179. Is Medicine Worth It? Real Talk on Debt, Purpose, and The Future of Doctors

Welcome to Medicine Redefined, a podcast focusing on helping you reclaim ownership of your health. I'm Dr. Darsha, and I'm Dr. Altamash Raja, 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. What's up? Back on the mainland. Back to your man. What's up? Your back is not working again. It's like 94 degrees outside, so if I melt on camera, I want you to keep going. You got it, man. I got it. Either way, right or die. Medicine Redefined. Yeah. Yeah, you carry the load. Pause. The topic of today's discussion, man, is medicine worth it still? And just a little background, I think this is a question actually shout out to Harita who brought this up, something that's top in mind for a lot of people who are going into the medical field. Honestly, this was a question that's been asked of me prior to the one big, beautiful bill asked by a couple of undergrad students who were shadowing and just come across my path. And of course, you know, like a long discussion. So here we are. And then if I do end up seeing them again, I'll just tell them to listen to whatever this will be episode 179 or 180. I'm not sure. Numbers are always off. But when you hear that, what are what are the first thoughts that come to you on? Yeah. And I just want to clarify for the listeners, I have Harita's text pulled up, right? So the reason she's bringing this up is she's seeing this online a lot lately, right? With TikTok, Instagram, and obviously because of the big, beautiful bill, a lot of people are putting their opinions out on there. But so she's asking us, hey, is it there's an argument that it's not worth it to be a doctor this era economy with time invested financial outcome, lifestyle balance, et cetera? So she wants us to talk touch on that as well as people don't think that you can do anything else and be a physician, but us two are doing it. So she wants our unique perspective on that. So yeah, I guess we can start with, you know, what do we hear when people say is it worth it? I mean, that's the age old question. I guess it's not age old. It's more of a new era question. I don't think we were hearing that question in the 80s or 90s as we always reference to the golden era of medicine, but obviously as, you know, we've touched on other episodes with the insurances, muddying the waters, private equity, education has changed or she'd lack thereof has not really kept up with the times. And there's been built up tension, built up frustration, yeah, the things that people know as we've talked about on this. I think what's interesting for me is when I chose the path of medicine and we'll get into this too about how the way we thought about medicine long term versus just really being in the present moment, I think we both probably had a long term perspective on it when we were pretty mad and even in medical school. When I was a resident is when I start to really get jaded and think that medicine was probably not worth it. I think I was also at a point where everything I was doing was getting dictated, right? The time I woke up, the time I was sleeping, it was all dictated around this training that you have to go through quote unquote grueling. I mean, we were in rehab. I mean, we had a little bit easier than other residents and other specialties. It was definitely a jaded perspective because we, you know, we're very much into lifestyle medicine. Integrated functional really root cause trying to take care of the patient and be more preventative and it's really difficult to do, especially as a resident and especially in our current health care system. But then when I started looking at, okay, now I got to find a job and I got to understand where I'm going to live and I have to understand the type of practice I want. And then do I have to build that out? A lot of it to me just became, oh my god, it's worth it at all. And I was under the camp that it wasn't. And I would actually tell students to really take a hard look in the mirror before they wanted to go down medicine and to really see the reasons that they wanted to do it. Now that I'm coming up on a year of being in attending, I have definitely flipped the switch. It's also a unique perspective because I've made it work. Like I really enjoy what I do. I have a good lifestyle balance. I'm in a great location. Money's good. Time is good. Everything like people say you can only have two of the three, but I've really hit all three. And so if you know how to do that, then yes, medicine can be worth it because it allows you to have options to practice the way you want to. It's interesting to me that you offer that perspective. I think outside looking in for the last couple of years, I would have said that you were already doing so much of that, making it worth it. So I think the question that I would throw back to are awesome interns and just anybody who asked that question is not necessarily is it worth it, but how do we make it worth it? And I think the theme of the podcast, if anybody hasn't looked at what we're all about and what the logo stands for and what the name suggests is, it's all how we are trying to make it worth it, how other people have come on here. Most recent yet, Dr. Bence Markezy, a ton before that, talking about how they are taking agency back into their hands. That question in the 80s probably wasn't asked because financially, that's, that just, it was a very clear answer was yes. And I think that now when people are probably asking this question, at least especially on the social platforms after the one big, beautiful bill, and I'll get into a little bit of that of how the finances really don't make sense. I will very clearly tell people financially, it's a horrible decision. I think when you just look at the return investment, opportunity, cost, time, all that kind of stuff, I think it's a really bad decision. There are better ways to make money, correct? Because things that we've highlighted before, right? It goes beyond burnout, it goes, it's like moral injury in modern medicine, right? So it's not just exhaustion. People go