146. The Rise of the Self-Determined Physician | Jimmy Turner, MD

Welcome to Medicine Redefined, a podcast focusing on helping you reclaim ownership of your health. I'm Dr. Darsha, and I'm Dr. Altamasharaja, where your hosts, hair to challenge conventional practices and uncover the stories behind pioneers shaping the future of medicine. Our conversations not only focus on the individual level to dissect common practices for health optimization, but also zoom out to enhance systemic change. Join us as we look to break the status quo, move the needle forward, and put the help back in healthcare. Our guest today is Dr. Jimmy Turner. Jimmy is an academic anesthesiologist, entrepreneur, author, and life coach. He obtained his medical degree from Wake University and went on to complete an anesthesia residency at the same institution, where he also served as chief resident. Subsequently, he completed a regional anesthesia and acute pain medicine fellowship. After his training, he stayed on within the Department of anesthesia at Wake University, and now holds the title of Associate Professor. But Jimmy's true passion lies in teaching doctors how to create the time, financial freedom, and mindset shifts they need to create a life they love, which he does through several mediums including books, podcasts, and his coaching program called the Alpha Coaching Experience. He hosts the Muddy Meets Medicine and the Physician Philosopher podcast, and his latest book, Determined, is a must read, which is geared to help burn out or overlaunch doctors turn their lives around and thrive in this broken medical system. In this episode, we talk about Jimmy's origin story and how he developed a passion to help individuals, particularly physicians avoid financial mistakes, and find their purpose. We talk about disability insurance, and then shift to the arrival fallacy, which is a critical concept every health professional training needs to understand because if you don't, you're in for a rude awakening. We then switch to discussing side hustles and the shift from physician burnout to entrepreneur burnout, and the importance of setting boundaries. You'll learn about Jimmy's Hell Yes Policy, and we spend a good deal of time discussing core priorities and the importance of being present where it matters most. From there, we shift the discussing some of the steps that need to be implemented in medical education to empower physicians and how to promote autonomy and minimize the risk of burnout. We close by learning the core theory behind what makes a self-determined physician as described by Jimmy in his latest book. I'm incredibly excited for this because we've been wanting to get Jimmy on the show for quite some time, and we finally linked up our schedule, which yielded an awesome discussion with tons of insights that you will appreciate. Oh, and be sure to stick around until the very end because Jimmy has a very special gift for you guys that you will not want to miss out on. Now without further delay, please enjoy this very special discussion with Dr. Jimmy Turner. Jimmy Turner, welcome to the show, man. Thanks so much for having me. Super excited to be here. Likewise, man, it's been a long time coming. We've been trying to connect, I guess, for it over a year, and so I'm grateful for you to be here. There are so many different questions I want to ask you. I think you're maybe about five years ahead of me. And so from a selfish standpoint, you know, how to be a good early career academic physicians, I might ask some questions about that. And, you know, we can go multiple ways, right? We can talk about philosophy. We can talk about finance. You're really where multiple hats. I guess I'll start by giving the listener a little bit of insight into your background. You host two podcasts. You work technically full time, right? You're 0.96 or something like that. Yeah. You know, it's varied over the years. And so at this point, I am like 0.75 clinically. Got it. So working two days a week, most weeks. You are in program leadership again. And so you're just doing all these things and you're doing an exceptional job at it. And I guess it's important for people to get an insight of like, what is the makeup of somebody like that? And so talk a little bit about your background and then, you know, where the passion for finance and coaching comes in and maybe even why academic medicine. Yeah. So I guess to just kind of flush that out, right? So academic anesthesiologist did medical residency fellowship all the same institution and then stayed on faculty at Wake, some of the big Wake Forest fan, which I don't know exactly when this episode is going to come out, but is a very painful time as a basketball fan. But, yes, academic anesthesia and my story into the personal finance space, I have to go back to my fourth year of medical school. And so, you know, long story short, some listeners probably heard my story, but in case you haven't, I, we had our first kid, she's now turning 13, which is insane. We had kids pretty young. And when we did that, you know, Kristen and I, we felt like the responsible adult like thing to do is to get term life insurance so that, you know, if one of us died, the other person we've taken care of, I mind you at this time, I literally know nothing about personal finance. I know that my, you know, my family went through bankruptcy when I was 10 because my parents, they lost their job, they racked up six figures in credit card debt. So not a lot of financial literacy in my household growing up. And so at the time, like, you know, we're getting term life insurance, someone told me I need to do that. I approached the brother of one of my medical school classmates and someone that I could trust and said, yeah, sure, we can get your term life insurance, but we should also probably get your disability insurance. I didn't know at the time, like, I was like, I, you know, I don't have an income. I don't really understand the need for me to get this. I said, no, a few times, ended up getting talked into it. I have a personal, or I have an essential tremor that I take perprano law for. And so I ended up getting denied. It didn't seem like, to be honest, to be like a huge deal at the time, except for when you get the training, there's something at many institutions, most of this point called the guaranteed standard issue policy where they don't look into your medical history. They don't look into your background. The only two stipulations for a lot of those policies is that you can't have been disabled and you can't have been denied. And so since I had an insurance agent try to make commission off of me selling me a product I didn't need as a fourth year medical student to this day, I can't get disability insurance because I got denied. And then the GSI was no longer available to me. And so in a lot of ways, you know, I started with a mistrust for the financial industry. And so I started learning about stuff as a fellow five six years later. And as I did that, I'm an educator, I love teaching people. And so my residents, my students, my colleagues started coming up and saying, hey, I've got questions about X, Y, and Z, you know, that led to the physician philosopher and money meets medicine and just, you know, saw a burgeoning need to marry personal finance to burnout. So, you know, very much have always been that kind of financial wellness space long before that was a cool thing to do seven years ago. And so yeah, that's that's kind of my origin story into personal finance. And then now my North Star, my mission is always, you know, doing what's best for people. And so, you know, to any of that money meets medicine and actually now we offer our own occupation disability insurance so that what happened to me literally doesn't happen to anybody else. And so that's the personal finance journey. But as you mentioned, I've been a coach, I've made courses, I've, you know, done online entrepreneurship for seven years now in a variety of capacities. So where lots of, lots of hats. Yeah, that really sucks, man. And that happened to my co-chief for fear, you know, as he was going and he worked with a company which, and I'll blast him at the time, pattern, at the time, they were doing good work and they were referred by somebody we both know and trust. And then he, you know, he had an episode where he had maybe a sinkable episode somewhere in medical school and no cardiac history, nothing like that. And he got rejected. And he was actually in training at Hopkins for some reason, GSI was still available to him. So he had that fall back on. So that's interesting. So that worked out well for him in that regard. But yeah, this, this is, it's ridiculous for people to do that. I'll follow up on that and, you know, as I mentioned before the show, I'm a super transparent person. So, you know, there are players in the space that, you know, like the one that you mentioned, that give very, very little time to the consult process. And so they don't really dig into your medical history. They don't really tell you like, hey, if you don't disclose this information, the insurance company is going to find it and they're going to deny you. And so there's not really that deep dive. It's kind of a, you know, a volume process where they kind of pump people in, pump people out knowing that, you know, they're going to have a 20% or something denial rate. So what happened to me is going to happen to 20% of people. And it's really tough, right? Because a lot of the, you know, the, the well-known people in the space have a list of, you know, disability insurance agents that they recommend. They are ordered in which that person gets paid and not in the order in which, you know, the best agents at the top. And so because of that, the, the space is rife with conflicts of interest and, and there's this big problem of like, who do I trust? Like, because if you, if you and I went out to dinner, right? And you said, hey, you know, who's the insurance agent that you recommend? I'm not going to be like, hey, here's a list of 10 people who go choose somebody. I'm going to be like, well, you know, I've worked with, you know, a couple of people and these are the people that I definitely recommend that you consider they're going to take their time. They're going to take a deep dive in your history. Do the right thing for you. Get you the GSI if there's any concern, right? And so I got so sick of seeing that in this space that we created our own disability insurance company so that that doesn't happen. And I've actually emailed people about specific companies expressing those concerns, having heard from a lot of people in my audience, hey, I went with X, Y and Z