf of your patients and your coworkers, how you see people, how you are investing in people in communities long term. And I just wanna celebrate you and thank you for being here with me today.

Mary Beth Alvarez 34:07

Thank you for having me, Erin.

Erin McQuade-Wright 34:09

Before we wrap up, I wanna name a few things that I feel are especially important from this conversation. First. Burnout isn't a personal failure, and it's not just a time management problem. As Mary Beth shared, burnout often shows up when we lose connection to why we're doing the work, not because we're doing it wrong. Second secrecy around money and mental health creates anxiety and distance, clear expectations, direct asks, and honest conversations aren't invasive. They're stabilizing. They help people feel included rather than unsure. Third, sustainable fundraising is a long game. Relationships deepen over time, trust compounds, and when we only chase short-term wins, we lose the steady, meaningful connections that actually sustain organization. Fourth, fundraisers, donors, board members, all of us are whole humans. Systems work best when they don't rely on people pushing past their limits just to keep things afloat. And finally, when fundraisers learn how to regulate their own nervous systems, the ask becomes lighter, the conversation becomes more human, and the work gets to happen from a place of steadiness instead of pressure. If this episode resonated with you, here's what I invite you to do next. If you're a fundraiser or a board member and this conversation felt familiar, if you've ever carried the weight of the ask in your body, I'd love to have you in the Brave and Balanced Fundraiser Facebook group. It's a space where we keep these conversations going, honestly, and without hustle, and where you don't have to carry this work alone, you'll find the link in the show notes. Thanks for being here. I'll see you next time.