into medicine because they were promised something, and that's not what we're getting. So it's more betrayal, right? You realize as you start practicing that RV use matter more than outcomes, documentation matters more than connection, metrics matter more than humans, right? And at that point, the things that you're highlighting in residency, sure, it's a grueling physically, sleepless nights, et cetera, et cetera, I think a lot of people appreciate that, yeah, physically it's very taxing, but I think emotionally is what physicians complain about the most because of all the things that I mentioned, the moral injury. And I know for me, getting through the residency period, again, Piaminar, I know if there's somebody general surgery listening out there, yes, I understand where Piaminar. So I don't put that in perspective for people. However, it can't be challenging, but I think that that's part that you can get through. I think it's the emotional part, it's the betrayal part that really makes it difficult. And the challenge is that moral injury has price tag, right? And that's where people sometimes often use the words burnout and escaping the system, et cetera, et cetera, like much like other people have come out and talked about healthcare insurance being a scam, which in some sense it is. And the irony is that this new bill that comes out, it's literally called the big beautiful bill, but really it's once it completely gets implemented, you're going to have nearly 12 million people losing Medicaid coverage, right? You're going to have 3.4 trillion added to the deficit for tax cuts. Corporations are going to be getting permanent tax breaks. What becomes especially challenging for students looking to enroll into medical school effective 2026? Let me just throw some numbers at you, right? So I was just thinking about, well, how is it going to actually impact? Are you familiar with the actual specifics of the bill here and there about, yeah, PSL app is still intact, but then there's a maximum about 100K, I think. And then people are going to have to take private, essentially, yeah. So the upper end limit, which makes it really interesting, right? So the grad plus loans that were previously available are completely eliminated, affected July, 2026. There is there are new federal loan caps. So 50,000 a year in federal loans and $200,000 total over time. Do you know what the average public school effective 25 AMC data and will tuition and board and everything included? I'm guessing around instant tuition, instant, I want to say 40. Yeah, or something around there. 73,000, yeah, private comes out to be about a hundred and three thousand. This is again, looking at AMC data across the whole country. So not just specifically obviously your state could be less than you for in the South, they're probably a little bit less. So the median debt graduations are on 205,000. And this bill caps you at 50 a year. So where's that gap going to come from, right? You have this gap of if you're going to go private nearly $400,000 for disclosure, somewhere in that ballpark, you have to fill that gap. You have to go to private lenders and qualify for that kind of stuff. That makes it very, very for people to bank on decision, especially people who don't come from an area where they can get these, get access to these types of loans. So I think that that's another point to consider. And I think that's a question that people are going to really have to tackle when you're 18, 19 years old because that's when you're going to college and that's when you're deciding you're going to go pre-med and you're going to run down this track into a 70 year advanced program or whatever it might be. And you know, people, once you put your head down, you're going to pre-med, you're just going to hurdle after hurdle after hurdle. But this is a very important discussion you're going to need to have with hopefully somebody who is wiser than you to tell you actually you should really consider this. Like what are the reasons that you're doing this for? If the reasons are non-financial by all means, we'll get into some strategies and tactics and things that we've learned, things that you highlighted at the outset, about how to make it worth it. I think that's probably what I'm more interested in. But I did want to highlight that because I think that that is something very important for people to consider. You know, you just can't because finances are really important in terms of this country and student loans don't get discharged when you get a disability or you die. That's the only one. 100% man. We'll go back up. And then you look at the sequelae of that, right? I mean, you're going to have less people go into primary care right off the bat. I mean, we're already seeing that trend. People are going towards more surges or sub-specialties. What feels that pay more? That's obviously going to be the trend now. If you're going to have higher interest rate, you're going to have more lows to pay back. That's just what we're going to see. So it'll definitely be an interesting trend. The whole healthcare world is going to be shaken up, especially with AI and what's going to get taken over and more private equity coming in. So yeah, it'll definitely be interesting. So it's a good point to raise up. I think one of the first things that's important to address is when people ask about is medicine worth it. I guess another way to ask is being a doctor worth it. I think an important thing that you talked about is like breaking this myth that the doctors are people who only doctor, right? I talked about the total events I was going to mention this. When we were prior to our conversation with events, I remember I was on LinkedIn somewhere. And there's this Harvard trained physician. I don't remember her name that I follow her. And she's now a consultant. So she's not practicing medicine. But she posts a lot about how to create your career, how to build businesses, etc. I remember an old EM doc commented on her, one of her social media posts, her LinkedIn posts, something to the tune of yet another person who took the seed