from this recommended list. I got denied, right? And I heard your story and I was like, oh, man, that's what happened to me, right? I hated hearing those stories. So yeah, it's, it's really, it's really important. Unfortunately, finding somebody you can trust is, is challenging. Yeah. Yeah, we haven't done a deep dive into asset protection. Something which certainly plan on doing my guy is Larry Keller, even though I don't directly work with him. You probably know him. Oh, I love Larry. So Larry's fantastic. The way that Larry and I got connected is initially I was going to work with him because I had vetted a bunch of people from my co-investor and, you know, we had a great conversation. I also have ITP and so he, Larry was like, okay, and he, a lot of time people don't understand is, you know, these people who have relationships with these insurance or the underwriters, they can kind of reach out and not disclose any personal information and say, hey, is this going to be a problem? Is it not going to be a problem? He did that for me. And one of the most amazing things Larry did at the time is, you know, I'm going into my intern year getting this and Larry said, okay, well, you're going to be in PA for your intern year, but then you're going down to Hopkins. And I know a guy down there and they have a GSI policy. So why don't you just wait down there? And so he referred that business out. Now he understands this because I've come back and I think I will have referred about nine people, including my wife to him. And he's written nine policies for the people that I know, right? And so there are some people who make good decisions like that and they'll say, this is 100%. You're not working for me. This is best for you though. Yeah, 100%. So Larry actually, you know, I'm happy to give as much airtime to Larry as possible. So Larry actually, you know, back when we were originally creating it helped us set up our process. You know, we used the same general agents as Larry, a phenomenal guy, couldn't get better service going to Larry by any stretch of the imagination. And back before we started our own process that I'll be honest with you, Larry encouraged us to do, I sent everybody to Larry too. So anybody that's listening by all means, he's a fantastic guy, one of the very few people in the space you can actually trust, just got to get him to come on the podcast, Larry. Yeah. Yeah. Well, it's a tougher space, right? Because like, so since I'm an anesthesiologist, you know, I can kind of say whatever I want. And like I'm not captive to to a company. So sometimes the the conflicts of interest and disclosure in that space are a little different for people that's, you know, that's what they do. But again, couldn't, couldn't recommend Larry more, more highly for sure. Yeah. So let's, let's shift a little bit. Let's talk about something because you mentioned kind of your north star about burnout and helping physicians find their purpose, so to speak, right? And I want to talk about a concept of that you've given a lot of airtime to maybe one of your most popular episodes, The Arrival Falsy. I remember you a while back posted on Twitter about this and just the way that you wrote about this were such so eloquent and made me think about this again to 2022 is when I became an attending. And so that light at the end of the tunnel was there for me and I quickly realized that that's maybe not the case. And I work a lot with residents now medical students and we all have this mentality that I just got to get over through one, two, three, four hurdle at the end of, you know, anywhere from eight, nine, 10, 11, depending on what fellowship you end up doing a residency you do. You're going to get there and that'll be your time, right? Student loans, car, all that kind of stuff. Talk a little bit about why this is a fallacy and how we should think about this as we're going through it, our training. So when we get to that quote unquote light at the end of the tunnel, you're not disappointed. Yeah. So, yeah, definitely one of my favorite concepts and just to give, you know, recognition. So Tal Ben-Shahar, Harvard Trains Ecologist is the person that came up with this. This term, but I know very few fields where this term applies more, you know, just accurately than medicine, right? So the idea is that we as humans have this concept that, you know, hey, when I, when I, you know, cross this mountain or, you know, achieve this accomplishment or this accolade. At that point, this goal that I've been working toward when I finally get there, that is when I'm going to be happy. And as Gertrude Stein said, right, like there's no there, there, right? And so because of that, what ends up happening is we work, work, work, work, work, get to this goal. And then we find out like, man, like this, this light at the end of the tunnel wasn't as bright as I thought it'd be. And the reason that that matter so much in medicine is because it happens multiple times to us, right? So like you finish undergrad and you're like, okay, when I get to medical school, like, you know, I pass my MCAT and I accomplish this. Like that's when I'm going to really feel like I'm, I'm starting to, you know, really accomplish my goals and finish medical school is like the low person on the totem pole. And I don't know about other schools, but like we totally have like the short white coat. You know, like where's like evident, I am not a physician, I'm up here, I don't have a ton of experience. So like, hey, when I get that long white coat, maybe that's when I'm going to be like, yeah, this is starting to be worth it. And then you get to residency and fellowship and you're just like burning out at both ends, you know, work in 80 hours a week. And again, you're like, hey, when I become an attending physician, I'm making attending physician money. And you know, finally, I finally arrived. That is when I'm going to be happy. So you've delayed that arrival with those expectations every four or five years that is going to get better. And unfortunately, when you become an attending physician and you start getting sadder with a whole bunch of different, let's just say expectations and, you know, different experiences, it really, it becomes challenging because for most doctors, they get to the end of the road and they're like, wow, I'm not as happy as I thought I'd be. And so now they think they're broken, right? They're like, something's wrong with me and I'm dissatisfied in my career. So well, respected profession, I'm well paid. You might not be fairly paid. Those are different things, by the way. But well paid, you know, by most standards, the vast majority of standards, right? You're making multiple six figures. And so, you know, people start asking like these existential crisis questions, like, did I make a mistake? Like, what is my purpose in life? You know, is this really it? And am I going to do this for the next 30 years, knowing that 50% of doctors are burned out and we have the highest rate of suicide of any profession? It becomes really challenging because we thought when we arrived, it would get better. And for many doctors, it doesn't. And the end result of that is they start saying, hey, maybe I need to change jobs, maybe I need to make a career transition, maybe I need to do something different. And the reason they do that is because they're setting up another rival, right? When I get to that space, that is what I'm going to be happy. And it just, it's not the way life works. And so while you're in training, you know, that might sound depressing, by the way, I recognize that. But at the same time, like, we have to learn how to enjoy our life where we are, enjoy the process. It's not about the destination, it's about the journey. And I'd be lying if I said that, like, you know, I had it all figured out when I finished because the reason I learned about this fallacy is because I experienced it myself and I went through burnout myself. But, you know, the process is what we need to learn to enjoy, not the end product, right? And so it does take time. It does take effort. It does take, you know, lots of insight and conversations with, you know, people that respect it kind of help you sort that out. Yeah. I kind of agree more. I think, you know, it won't get better. You have to make it better, right? And you, you mentioned, you know, having all that attending, money, all the attending, the positives, but you also have attending problems, right? Expectations, you put it very nicely. And it depends on the type of medicine you're in and there are different challenges with academic versus private practice. We've talked a lot about physician burnout. That conversation, particularly after the pandemic, has just really in terms of the volume has increased. And so the other thing is over the last couple of years with the advent of social media, internet, right? You've done a lot of coaching courses. People have had opportunities. Now I see trainees, medical students, they're really connected. In fact, actually one of your anesthesia colleagues, I think, um, man, Dr. Aloy Patel, I think her name is on, um, she's Instagram. And she talked about how to, uh, be responsible social media and anesthesia, she was the ACB, uh, ABCD, excuse me, you know, advocacy, branding, communication, um, and then, um, education, right? To DE. And I thought that was super awesome how to responsible to use that. And that creates opportunities that opens up a lot of doors for you. The problem with that becomes, right? We're heading from this physician burnout to entrepreneur burnout, something you've talked about before. And, uh, I think we're both millennials, yeah. Right? Uh, yeah. I'm like right on that hospital. You're on the cousin. Okay. But you know, you know doing the rock Johnson, right? And so I think about this quate quote from the rock and maybe a long time ago, I saw an Instagram somewhere and he, it's something to the tune of, you know, if you're working nine to five and then you go home and you're not grinding more on your own craft or something you're passionate about and you're not working on the weekends, um, it's not that you don't have time. You're uninspired. Like holy man, come on. And then you, you grow up, right? As a millennial in this age, and it's all about hustlers, ambition, hustlers, mindset, and you like got a grind, grind, grind, grind. And it's a little bit different because, you know, one could say, well, how are you not a hustler? You're in medicine with residency. Well, I think when people are quote unquote hustling, they're doing something outside the norm. They're doing extra. And in medicine, it's demanding, but it's all laid out for you. That's the norm 80 hour weeks. If you're following rules and stuff like that, that's, that's laid out for you. So it's got to be on top of that. And now we got all these opportunities. And so I guess I, uh, my question for you is, you know, as you impart wisdom onto your trainees, you work with fellows, right? Uh, so I work with residents and fellows and actually, that students do. Yeah. So, but people who are going on to a tenting hood, uh, and maybe even to me or to your younger self, um, how would you caution caution yourself not to fall in that trap? You know, this is always a really tough question for me to answer because if I'm being honest, which, you know, that's my mo, right? So, um, when I finished training, I was working 50 to 60 hours a week and 20 hours on my blog. Cause back then it was just a blog. I was putting out three posts a week, every single week for like two years, right? So you can think about the amount of time that goes into maintaining a website, writing the posts, figuring out what you're going to write about doing the, you know, the research all that stuff. And, you know, I was very much in the midst of the hustle culture that you're alluding to. And there are really prominent people in this space. You, you mentioned when the rock Johnson, but online entrepreneurs as well, that will tell you like, if you don't hustle, like you're just not, you're never going to accomplish anything. And for me, I exactly what you said earlier, I traded physician burnout for entrepreneur burnout. And so I looking back like what I tell myself, hey, don't do that. You know, keep things simple, uh, you know, it's not worth it. It's, it's tough, right? Because 90% of small businesses fail. I was in the 10% that didn't. So like looking back for me, like I, you know, it's, it's not a fair question in some ways, because it's like, if I knew I was going to succeed like I have, what I do it again, 100%. Right? But if I was in the other 90% of bloggers that like don't even exist from seven years ago, uh, putting in the same amount of work, like would they go back and do it again? I don't know. Maybe they've learned a lot of lessons and they'd say yes, uh, maybe they'd say no, because they put the extra 20 hours, and, and, and that's an addition to like just let's put this in context, because medicine and one thing I'll say that I really try to bring to my trainees is a business experience, entrepreneurial experience, and just this idea that like medicine is the way that it is, but it doesn't have to be that way. It can be different. Like there are other options out there that you don't know about because you're so just ingrained in the medical system, right? So we work 60 hours a week, last time I checked full times 40 for most professions, right? Of those 60 hours a week, 20 of them are on charting, which is like, you know, total soul sucking experience for many doctors, and then you're going to add another 20 hours a week. So now we're 80. You're working two full time jobs and expecting that somehow this is your salvation and you're not going to get burned out, and that's just not a realistic expectation. And so for me, as my business grew, I started learning, you know, not only more about business and having more experience, but that to be honest with you, simplicity is great, right? And so there are other ways to get to some of your goals. It is working part-time like me. You can create side income. Great. That is one way. You can also save less money, right? And this is coming from a personal finance guy. You can make less money, right? So just because you finish and you graduate with a $300,000 salary, it doesn't mean you have to live on it. Right? There are a lot of people in this country who live on a lot less than $300,000, but the second you go through, you know, the Dero effect where you have that sudden accumulation of wealth and now all of a sudden, like you feel like you need the new car, you need the new house, you need the private schooling for the kids. You adapt to a lifestyle that now, if you did cut back in terms of your spending, it would be extremely painful. And so I talked to my residents a lot about, you know, when I finished training looking for jobs, whether that was private practice or academics, the number one thing that I didn't know seven years later that I wouldn't eat in a job is flexibility. And so for me, going into a private practice, becoming a partner where for most anesthesia practices, there's not a glide path or an opportunity to go part-time, I didn't know when I took my job that the most important thing that I needed wasn't even on my radar. And now looking back, I'm like, man, I really lucked into a great opportunity where I have, I've gone five days a week, I've gone four and then two and then three and I back at two now. Like I've changed so many times based on my family's needs, based on my business needs as things have gone up and down. And so I talked to my residents a lot about like the value of flexibility and the value of, you know, who are you going to be five or ten years from now? Is that person five or ten years from now has very different needs fundamentally than who you are at the moment, right? So if you don't have kids and you plan on having kids, I can promise you having gone through this, I got three kids, three, thirteen, ten and seven. I at this point, like the only thing, the number one thing that I want to accomplish right now is being at all of my kids stuff and whatever I need to do to accomplish that is what I'm going to do, whether that means being two days in medicine or building side income or what have you, but just just recognize there's a lot of different lovers and you got to get clear on who you are right now and who you're going to be. Yeah, that's tough. I remember listening to one of your podcasts when you were talking about maybe your kid had asked you to put down the phone or something like that and how that was daggered here art. What's crazy about listening to you is I was listening to another podcast called Happy Human. Great podcast. One of the new ones saw by parenting and I think these guys, there's an occupational therapist or a speech therapist and then once a psychologist was working with the kids and they said the same thing. They're trying to build a business and what's challenging, my daughter is two and she says some things but she can't explicitly say hey put down your phone but I hear her all the time calling me like say my name seven times what she doesn't understand is I'm not necessarily scrolling on social media. Maybe I'm responding to an email that's somewhat urgent or maybe I am responding to something just out of a podcast or communicating with my co-host and stuff and building towards these goals, this ambition that I have and frankly she doesn't care right she just wants my attention she just wants to be a president and I've been thinking a lot about that you know but the challenge with that is and Darce, my partner had a really good post about this recently. You know this whole concept a lot of people entrepreneurs people who've quote unquote made it will talk about the importance of saying no you know and they'll go something like when you say no you're saying yes to something else or rather when you say yes you're saying no to something else but you don't know what that is yet. I'm a firm believer in that and I have been more mindful of that is what I'm saying yes I'm like it's not an absolute yes let me pause or get back to you later. And I think Darce's post or tweet every single was like all these people who are talking about saying no maybe 10-20 years they forget how many times they said yes earlier on in their career to be able to say no later on. Sure how do you think about that? Yeah so I call it a hell yes policy so the idea that you know you say no to anything that doesn't make you say hell yes and it took time for me to get you know pretty good at that and part of the reason and actually you know let's be honest one of the reasons that we struggled scheduling this show right is because I don't answer emails very frequently I am very explicitly clear about when I will and won't do a podcast and that is based on my family. Yep. And so yeah back in the day I'd be like oh yeah you want to do a 9 p.m podcast absolutely let's rock it out right and now I'm like a sleep at 9 p.m. because sleep is important and nutrition and health are important to me now and so it is challenging because again being honest looking back I did say yes to a lot of things but for me that came from like just a baseline as a people pleaser and so I had to do some recovering from that process and learn that like when I'm saying no to somebody honestly I'm not disappointing them what I'm doing is being honest and you know my integrity being a huge part of who I try to be that was an unacceptable kind of thing to do but yeah I said yes to a lot of things and the huge pivot in my career was actually two years into my career as an academic physician I was like fully engaged all in you know primary author on randomized control trials you know when in the best teaching award is my first year in attending like I was checking all the boxes really good clinically and so there were some leadership positions in my department that I really you know wanted to be considered for let's just say there's political decisions being made in the background and so despite doing everything I possibly could saying yes to everything it didn't pan out and this isn't like a door closing it's like the same door closing four times and so and I talk about it in my book determined but you know for me I learned very quickly that even when you say yes to things it doesn't necessarily mean it's going to end of the result that you want and so you know I'm not going to at this point waste my time on things that aren't very specifically going to get me to the goals that I I have in mind but yeah you know there there is this idea that you got to say yes early and I think that a lot of that comes from the fact that when you're a physician in training like it's just expected of you to do what you're told and to do what you're asked and take some time to realize like that's not true like that's not that's not a fact that is a thought and believe it or not when I learned to say no to people people didn't get angry at me like it's not like they're pissed off you're like wow I really respect that right I'd have someone come be like hey can you teach me how to do social media you got 12,000 followers and an email list with 10,000 people on it like can you teach me how to do that you know like we're going to hold a session a webinar for faculty who want