of another an other medical school seat that could have gone to somebody. And I just thought I was like, man, that is such an interesting thing to say. And I think this toxic gatekeeping of the zero sum game as you about is like, oh, that's he could have gone to somebody else who would have gone on to cure. I just found that to be really interesting. She had a very awesome diplomatic response. But I was just thinking of like, what an interesting thing to go and comment on somebody. And the unfortunate reality is that there are a ton of people who have that mindset. And I don't want to just say, oh, it's the old guard that have that. It's actually, there are a lot of people in our generation, millennials, five, 10 years out from residency who have a very similar mentality. And I think that's one of the things that makes it very difficult for anybody who is trying to break the mold, so to speak, who is trying to do things that that make it look like medicine is a jumping off platform rather than a prison, you know, and if you let those people dictate to use your word, it's going to be very hard for it to be worth it, quote unquote, on on certain days. It's funny. You mentioned the jump off. I'm lucky to have mentors. You said go and get your medical degree because once you get it, it is a platform for you to jump off to so many different things. And it's been absolutely true, especially in the game of social media now. When it comes to branding, when it comes to any any type of career choice, if you want to be a mentor, if you want to be a speaker, if you want to be a consultant, if you want to open up your own practice, and we talk about how our generation people look down at people who do cash-based practices, you know, so I mean, that's still within the realm of medicine. I mean, look at Peter Atia, who got out of surgery, did consulting, and then came back to practicing medicine. I wonder what the EMDOT thinks about that, right? Somebody who goes out, gets experience, comes back, still making a difference in the world with his podcast, but is doing it cash-based in a concierge way. I really wonder what that EMDOT would say in regards to those types of people. Yeah, I actually, you know, I'm not in the habit of this type of stuff, but I really considered strongly commenting on that, or re-sharing it in such a way, and just really getting to talk about it, but I doubt that kind of conversation goes anywhere. There's going to be no dialogue there, and that person is going to come back and forth, we're behind, so I choose not to engage, but I really generally would be interested. I also think, though, that there are physicians who will feel guilty doing anything else. They'll feel guilty posting on social media, they'll feel guilty marketing themselves. This is something that I struggle with deeply, so I always try to pick Vince's brain, right? How do we do this? I remember Sassy and me offline talking a while back about how important it is to go put yourself out there, because I think it almost feels salesy, and you're not supposed to be that. You're supposed to be anything but. I recently had a trainee who were working with, and we were talking about, you know, what the options might be for the patient, and I remember him saying, we could convince the patient to have an ejection of it. I said, no, no, we don't want to convince the patient to do anything. We present with options, we guide, we do that kind of stuff, but it's even interesting, because I knew what he and I was gently guiding, but the verbiage is really important, because you say that, it sounds like you're selling something, but the reality is we're all doing that. The whole thing, the first impressions, everything, we're all trying to sell ourselves in one way or another, but physicians particularly feel incredibly guilty marketing themselves. What do you think that is? It's tough, right? I think we, when we look at first principles of why we want to go into medical school, we're always told it has to come from a clean conscious, which is why to help the patient. So we go through, we study our asses off, we're learning all these things, we go through all these grueling exams, we go through residency, and then we're finally at patient encounters. That matter, right, as an attending. And I think we take this oath, I don't think anyone remembers the oath, but there's this aura of this oath that, oh, I can't do that, because what if I get caught? I think that's really what it is. It's what if I get caught as a fraud, as a doctor who's trying to convince or sell, or trying to influence behavior, because it doesn't feel natural? It's interesting, because even today at my hospital, we had a discussion about patient rights. And Florida is a state where patient rights are, it's part of the culture, it's very big. For example, if a patient comes in and they want to sign a waiver, because they're a fall risk and they want to walk, they can do that, because patient rights say wherever the patient wants to do. Whereas where I trade, you know, in Pennsylvania, we would convince the patient to stay in bed, because we don't want them to fall for an injury, and then we'd have a discussion the next day when therapy evaluated them. So we get into this muddy water of like, if you're convincing for a better benefit, versus it's up to the patient and they can do what they want. I think that's kind of where that dilemma comes from, is that like for instance, you talk about metrics, is yes, I have to influence behavior in the inpatient setting in order to satisfy certain metrics. I have to do it in a way where I know that it's best for the patient as well. I don't know if that skews judgment at all, but there's definitely thoughts about convincing myself, saying hey, if I get this patient out a day or two earlier, yes, it helps metrics, but maybe they also won't catch pneumonia or a UTI or any other hospital-related infection. So there's this constant game of back and forth in my head at least, as if you know, if I'm talking about my own experience about when it comes to convincing patients, quote unquote, but also