to grow their social media reach could I do that yeah I could am I going to do that no I'm not you know like that's not that's just not on my on my priority list and I found out that the more that I said no to people actually the more respect that I garnered when I told people hey I don't check my my work email for the hospital when I am not physically present on the premises and I mentioned earlier work two days a week so you can imagine some people send me emails and don't hear from you for seven days right and so they just know that and they know that if they need to get in touch with me sooner like my section head my chair everybody knows you're going to call Jimmy or text him because I've set those boundaries and people are afraid to do that when they're young in their career not recognizing that people don't get mad at that they actually respect it and the thought that goes through their head is man I wish I was like that I wish I had the priorities that that person has to be very clear on what's important to them what's not and to set those boundaries like they do and I found that interesting that and I didn't know that when I started right as a young faculty member yeah I love this concept of setting boundaries right and because that's what you've done I'm wondering like with that personality that you have of people pleasing earlier on so if we rewind the clock maybe six years right five six years or so when you're still early career attending and you're saying yes to all these opportunities and maybe people are reaching out because again email is big right and I think context and tone all those things by language super important so when maybe your residence or a colleague or communicating and you say hey listen here's situation and you're communicating in person they get it they'll respect it but have you found a way in email to politely communicate that did you have templates and stuff like that that maybe I could borrow you know I definitely don't have templates I try to respond to you know as many emails as I can and naturally as that volume gets larger it becomes more and more challenging but you know at this point I'm just pretty direct about it you know someone says hey you know I'd like to help you with this like I see that you've got the social media presence and I want to help you grow that or like hey I saw you have a coaching business and we help coaches reach X Y and Z or hey I want you to come on my podcast or hey can I be a guest on yours and you know I just reply and say hey you know I'm not interested at this time and and it's just very matter of fact very blunt like I don't need to give you reasons I it's just the answers no and and before like I used to feel like so bad about it be like hey you know like we don't really have guests on the show and so you know because of that you know we're not going to bring you on and I'm sure that you're great like I don't do any of that anymore it's like hey I'm not interested and some people are more persistent than others and sometimes you know persistence pays off but but for me you know it like no is a complete sentence right and so like I don't like I don't have any reservations at this point of just saying that and and the reason why like let's talk about boundaries because you mentioned boundaries you know if there's an equation in life right like happiness is you know let's say just expectations and reality right those are the two things that do it if you have high expectations and reality isn't quite meeting that goal you're going to be to satisfy you're going to be unhappy and so what we tell ourselves is that like hey we're going to you know manipulate reality such that you know we're going to be happier because we're going to make reality better and when you're dealing with two human beings right their expectations of how you're going to respond are completely independent of you you can't impact that right so if they have super high expectations you could say yes and still not meet those expectations they might still be disappointed in you no matter how much work you put into it so this idea that I'm going to say yes to somebody and make them happy isn't true or the idea that I'm going to say no and it's not going to make them happy also isn't true like you can't dictate people's reactions to things right but what I can't dictate is my expectations of how people respond right so if I say no and they get upset that's on them right like you know maybe they're having a bad day I have no idea but like I'm not going to like set the expectation that if I say yes to people that I'm going to make them happy because you can do everything right in life in relationships where that's marriage children colleagues at work you everything in your power to do something right and they could still end up being angry I love that you know as you're talking about that I'm thinking about you know I think there is a sense of freedom that you have to have to be able to do that right to make those fur boundaries I think a challenge that I think about a lot of you know in again in medicine you mentioned you you don't feel like you have that right it's there's this the culture of medicine is like okay when you're told something you got to do it I even find myself following this chapter if I'm being completely honest again you know I tell people there's no type Bs in medicine your type A or A1 or A2 right and so you have to be intrinsically motivated and you just figure stuff out and so sometimes when you're providing guidance to somebody or maybe it's publishing or case report whatever it might be you say hey I can figure this out and there are certain people who won't do it and you have to be more like pestering them and as attending you're like I can't believe this is happening it's like okay well if everything that I'm talking about here everything we're talking about here is that we have to break this mindset of this antiquated mindset it was like because it was hard for me or I had to go through all these challenging therefore you should too like I'm being pretty hypocritical right now if I'm not going to make it better and and so you know that's the cognitive distance it's so interesting that we've been talking about this for three years right we call medicine redefine we want to make it a better way yet I find myself following that trap all the time so that that is so interesting to me you know I think it's an interesting thing and and I will you know controversial comment or not I think you're a bad human being if you want things to be worse or as bad as things were for you like great can you can you think about that from like a parenting perspective and like imagining a conversation with your kid where you're like you know what son I want things to be as hard as they were for me or harder for you and so I'm not going to help you in any way shape or form even though I've got the resources and the abilities to do that like that makes you a bad parent now I'm not saying that like you know you should enable your children like I'm like the most anti-enabler possible like my kid if they have a you know a problem I'm like go deal with it go solve it right I'm not going to talk to the teacher for you go have a conversation with your teacher sorted out see how it goes go have a conversation and learn how to be an adult right that's the process of becoming an adult and right your parenting is responsible for that and so for me like I don't enable my children I don't solve my problems for them but like this idea that like I want it to be as bad or worse for you than it was for me like I think that says more about the older person you know in their journey than it does about the younger generation and there is a lot of generational conversations at this point because what the generations you know let's just say you know behind me have figured out is like I don't want to sacrifice being you know a doctor and a partner and a you know a parent if that that role is something that involves you like I want to be good at all three of those things whereas the people ahead of my generation I'm like right on the cusp of both of these conversations my old you know older generation like like there's a reason you call a house officer right like that was your house it's where you're expected to live and you have people from those generations if you ask them they'll be like yeah my kid was like you know hey daddy like are you gonna you know stay at the hospital or are you gonna you know come where I am you know and they're like what do you mean they're like well you live at the hospital right and and so like being a physician and doing that was your identity and so they've laid this expectation on younger generations that it'll be the same for us and we're all saying like no we're gonna buck the gourds like there's no way in the world I'm gonna you know make this a priority over my children or my wife right or your partner depending on your situation right so like it is it is an interesting conversation for sure that friend of mine that I was talking about with the disability insurance earlier he's in private practice down in Texas and he uh just two group fighters and he was expecting um it's gonna be a couple of months and he had told his boss when uh when he was expecting to hey this is happening in May and his boss's response was like well you could be a good doctor or a good father you can't be both yep it's like wow all right so if that's not like telling at that point right and so yeah it is very very disappointing but I think it's super helpful for us to have more of these conversations particularly in academic medicine right I think because yeah we're directly working with trainees and yeah it's good in social media but there's a lot of poison out there too and so I think you know these trainees and the next generation our generation are inspired to have this but we don't know strategies and tactics which we're gonna get a little bit into later that's our guide and I was gonna say I think this is a really important point right because when you go through medicine so much of what it does to you is it makes being a physician your identity and so when you get to that arrival fallacy and you realize that that identity isn't what's gonna make you happy in life that that's the issue that's the existential crisis that people have they're like wait hold on I worked so hard to get to this point professionally this is the point in which I'm supposed to be happy and it turns out that your satisfaction and fulfillment and happiness in life often don't come from medicine right so when when people ask me like you know who I am right I'm like I'm a godfiring husband father and honestly at this point I'd probably put entrepreneur before physician and people are like I mean sacrilege like screaming at the top like you must be a terrible doctor because you have all these other priorities ahead of you and I'm like if if I took care of you clinically I can promise you you feel like you're my number one priority when I'm at work because you are right and I would take fantastic care of you because I can it doesn't make me a bad doctor that I've recognized that it's not in the top three or four things on my priority list at this point but when you get done the identity of being a physician is so strong amongst doctors that learning like that that's the existential twist right is exactly what your colleague was told right like you can be a good father or you can be a good doctor but in the reason why is because it goes back to that hell yes policy we talked about before you can't say yes to both things and and in one of my favorite quotes on this is Greg McEuny wrote the book essentialism and he basically points out that like the word priority originally meant like the one thing above all others and then at some point in the English language you know 100 years later we decided to make that word plural and pretend that like there can be multiple things that are above all others and that's just not the way that it works and so if you're being honest there is a priority list and you know I wouldn't go as far as say like you can be a good dad or a good doctor but I will say that you were going to focus on one of those more than the other and you're going to recognize that when you say yes to being you know quote unquote a good doctor and doing the committees and the research and all this other stuff you really saying no to your kid and eventually the rubber is going to be thrown I'm not telling you what to do like for some people like professional fulfillment maybe more important to them than being apparent and you got to be honest about that right and that's really ugly to say on a public podcast but if some people are honest it's more important to them than being a parent right and for a lot of the others of us we're like no I'm going to be honest with that when I have to choose I'm going to my kids baseball practice like it's just it's not even at this point a a you know decision it's just I've set the priority right but it's it's a lie if you think that you can prioritize multiple things is the normal one thing in your life right yeah particularly with competing demands right I think I think about chip and Dan Heath they wrote this really good book by decision making and I think the very final chapter and it's talked about enshrining your core priorities like you're putting it on the mantle up there like what is the most important thing to you at that point I was like okay listen it has to be family and then you look back and you're like okay well but do my actions reflect what I'm saying 100% and and I had to go through quite a bit of therapy to to realize okay how do I step away and the other thing is you know talk about patients or or even your colleagues who are like whoa you've gone through like what so you did six years of training on top right so you did no five years five years right yeah so nine years of training and whatever student debt and all that kind of stuff and you know it's a it's a disservice to humanity especially with okay doctors are a shortage you know code everything that happened and it's like okay how are you not gonna prioritize that in that service industry well I think it also goes back to another thing we're talking about with family being present so when you're there you're a doctor in front of your patients you're in that room right we're having these conversations you're not thinking about the charting you're not thinking about the billing on the prior patient or the procedure that's coming if the you are there you're present you're letting that human being know that this connection right there this is what it's all about this is what matters now and that is so hard because the other thing is like you know we think about productivity sexy word right and this the the concept is okay the more you can do the more tasks you can juggle the more productive you are well Cal Nupor just came out a new book or it's coming out slow productivity big fan of him and I was listening to him on Adam grad's podcast this morning talking about what slow productivity means and he only has three principles on it right you you do fewer things not more things you do fewer things um you do them um I forget about the second one but the third one is the most important one is you obsess over the quality of the work right and and I think that's another important thing is like as we take things off that priority list which might be 10 things you can focus in hone in be present in your connections family patient interactions and the quality of all those interactions the quality of what you end up producing putting out on the world is just gonna rise and that'll open up more doors for you which yeah we eventually have to say no unless it's a hell yes uh so uh that's another oxymoron that you think about and and I think we don't we don't talk about that enough yeah no I agree and an entrepreneur like for those that are listening to this like you really need to hear that and so for me the the live it I kept listening to early on is that you have to scale right like you got to help more people it's got a scale you know you got you got to make recurring revenue and all this other stuff and when it really came down to it like I just like helping people right and so like at this point like we do coaching we do disability insurance and we do student loans and all those are very like for the most part non scalable you know just simple things and so like when you talk about slow productivity for me it was getting away from this idea that the rest of the world tells you like you got a scale and and making things simpler and slowing down and focusing on financial literacy like I give away a ton of financial literacy content for free and you know why I'm be honest because I like it it's I enjoy it I'm slowly productive I create videos I edit them myself I write the blog posts do the podcast and all that sort of stuff and and and I think that that is something that a lot of people miss in that hustle culture and I will say that you know for entrepreneurs listening that that third point that you pointed out by Newport is is kind of a tough pill to swallow because at some point you got to be okay with B plus work if you if you obsessive or perfectionism which every single doctor that I know is yeah you will just never get started when it comes to entrepreneurship that is the biggest hurdle like oh well I got to learn everything about podcasting the you know the exact equipment and like exactly I'm supposed to edit do all the stuff and it's like no no no just keep behind a microphone start talking into it you're going to be terrible that's okay you're going to learn from it and like you know your first 47 episodes are not going to be good it's not 47 it's more like 10 but like you know all that said like you learned by doing and medicine is no different you you did the same thing in medicine but this idea behind perfectionism and like an obsession on quality like I think that would be in entrepreneurial space challenging but I do love Newport to do deep work and like seems like that's an extension of his other idea so I look forward to doing that one yeah yeah I wonder if and you know if he helps I make the distinction between and I got to pick up the book the between the perfectionism because I couldn't agree more and this is where shout out to Dar she's so good at this right and then this is one of the reasons I parted up with him because and I think I bring a slightly different dynamic to this and where I am the crazy researcher and I will go do a deep dive of what's the most optimal mic that's you know gonna be done this and that and he's just gonna like I'm gonna pick up a mic from Amazon for 40 bucks because that's what I get afford right now we're just gonna record yep okay great um and so yeah I couldn't agree with more because I think that you know again I am prone to paralysis by analysis that a lot of people like that are and so you know couldn't agree more with that um let's let's shift a little bit talking specifically about academic medicine you know we've touched on the importance of training the next generation and how even helps us grow and not too long ago or maybe it was like last year or some point you you had tweeted about becoming a associate professor who are asked by the way um and how your academic promotion journey stops there and I'm curious why yeah so this goes back to the hell yes list um for me like I've slayed that dragon like I know I can publish you know RCTs and be a you know PI or you know more senior author I know that I can teach I know that I can work clinically uh and for me it's a question of like hey I've got I've got 24 hours in the day like I really human uh and I do like that quote like the first half of that quote by you know the rock like like you only have so much time and so what I would say is like you're not prioritizing things uh if if you use this phrase like I don't have the time like people say that all the time it's like that's not true that is 1000% never true you just aren't prioritizing things right and so for me like it just it's a low priority at this point like I'm not doing research like all of the additional hurdles that have put in place like it's not just like clinical medicine we're like oh it's now like peer reviews and all this charting like you know boxes you have to check in order to build somebody and you know just keeps becoming you know more more complicated and challenging they did the same thing with research right it's like all of the information you have to put on clinical trials.gov now like it's stupid uh you know and and the vast majority of the work to go into research to answer a question that you may be passionate about for me just wasn't worth it anymore. I was like I'm not putting in all this time right to to potentially make a non-clinical incentive three years later that's definitely not worth the amount of time that I put into it when I can help doctors with other things and if I'm being honest I'm more passionate about and so um I just know that in order to get like for for associate professor at wake you have to get to about 12 or 13 like solid publications in addition to educational and clinical um you know whatever you want to call it um cloud and um so to get to full professor I