trying to influence for the better, right? I think I think there's multiple games happening at one time. There's the hospital game with the metrics, there's the patient interaction game, there's a game with yourself and in your own mental. Yeah, that's interesting. Yeah, I think in the Northeast, I was recently had a family member of the hospital very much, so you're not clear to walk, you're not clear to get up without assistance or nursing and stuff, and it's almost like no discussion of, yep, you can do that if you do that. There's no opportunity to sign anything, even if family's there, right? Even if me can assist somebody appropriate to do that. So that is interesting. You brought up earlier Peter Tia, right? You said he left, got a ton of experience in a completely unrelated field, consulting some deep analytics. It sounds like it comes back and can apply that knowledge base to the current problem solving, is situations he deals with. My guess is, and from following this person for a long time, it seems like this made him a better clinician, only he can speak to that. And there's this talk about when people are applying to medicine, you want to see a variety of backgrounds, you want to see somebody who's got some finance background, so they can go through this problem-solving process and look at it from different lens, not everybody's doing chemistry and biology. And so that begs the question, is are you doing yourself and your patients at the service if you are not diversifying experiences, building range in your words, right? Like, so, you know, are you just, if you're just going a mile deep and, you know, not at all wide, are you the best version of, best version of developing, delivering, excuse me, patient care, not just, you know, a special skill, but patient care, because that's ultimately what it is, human care. And, you know, I'd argue, you're not. So it's almost necessary to do that. I think we can probably give a ton of examples of how just spending the last five years behind the mic and meeting a bunch of people and interviewing tons of people spending thousands of hours has made us better at our current jobs. And, you know, I'm curious to see if you have any thoughts on that and I can certainly share some experiences, but what do you thoughts about that? I 100% agree. I think this is Toucher's on Herita's second question about how can you be a physician and XYZ and do other things. I took a, I was forced to take it to your gap year, right? I mean, I didn't get into medical school for two years, but that was the best thing that has happened to me. Oftentimes, we're applying a medical school at the age of what, 21, 22. The frontal lobe doesn't develop until 25. I mean, I was making dumb decisions even at 24, like, first year of medical school. I look back and, I mean, I just think about my thought process and how I was thinking about the world. There's not enough time when you're that young coming out of college. Again, dictate is the world I use because that's our education system, out of high school, out of college. You're type A, and you're taught to get in, get it done, and go on to the next and be the best you can be. I don't think like you said, I don't think you're going to be the best you can be by just having that single experience of going down one railroad track. But rather, going off the beaten path, learning some new things, getting some job experience, learning how the real world works. Because I think what happens is when we get to our patient interaction, it's not only the patient that we're interacting with. So often we think that when we're going through medical school and residency. But then you have a whole administration, you have nurses, you have other patient, your patient family. You have a whole world that you're interacting with and everyone comes in with their own experiences. And if you only have your experience to share and only your perspective, what's not going to be a great dot, what's not going to be a great back and forth, it's difficult to understand different perspectives when all you have is your own. And so that kind of leads to one of the thoughts I had of us that I don't just still think people read enough, right, especially medical students. I mean, I'll change that. They read a lot, but they're just reading medicine. They're not reading other op-eds. They're not reading opinions. They're not reading about the world. They're not reading about what else could be going on. And so when I look at a read this question about how can you be a physician? And I mean, I look at both of us. We're pretty worldly. I mean, we're looking at different things. We're looking at different perspectives. We listen to different podcasts that are not just medical related. But you start to form these links and you start to understand how it all works together. And so that's why I think having a gap year is crucial. Yes, is it two years delayed? Maybe you're three years delayed in terms of making money and maybe it might delay starting a family? I mean, I don't know. It's a difficult conversation, a different, difficult topic because everyone has their own timeline. Because you finish around 30, 35, depending on what residency you choose. And there's a lot of big, big decisions you make at that time that can be life altering. So that's just my opinion. I don't think it's the right one. But I'm a big fan of diversified experiences so that it makes you a better clinician. Yeah, diversity of thought creates excellence in practice, I think. And professional diversification isn't betrayal. I think it's evolution. I would say to that physician that I was commenting on on social media, the EM doc is, what if that consultant redesigned systems that save thousands of physician jobs, hundreds and thousands of dollars, right? The best doctors like you're highlighting, but they bring outside prospects. So I reject this martyrdom approach that we've had because that's what makes us a sustainable physician, right? So I just don't think that sacrifice is the answer. I think a lot of people of us, certainly our generation, even the