want to say 25 or 30 publications and like at this point like there is next to zero chance unless I'm just like a co-author on a bunch of papers from my colleagues which I enjoy helping other people do their stuff but I just don't want to do it myself right. And so for me like I just can't imagine getting to a full professor ship where I'm not the PI or senior author on papers anymore uh and that's just not a not something I'm gonna prioritize maybe when my kids are grown and I've got nothing else to do like okay you know maybe 20 years from now. Yeah. You know but it's so clear from the work that you put out there that there's just not passionate about that aspect of it right um I mean you don't you don't talk about that types of but you know what man you're right it is stupid because you know all the things that you are doing you know the the financial education that you're providing the coaching courses that you've had the book that you've written that is exponentially more important in making somebody a good quality physician right and a well-rounded physician as well. And and I'm just wondering do you see of a future 10-15 years from now hopefully you'll still be practicing an academic medicine where we we prioritize those things that will allow you to kind of escalate the ranks as opposed to the research publications which are completely irrelevant and we also know there are a lot of ways to to work first of all like good quality to research and putting in reputable journals hard work agreed but there's predatory journals all the time you pay 150 bucks or $200 and you get it published right and we just become a PI and make your trainees do all the work which is bad practice but you know people people have work around sort of that and it's completely irrelevant. Do you see that? Yeah so it's an answer question your first question about do I see a world in which this stuff is taught the answer is yes and and it's been interesting because like being at the tip of the spear in academics because like when I think about the physician finance space to be also I think I may be the only academic physician in that space I'm not I'm not certain of that certainly among the you know more well-known personal finance you know blogs podcasts that sort of thing and and so when I started you know I offered a personal finance curriculum to to residents to the SRNA students because you know I do anesthesia and I think every medical professional deserves to be financially literate to the PA students I cannot tell you the number of times people said no and this was like completely free financial literacy I'm happy to help you know your students learn how to to do this and as the data and the research came out that like oh like financial stress is one of the most stressful aspects of being a physician oh and by the way financial stress is linked to burnout oh and by the way you know like all of this stuff and like it just makes sense right like when you're burning out in medicine and you hate your life and you hate your job the only reason that you stay in it is because you cannot financially afford to leave and pay off three hundred thousand dollars in student loans or continue to pay for the lifestyle that you've created the only thing keeping those people in that situation is finance it's it and so like like just logically philosophically it makes sense that the literature is now bearing this out and so do I think not only will the stuff be taught I think the ACGME unless they've just got their head in the sand will absolutely mandate that these topics get taught in residency because financial aid offices exist in medical school but then when you actually have to implement a plan in residency they are not required by the GME which is insane to me and in fact I've offered services for that at institutions and some people are like yeah I'm willing to pay and some people are like no the GME's poor we can't do that it's like that again a lie the 24 hour lie like you're not poor you're just prioritizing money in other locations but I think at some point the ACGME will mandate this because they'll have to reckon with the fact that physician burnout exists it's related to financial stress financial stress has been shown to be related to low financial literacy and higher student loan burdens would continue to increase and at some point you just have to say like if we're doing the right thing by people this stuff has to be taught in training like not not like it should be taught at some point it has to be taught couldn't agree more and hopefully I mean ACGME is in me wellness a real point of you know medical education for the last couple of years and this is part of that you know I think about my own financial education journey and it was all because of my student loans I am just shy $400,000 in debt yep and at the time I was like oh it was my greatest source of anxiety no kids no no no marriage at that point greatest source of anxiety coming out and I just remember that time so it graduated in May 4th year 2017 and I just stumbled the bone white coat investor and I went down this rabbit hole you know Ben White this all that kind of stuff and then I realized I was like oh man I gotta follow my taxes this year right and so I can get that first year zero dollar payments and stuff that's thousands of dollars on the back end right that people don't think about it's the simplest strategy it didn't have any income that year and so just simple things of that nature right I mean we talk about people who are still investing in the whole life insurance right because that's gonna be good policy and it's just it's sickening that people are 20 years in and as you mentioned right you are well paid you make multiples millions of dollars there's no reason you shouldn't be able to to you know have your financial situation figured out it's just a literacy piece of it I mean Jim Dolly posts on white coat investor like I think recently he's been doing just the burnout rates and different professions and student loans and this and that and it's crazy but again you know these types of conversations platform such as yours and a lot of other folks in the space I think do help and we just have to kind of promote it but yeah academic medicine sometimes isn't a silo so I'm a little shocked to be honest that people wouldn't take you up on stuff like that but I think it just goes back to like what medicine has prioritized is like okay that's not important learning renal to a grass adosis is far more important because you're gonna use that you know at some point there's an inherent challenge here right that has to be has to be recognized so you know I'll give an example of my own institution right so having these conversations internally I have a business that's external to the institution but I'm an internal faculty member and so I certainly can't take an hour or two hours on every student loan consult and provide that for free to the residents and fellows awake right so that time has to be paid for from somewhere whether that's the GME office or you know we charge the the residents and fellows a like ridiculously low price so they can get student loan consults that don't cost $600 because I think that you know when you're in train I couldn't have afforded a $600 student loan consult when I was in training and so you know how do we make this affordable for residents when they really need the help and and you know for me it's like I need the money from one place to the other and really it's not money because money is a surrogate always for time right I need the time to be able to do these things and so it brings in conflict of interest conversations right which are really challenging and I totally totally get it from my institution's perspective but yeah it's it's you know how do you sort that out right because the people that have the knowledge aren't going to be doing this for free right because by nature they are entrepreneurs right and the people that are inside the hospital that may want to help typically don't have the knowledge you know the vast majority of physicians are financially illiterate so like who's gonna teach these people right and yet we pay for consultants to come in all the time to hospitals to help us figure out really expensive problems that you know they just give like they're they're you know generic blanket statements of like ways to improve x, y and z the hospital pays millions of dollars to come in and instead of just asking like the people that are internal to the institution like hey what's going on right yeah so like it's not that the money's not there it's not that we don't use consultants in other areas of life but when your consultant works the hospital for you it's a different it's just a different flavor of conversation you know what I mean yeah yeah it's really tough I totally get it yeah yeah I don't I don't really know the workaround with that because I think about that all the time right and so because you are a mentor and stuff so a lot of times we end up doing these things for free right and and you're not getting paid for your time well people are going to ask anyway like even if I don't have a formal curriculum people know who I am yeah yeah hey jibby uh I've got a question about you know student loan side yeah exactly so I there is not a date at this point that I go to work where someone doesn't ask me about personal finance it doesn't happen so so tell me this then it that happens uh your APD or program director fellowship so I was the program director fellowship actually stepped down in in July handed off to my body but I did that for a few years yeah got it okay so you you feel a sense of responsibility to your trainees and stuff right because you are again you use the analogy of being a parent and I'm passing it on I said quite not the same relationship but you do feel a sense of responsibility that hey I'm I'm responsible for the education I got to put good physicians out in the world or at least be a positive along their training and if people come and stop you and ask you about that stuff you know how important this is maybe even more important than the other procedure that you might have told them how to do um reconciling that with the fact that I think you've mentioned at some point that you would tell people can this conversation happen in five minutes or sixty seconds or so if not email or something like that um how do you how do you handle that now so for me because I like helping people so much anytime resident student you know colleague stops me at the hospital like I'll take as long as I need to have that conversation um because I recognize that the resources aren't out there for you know that that maybe they don't they don't that they trust uh to to help them with their need and and again like I mentioned earlier I love simplicity right so I love helping people on on I love making that connection I love uh providing providing help to people like is is that going to make a business like go to the moon and scale like the answer is absolutely fundamentally no um the the comment when I tell somebody and and I remember reading like what is it the uh the four-hour work week by Tim Ferriss when he's talking about like being in the office and like just having headphones on your ears even though they're not like listening to anything just so the people don't bother you uh and so for me when I make comments like you know hey I've got uh you know I've got three minutes till this meeting and looking at my watch you know given the social queue it is typically around those things that I say no to yeah right so like will I let you curb side me on um you know it's something that isn't a priority to me like yeah oh you'd be five minutes yeah right but but if it's if it's not something I'm passionate about if it's not something that is in my wheelhouse I'd much rather refer you to someone else and or just tell you like look I you know I do not currently have the time for this um so so one on one for like the financial stuff I can't tell you the number of times I'm like on second shift and have a resident saying hey you know um I don't know what student loan program to enroll in you know I like where do I even start and just start asking the questions about their situation and giving them general ideas I have to crunch the numbers to tell them for sure but um but yeah happy to take time to do that stuff you know what's funny I'm thinking about maybe I got this from Ryan at one point he was just talking about enough people were asking him these questions or maybe it was different podcasts where when he started the podcast um he would just send the podcast to somebody it's like hey listen to this this will answer all your questions stuff I do the same thing yeah does that work for you because it doesn't work for me and and I'm wondering why like for instance um recently I've had a couple of friends who were asking me about job contracts and negotiations and like that kind of stuff what's important and we had uh John Epino from contract agnostic come on here and we did two episodes on them and we covered a lot of that stuff and they're not long ones either right so it's less than two hours of total content and I'll be like hey listen to this this is literally answer every question and more give you thoughts to think about um and then I'm and then I still hear about other questions but like well what about this and like you didn't listen at all I know you don't listen yeah so so my my experience in education is interesting right so like I I will have um 80% of the medical school class I do a fourth year curriculum for the personal finance so like I'd they actually pay for 10% of my FD to do that um and so you know take time love helping the students but man you'll have 90 hundred students sign up and then like 24 of them will show up live and and it's just my experience over and over and over again like people want this stuff um but really what they want and and you can I mean it's makes sense right they're busy physicians it's like tell me what to do um right so like I can go and educate myself but 80% of the doctors out there are going to be like I mean I could go listen to your podcast but you know you could also just tell me what to do right and so like simplifying things and being like look you're a resident you need three things right you need a student loan plan you own occupation disability insurance we can add term life insurance if you have people dependent on your income and you need to be financially literate it's like the extent of your knowledge and like the tasks that you have while you're in residency like there's your to-do list right go get a student loan plan go get a occupation disability insurance and get some sort of financial literacy however you want to consume that sometimes the answer is that people don't have time sometimes it's hey you know I really appreciate the podcast but I'm I'm a book person I'm a blog person actually I like watching videos on YouTube so people consume content in different ways right if I'm a car guy if I want to go learn about cars I'm I'm going to throttle house on YouTube it's my favorite channel I'm gonna watch like every video that they point out they put out it's like three million subscribers at this point I was following them back before they were like below a million and you know but like if I want to learn about personal finance to be honest with you I'm gonna probably go read a book but if I want to learn about like you know self-improvement or if I want to learn about you know maybe like more let's just say like philosophical ideas around money or you know some of the ideas I've talked about today like Cal Newport I'll probably buy the audible version of that book and let's do it in my car right so everyone consumes content differently some people don't want to have the education they just want the list of like hey here's the things to do and so I definitely have run across that but at the same time you send me an email and I've got content that's specifically created behind answering that question I'm going to send that to you and if you don't want to read it that's on you you know and again it's like yeah I'm trying to help you but like I can't meet one on one with everybody for 30 minutes like that's that's awesome yeah and you know hopefully all my trainees are going to listen to this and my mentees certainly I'm gonna send them this and I think that here's a little thing that's important for them to know I mean just like you you thrive in rotations and when you're trying to get a letter from somebody you have a conversation you go back you read a little bit more about it and you come back and you discuss with the attending right because that gap between medical school or medical 30 or 40 or medical student attending like it's astronomical people don't appreciate that right even though it might be six years but it's astronomical but if you go learn about a concept or at least just introduce yourself and then you can have a deeper conversation attendings and really or somebody who's an expert in a matter subject matter expert can within moments tell who's interested and so I couldn't agree more recently when people ask me questions like well what do you think about supplementation or what do you think about intermittent fasting or do you think about this type of stuff well say okay well how do you how do you like to learn right is it YouTube is it this because I can literally you know as a blog we're going to visit philosopher WCI that kind of stuff you're right is it a is it a podcast this is this a student loan planner they have a good stuff you know books and they'll do that and then when you come back we can have different conversations and I am more likely to give you that extra time that if I know you're not interested in and we can't learn from each other and we can't have deep conversations that's just we're both wasting our time let's find another way to connect with somebody else yeah I first somebody say before that you know it comes like a mentor mentee relationship that is driven by the mentee and in my experience that's true because man I can as you're experiencing on the show talk about things for forever and and I love doing that but if you're not engaged or interested or willing to implement the things that we're talking about at the end of the day it doesn't really matter so like I I much prefer the situation where a resident comes up to me and says hey Jimmy you know I've got this question than to you know just sit people down on like a rotation and be like hey we're going to talk about personal finance now because like for the you know people that aren't interested in it it's a you know it's it's something that it's just not going to be super meaningful to them maybe I expose them maybe there's something like see that I plant that like comes to fruition seven years later like I've got no idea but for me when like it's driven by the mentee and they're interested it's such a more engaging conversation it's it's something that they actually do and apply and so you know for me that that's been my experience people reaching out and being proactive and then it's up to them how you know how much they want to follow through on something yeah you can agree more earlier you mentioned that you didn't appreciate how flexibility would be the most important factor for you when you were looking at medicine and I think you know that's we always talk about high-tech being 2020 and again residents fellows looking for their next job first job whatever it might be even medical students when they think about five years from now how did like to practice I think foresight is it's a superpower right having that but what's called foresight and that's why nobody says foresight's 2020 how do you have conversations with your trainees so they can strengthen that foresight so they can make important decisions along the way so they avoid all these pitfalls like the ribon fallacy early burnout that kind of stuff yeah you know that's that's a tough question just because like breaking it down in different areas of your career like fourth year med student asking like hey which residency do I choose like I'm trying to think about specialty like I've got a whole you know framework of thinking around that versus a resident choosing a practice you know whether that's private practice or academics what have you and you know it's it's challenging I think when people are choosing between choice A and choice B like I'd say that's the situation you're choosing between two different jobs I think pro con list are absolutely worthless and that's kind of the common way the people go about thinking about that I think a much more helpful exercise that I go through clients and you know coaching is what what is the worst case scenario right you've got option A what is the worst case scenario in that situation and then option B same thing and if you can tolerate either of those or I should say both of those situations then just choose whichever one makes your heart happy right but if you're like looking at option B and you're like man like if we move there and it's away from family the income's not great you know we'd have to buy a house and the market's terrible right now and we have to you know come up 8% to sell the house plus have an emergency fund