generation before us, and anybody who's coming into practice, Gen Z in particular, they're asking a lot of questions. Melinas do that too, but we've been through some stuff over the last couple of years. But Gen Z in particular, asking a lot of questions and I think they're challenging the status quo. So this idea that you have to be a martyr, well, it's just not sustainable. It's not good for longevity in practice. And if you can't sustain in practice for 10, 15, 20 years, or maybe hopefully longer than that, then what good are you doing? At the end of the day, wouldn't it be better to have professional diversification so you become a marathoner and can actually last 30 years, and extra 10 years times how many patients, how much do... So I think that that's another way to think about it as well. You can't just be sitting in one silo, but like you talked about, the diversity of thought is critical because it gives you ways to relate with people from different backgrounds. Not everybody is coming and looking at the world with the lens that you're looking at. And the reality is so many of these discussions that we have with patients are back and forth. We do share decision-making. To your point about a patient says, I very much understand what getting up out of this bed could mean for me. I could fall, I could break a hip, I get it. I'm going to make that decision. You balance autonomy with, I think it's... Beneficence is the principle, like that this is the best thing for you to forget. Somebody can look me up on that. The last thing I'll say about that is this thing I'm thinking about in terms of challenging that culture is people think that excellence requires you to self-destruct and you have to dive deep and you have to work really hard and that's not the case. You can be dedicated to something and not be depleted which used to be the old thought model and establishing those types of boundaries and being very clear with them that's not selfish, that's your teaching. I love that. So that's kind of what I say. What would you say if an entrepreneur comes up to you as a doctor of Roger? Well, how do I, I'm trying to go into neurosurgery and I'm in there, you know what I'm going to say, a pre-meds, or a medical student, sorry. I'm trying to get into neurosurgery. They're an M1. How do I diversify my experiences? How do I do that? I think it all starts with what their experiences have been thus far. I'm always interested in what are you interested in? I think if you're just diversifying your experience and you're going and learning about things that you have zero interest in, it's not going to last long. You know, most people there are attracted to something and I think that's what makes it interesting, right? Like I mean, what is it that we talk about, you know, when you try to pick up a book as somebody says, it's good and you start reading in half a year, like, man, I don't know. I know you and I have talked about this. You argued that you have to finish it. But I think that if you make that a habit of just, I'm only going to do the things that I'm interested in and I'm only going to diversify my mind with things that I'm interested in, that's not diversity. That's just filling in your biases and things. So I think the first discussion would be, well, where are you coming from? Like I want to understand a little bit more about that. What experiences have they had? And what experiences are they attracted to? And then understanding that medical school, most medical schools are going to walk you down a certain path. And we all know the boxes you have to check to get to neurosurgery residency. Actually, we think we do. I don't know, I didn't match a neurosurgery. But we have a general idea. Like you have to have a certain score. You have to have this. You have to have these type of letters or recommendations. It's pretty much the same template. But once you become the neurosurgeon, how are you going to be different than the other neurosurgeon? Is it just going to be your outcomes, your complications? Or is there going to be something special more so than that? I'll give you a personal anecdote that's completely unrelated to medicine, right? This is interesting. So I've got this HVAC situation I'm dealing with. It's a freaking nightmare. And like this one person came, installed it, has not gone according to plan. And it's just, it's been horrible. Kid you down in a nine degrees. And so since then, I've called the couple other people afterwards and I said, hey, listen, I just had the system installed three months ago. It has not been the best experience with a person I worked with. Will you help me? Nobody wants to touch it. For liability reasons, nobody wants to touch it. Imagine that you're a physician. Somebody else did a surgery. You did a procedure. And this poor patient just go on from patient to surgeon to surgeon, doctor to doctor and no doctor wants to touch the patient. Like what business are we in? We're in the business of helping people. Or we're in the business of just securing the best outcomes. So our resume looks good. So I think if you look at it from the latter point of view, then that neurosurgeon should do only the training required to make them an exception neurosurgeon minimize adverse outcomes. But if you're looking to be an exceptional clinician and somebody who's going to make an impact in lives and change lives, then you need to think outside the box. I totally agree with that. I always talk about how the goal, I think a lot of medical students, they think that they have to be the best orthopedic surgeon, the best. Fill in the blank. It's not about that, right? It's not being the best doctor. Darshan is about being what makes you the best. And what makes me the best is doing research 24-7, putting out papers, being in the hospital all day. It's working out, reading books, being living my best life, going to travel, having fun while I'm at work. And that's how I show up the best, right? I think patients want a doctor who shows up well, shows up for them. And so it comes down to that energy, right? I mean, if you're draining your energy and trying to be the best of something that you don't truly care about, but you think that's what you have to do, it's not going to work out. And that's where that moral injury, I think comes from, that's where that burnout comes from. And I think it's just that we've been told throughout medical school. And it's funny, I think about these in frame. I'll let you go ahead and then I have some frameworks that I think of at least in terms of how medical students can diversify and kind of think about being entrepreneurial, let's try Z rather than just me. I want to finish it by making it tactical for sure, people. I think that what I'm hearing from you and I know what we're echoing here is like, it all starts with a mindset shift, right? So reframing of that question is very important. And it's not binary, is it worth it? Is it not worth it? You can't answer that question if you just put it to the numbers, which I highlighted for you that probably isn't, if that's the case, unless you got a lot of money in the bank. But the question is how do we make it worth it? And the path forward, like for me, you know, people were to ask in terms of students' residents, you know, let's say start building your platform now, not after training early on. Luckily, a lot of people have done that. Spend extra time outside of your requirements to be a good medical student resident on professional development. Diversity of thought if we can say it another way. Document your journey. This is something you said to me back in what 2019-2020 when I reached out just because everybody's journey is unique and it becomes your differentiator. Your unique experiences, right? It's also going to help you become more comfortable, quote unquote, marketing yourself, selling yourself, which is going to pay dividends down the road when it is something that you can monetize, when it is something that you can actually make a business out of. So that would be for early career physicians. I can probably give something for mid-career physicians, but I'm not really sure I'm qualified to because I'm probably still considered an early career physician. But I think that's probably the core principle that I want people to keep in mind as they're thinking about. Love that. So yeah, frameworks at least. The way I kind of think about this, one of the most common questions I get is how do you have a life in medical school? And so the way I think about this, you've heard of minimal viable product. I mean, it's like a startup business term about, yeah, so basically what is the minimum that you need to create for a product in order to sell it? Because so often when you work in a startup or business, you're thinking grandiose, you're thinking, oh, let's keep going. And this is all the features I'm thinking of. But it's okay, let's break it down. Where are the first principles? How do we get down to just what we need? So instead of minimal viable product, I think of it as minimal viable productivity. The thing is to get the difference between a 90 and 100% on exam is probably 10, 12, 3rd. It's four more days of studying. It's a lot more. The problem is you're trained again as a type A to go into medical school to try to compete and be the best. But the thing is, what are you trying to achieve for? If you're a neurosurgeon, again, it comes down to boards. I still don't think grades matter that much. But what is the minimal viable energy productivity that you need to put in to become a doctor? The difference between the lowest ranked a medical student and the first ranked medical student is not much in the real world. And I would even argue the last ranked will now have more time because they probably, if they spent less time studying, more time divers find their thought, more time doing the things that they want to do. And you actually have time to think about the things that you want to do. And that, as we talked about, can lead to better outcomes, lead to a better life. I'll just lead to a better reframe of thinking. How do you gauge productivity? So that's it. Yeah, it's interesting. I think it comes down to, well, there's many metrics. I think one is energy. Do you feel exhausted after the day or studying or whatever? Right? We talk about putting like a calendar and seeing if it's green, if it gives you energy, red, if it drains it, yellow, if it's neutral. I think a concept for Sahel Bloom. Time is another one. If you use Parkinson's law, I remember in med school, I only gave myself four hours or five hours to study a slides. And after that, I was done. And if that got me a passing grade, great. That was the minimal viable productivity I knew that I could be measured the time. The outcome for it was just a pass classes. I didn't care about getting A's or B's. C's got decreases my mantra because it allowed me to put more thought into other things. I think another metric that you can use are iterations. How many iterations does it take for you to then get the outcome that you want? So I think those are the ways that I think about it. I think in medical school, those three kind of make the most sense because every class is going to be different, every day is going to be different. But when you can look at either energy, time, or iterations, you have something that actually measure over and over again. Yeah, I think to your point about being very clear with the outcomes that you are looking for, and then you can know which game you're playing. If you're going from your surgery, then C's get degrees is not going to work. You're going to have to figure something else out or something really, really competitive. But you just have to be really honest with that. And you might have limited time, but just understand that that's the trade-off that you're willing to do. And that's okay too, if that's what you decide. I think some of the parting words I'll leave people for is because I think the reframe is really important. It's all about perspective in life. Another thing that I think about is, at this point, you and I both have, we have this venture that we've been on together for a long time. You've got your own consulting