like I cannot oh and by the way the malpractice I'd have to pay for the tail like I would not be able to financially afford to leave this job if I chose that job there's no fallback plan and then option A is like well I can just come back and practice where I am right now that's not terrible right you're gonna choose option A right choose the one that has you know a worst case scenario that you can that you can handle and so when you're thinking about foresight it isn't 2020 you're not gonna know everything and so you know thinking forward and you're like well you know I don't have a family yet but I plan on having a family what would be important to me then and and thinking about what is the worst case scenario if I have one two three kids and I'm at this job like what would my option B if I wanted to cut back and if there isn't an option maybe you don't consider that job maybe you're like hey instead of taking a partner track what if I take an employee track I'm gonna make less money but I'm not working nights and not working weekends and not working holidays there's no 24 hour call maybe I can cut back are there employed physicians in this group that do that you know they're working four days a week instead of five and you're gonna start figuring out like oh this is something that potentially my future version of myself wants and worst case scenario I could always do X, Y and Z right and so hindsight's 2020 foresight is not so I think understanding like hey what would my options be in the situation based on where I'm planning on going knowing that I'm strong enough I'm smart enough capable enough to pivot if I need to I love that I love it what does it mean to be the self-determined physician oh man so I wrote an entire book about this so yeah when you think about you know Edward DC Richard Ryan came up with this this term self-determination and the research on basically intrinsic engagements you can think about like the self-determined physician to someone who's engaged they love what they do they're fulfilled in order to do that you need three things which are broken up in the I guess five buckets right so autonomy belonging incompetence so I call them the ABCs of self-determined physicians so the A is autonomy it's kind of broken into a couple of things so you need personal autonomy so I talk about making my kids seven PM baseball practice tonight like I'm gonna be there and that makes me happy right hasn't played hasn't played baseball since like you know T ball like all of a sudden took a love for it actually has a really decent arm so I'm excited to see and pitch and bat and baseball is my favorite sport going up like wouldn't miss it for the world but if I was on call tonight I would right so having the personal autonomy over my schedule is really important is also professional autonomy right so that's the second of the five buckets and what that means is like you get to practice height one right so like when you when you start thinking about people and they're complaining about you know having to have peer-to-peer reviews where their quote-unquote peer is not a peer or having to do you know like go through insurance to get pre-approval for something like that's impacting your professional autonomy it's white upsets people so much you know similarly you know being able to to practice the way that you want which may be dictated by policies and procedures at your hospital or clinic wherever you work the B is belonging so this is the the idea that like you feel valued you're not a cog in the wheel you're not a number on a spreadsheet like you were a valued member of the team who's accomplishing a deeper purpose which is the second piece of that right so we got personal autonomy professional autonomy a sense of being valued team member who's for accomplishing a deeper purpose that one's interesting because most doctors do like I mean I am taking care of patients like normally that when checks off the list the fifth one is competence of being good at what you do and more importantly feeling like you're good at what you do which brings in the whole conversation of imposter syndrome and people actually being good at what they do but you know feeling like they're they're terrible and judging themselves for perceived mistakes and so when you have that autonomy the personal professional autonomy feel like you're valued and that you're accomplishing a deeper purpose in other words that you belong and you feel good at your job when you have all five of those things you are a self-determined physician and you are someone that is engaged love what you do feel fulfilled at work and when you have all five of those pieces that is the person that reads my Twitter posts about the rival fallacy and things that I'm like just full of it right because like I finished and I love what I do well you well guess what you have all five of those things but for the other 80% of physicians that don't that is why they're unhappy they're they're missing the personal autonomy they don't feel valued by the healthcare system right they've got peer-to-peer conversations that are impacting the professional autonomy maybe they're going through massive imposter syndrome they don't feel good at their job when you're missing one of these five things that is called burnout right that like it is the antithesis of this right so you know talk about the emotional exhaustion and the lack of perceived accomplishment like like the three pillars that Frudenberg originally described don't burn out they are the exact opposite of having ABCs of being a self-determined physician well thank you for that man I know you spoke about this a lot in your book but I wanted to introduce people to that because I think when people think self-determined they're like well of course I'm self-determined I'm in medicine I went through all the steps I checked all the boxes I jumped all the hurdles I got where I am how could I be if I'm not determined in fact you know my group are from from college like that's how they were describing they would say discipline determine and this and stuff and I'm like yeah it's actually you know it's just you just got to the steps are all laid out for you but everything that you've talked about here and elsewhere it's like you know these are not steps that are laid out for you which is why I think it's important for us to have these conversations for for your coaching and for us to implement into medical education and GME Jimmy I appreciate everything you do man thank you so much for for being here if I've learned anything I want to respect your time and I can take too much of it and you know hopefully if you enjoyed it then maybe we'll we'll find another time to to talk about this because we can we can do this all day right so sure you know tell people where they can connect with you you're on Twitter you're a couple socials you're you're a coaching practice a couple podcasts as how do they connect with you what's the best way yeah the best current way is go to money meets medicine dot com you can also check out the podcast money meets medicine as well and yeah so actually if if people want because this is like the your financial literacy for me like I just I'm trying to give away everything because I want people to know what they need to know they can actually go to money meets medicine dot com slash redefined and get a free copy of my book the physician philosopher's guide to personal finance so it's it's an ebook and a PDF format so you can download it to your Kindle if you like to consume it that way and and wow means share it with all your friends family other medical professionals love it man thank you for doing that last but not least this is kind of the theme of the show right so the question that we like to ask people we we say that we practice in a sick care system burnout large contributor to that for physicians and so the question for you is you know we're aiming to put the health back in health care how do you think we do that man complicated so right now I think that we have a system that is profit over people right so so your administrator say stupid things like no margin no mission which on the face of it makes sense like you're like well if the hospital doesn't make money it's a business and therefore we have to like you know quote unquote shut off the lights and you're like right but that's short-sighted the way that you get a margin is by helping your physicians and medical professionals become self determined and then it's amazing what people can do and they're intrinsically motivated and engaged and how much money your hospital will make when people love working with you they feel like they have autonomy and they feel like they're good at their job right so if you want to make margin you have to put people over profit and you know specific ways to do that are a little more challenging to answer because it's going to be individualized to different institutions and just say companies because that's what medicine is nowadays but you know I think ultimately from a philosophical standpoint that that's what's going to have to happen love it thank you Jamie yeah man thanks for having me on thank you for listening to another episode of medicine redefine as mentioned in this show please be sure to grab your free copy of the physician philosopher's guide to personal finance this is an amazing resource made available to you free by Jimmy and you can download your copy if you go to moneymeatsmedicine.com slash redefine again that's moneymeatsmedicine.com slash redefine and as always guys please remember that nothing in this podcast is to be construed as medical advice or financial advice of any sort be sure discuss your special circumstances with your physician coach or financial planner and discussions in this show are for educational purposes only no physician patient relationship is formed and anything discussed in this podcast does not represent the views of our employers we do this because we're passionate and we're hoping to do our part in helping make medicine better and make your lives better by promoting health rather than just avoiding sickness so if you do enjoy this show or you find anything valuable here be sure to subscribe to the show so you don't miss any more of the future content just like this as we keep bringing more and more to you also if you think this is valuable or you know someone who's going to value from this he's be sure to send them this episode or any other episode that resonated with you last but not least we want to thank our team for the production of this podcast sarah Khan Zanab Lugmani Ethan Jew and her with the apory thank you for listening and we'll catch you next week