practice. I have one of that. You know, I've got, I'm an employee as well. I guess breaking news that people should know that in the very near future, I'm going to also be starting my own direct-pray practice in the tri-state area in New Jersey, New York, Pennsylvania, seeing patients in both telemedicine as well as inpatient, or excuse me, in person. But I think stop calling it a side hustle is really important. Rather, I would call it career insurance. Professional diversification equals risk management. That's what we're talking about, right? When we're talking about every single year over the last 20, 30 years, the reimbursements have been cut. We have spent so much time talking about how these corporations and, you know, the administrators are making more money, and the physician that money is not coming into our pockets. We've highlighted that these graphs of the healthcare burden is not because of physician pay. But you still have to be compensated for your time. Something I actually want to get your thoughts on because this is something that I struggle with. I recently had an incident. I had a patient come to me, just a very classic plantar fasciopathy, talked about how another clinician was taking care of it, a couple of injections, had now recommended shockwave treatment. I don't want to get too much into the weeds here, but shockwave treatment actually a very reasonable option to enhance healing a lot of positives on that. The cost though that was quoted to this patient was for somewhere around, you know, 1,500 bucks for treatments. I am very familiar with what the market value is for that, and that was very, very high. This person worked at the hospital that I did, and I'm going to give you a professional courtesy, and I'm going to tell you that is a very high value, and that is not the market rate for that. I felt bad. I felt bad because I'm pointing out that this person is being given a bad deal financially speaking. This was my first meeting for this person, right? And I also think about like, okay, as I'm thinking about setting my own prices and that kind of stuff, I talked to Vince about this, you know, his costs, we talked to Sassy about this, like how do you set that? And you talked to a lot of people who do the direct pay practice, and there's a huge variability. It's anywhere from like 150 bucks an hour or for a consultation, all the way up to $2,000, $2,000 a consultation, something that sounds ridiculous. But like, how does one, because I feel like you and I have had some conversation, how does one get comfortable with being a business person, charging somebody for healthcare, and especially if they're doing the direct pay model or consider a model, and not feel grimy almost? I think it's difficult, but I think it comes down to a reframe mindset. I don't think I'm the best person to ask for this, but the way I think about this actually comes back to the big, beautiful bill in a way. I don't think it's worth taxing people who make high income murders. For the, you know, making it more tax heavy. So I think tax cuts can be good in this part of the bill, right? One of the trade-offs that they're thinking is these high income earners can actually now put back money into the economy. They can build more things, right? So when you look at Elon, when you look at the podcasters of all in podcast, all these people have come up to make it. And so they feel like they're penalized for something that they now will be able to add more value to the country or to the world. So if you break that down to like our version, it's if I can make more by selling, I now can open up maybe a different clinic and I now can have more access. I think having that more income come in will allow you, allow anyone in our field to start building it out a little bit more and getting more access and providing more value to other people. And I think it's tough, right? It's like also a guilty, conscious thing. It's then do you pick a niche? Do you only do people who can afford certain treatments? Do you do a subscription model where you have different things? I mean, in the end, I think it comes out to the game that you're playing. You know, are you do you want to affect as many people as you can? Are you looking to change the way the field works? Are you looking to just give access to people who just need it? I think it's a tricky question but I think it really comes down to the game that you want to play in the end. I think it's, yeah. It's so tough. And it's interesting. I hope people can understand like even me who's been thinking about this for five years is when it's actually kind of become clear since we've been doing this. But much longer than that. This has been a dream of mine for a long time. But I still go back and forth. That question that I ask was a very genuine one because I was feeling this way two days ago. But I'll share another anecdote that that also makes you feel less than good, right? I've often talked about how the business of medicine drives the practice medicine. Not long ago, I was at a just a training conference where we're talking about certain procedures and how they get reimbursed. And what we were talking about amongst clinicians were and the providers who do that procedure was, okay, well, this is how the procedure gets paid for. This is how many targets you would do and each target would pay you X amount of money. At some point, somebody had mentioned in order for you to break even your cost of goods, you have to do three separate targets, right, for the injection. But that feels so wrong to me because now you're letting recouping of funds make the decision of what it is. It's probably still appropriate. Nobody's talking about doing fraud. Nobody's talking about inappropriate procedures and unnecessary procedures to people. I know somebody's going to clip that up and talk about how, look, this is what doctors do. They do unnecessary surgeries. No, that doesn't happen. But even having that decision-making process in the back of your mind is something that is not we sign up for. At least I didn't, right? Maybe I was naive when I did that. So I think that either way that you look at it, I go back and forth and it's just so frustrating. I'm like, I don't want to do this anymore. And so then you're like, okay, well, I'm going to do it the other way where I should be compensated for my time and we're not paying for anything else. And it's just, I think this is something that you're going to have to get used to over time. I'm sure Vince has. I'm sure Sassy did. I'm sure other people that I've talked to did. I'm excited to share how that happened. So hopefully I'll get acclimated faster than... I also want to say, I think the game that you're in requires you to put a higher price on things. Because in the end, you're also going to be competing with other providers who are essentially kind of doing the same thing you are maybe. But if I were a patient and I see a $5 treatment versus $100 treatment and typically let's say it's around $70, you're going to question the person who's charging less sometimes. And then I think that question is, do they feel adequate or they actually a good provider, etc. Whereas, and I'll get all this comes down to influence and marketing and behavior and stuff too. But it comes down to what your goal is. Because I also think there's this effect where if you charge more, you're going to start living up to that as a provider. And you're actually going to fulfill that gap that you may feel like in Poster versus actually giving that price level of care. $1,000 or so. There you go. Putting it right there. You go. It's interesting. The example I push back a little bit because the example you get at $5 and $100, yes, there's a big gap, right? But what if it's somewhere in the 70s, market value, somebody charging 65 and somebody charging 85? That's where it gets challenged. Because everybody wants value. Everybody wants the deal. I don't know anybody who wants to pay 85 when they think it costs 70. Even if you promise it, this is going to be worth it. I promise you you're going to get better quality service. I'm doing this all the time with certain clinicians I'm sending to. Hey, heck, try to affect it, right? I'll give a shout out to Jeremy. And they are typically, they're direct paid. They're out of network. And I'll tell when I say, hey, listen, you need to go see these guys. It's very clear that this is investment. They're not the only ones, right? There's a couple of really great folks down in here in the such or as the area where I say the same thing. But not everybody does take insurance. And so I think that that's where it gets a little bit but I think your point still remains. Yeah, it's a tough, it depends on the game you're playing. It was $10 extra dollars. Allow you to build out another service if it's aesthetics or, you know, different equipment that nobody else is using. I think it just depends on kind of what the scope is. Right on. All right, man, I know we're coming up on time. But so what are some parting words of wisdom for the folks here? Maybe I think we've answered the question. I'm sure everything can reach out to us if there's more coming up. But anything else that you think that we should leave now? I mean, I mean, I could talk about this for an hour or two, a different framework that medical students can use. But I think the one about the minimal value productivity is probably the main one that I like to use. I think that hits home for a lot of people. I mean, there's other things that we can do reverse engineering, think about present moment in the future versus now and reverse engineering yet. But we'll see that for another time. Yeah, I think that the couple things that I just want people to remember is this the whole concept of professional diversification. I think that's really important. But we want to be able to build something that somebody can't take away from you with all these legislations and that kind of stuff. And minimal regulation over you if you are your own business and you want to run it like one, that's going to end up working in your favorite down the road. Name of the game is longevity. And it has multiple meanings as we talked about on here. And longevity in your career is going to be really important. So it's all about reframing and how do you do that? And so if you are a young physician who is going into it or if you're an early career physician, if again, it feels awkward trying to give advice to somebody who's further ahead of us. But I know we have some late career physicians who will listen to this and it's for a fact. So if you're waiting for permission to build beyond medicine, you've got it. This is your permission. I give you permission to do that. And if you're early on your career, just remember the medical degree is a platform. It's not a prison. And yeah, the best revenge is against a broken system is a life where I live, man. Love that. Like it. All right. That's good. Till next time, buddy. Thanks for listening to the other episode of Medicine Redefined. If you enjoyed this episode, please be sure to check out some of the additional resources in the show notes. Please also check out our social media platforms where you can find more content like this. You can follow us on Instagram, Twitter and TikTok at Med Redefined. We also want to thank our team for the production of this podcast, Arita Yaforian Social Media, Zanablegmani on Research, and Sarah Hahn for Newsletter. Oh, and if you want to get similar bite-sized information delivered to your inbox every Sunday, please be sure to sign up for our newsletter. Also, if you enjoyed the show, please be sure to subscribe, review and share with anyone who you think will gain value from this as well. Now, time for the ever so important disclaimer. This podcast is intended for general public use and is for educational purposes only. It does not constitute the practice of medicine, nor should be construed as medical advice. No physician-patient relationship is formed, and anything discussed in this podcast does not represent the views of our employers. We recommend that you seek the guidance of your personal physician regarding any specific health-related issues.