Stimulus | Helping Doctors overcome burnout, excel in leadership, and unlock their most fulfilling careers

A cautionary tale about how I mismanaged my own physician burnout for many years, doing the easy thing instead of the right thing. 

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Psychological safety is a crucial factor in creating a healthy and effective workplace. It involves a shared belief that the team is safe for interpersonal risk-taking. This episode delves into the intricacies of psychological safety, particularly in high-stakes environments like medicine. We explore how rigid hierarchies, cultural biases, incivility, and unrealistic expectations can hinder psychological safety and how fostering a culture of openness and vulnerability can lead to better team performance and resilience. We explore various strategies to enhance psychological safety, including setting clear expectations, modeling vulnerability, and showing gratitude. Finally, we provide actionable tools for leaders to create a psychologically safe team environment.

💡 Check out our Free Resources specifically designed to address pain points in medical practice💡

Guest Bio: Kim Bambach, MD  is an Assistant Professor of Emergency Medicine at The Ohio State University and Assistant Director of the Kiehl Resident Wellness Endowment 

We Discuss:

• What is “psychological safety”?
• Google's Project Aristotle
• Why psychological safety is important, even on a SWAT team
• Threats to psychological safety
• The Korean Air Crash of 1997
• Contributors to trainees feeling psychologically unsafe
• Collegiality between specialties and its impact on psychological safety
• The Psychological Safety Scale
• Six key leadership behaviors to create a culture of psychological safety

Mentioned in this episode:

Physician Coaching

I work with physicians to help them flourish in medical practice. If you're feeling stuck, burned out, or in trouble at work because of communication or conflict, check out our FAQ page for more info.

Physician Coaching FAQ

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4 Free Resources specifically designed to address pain points in medical practice

Scripting your least favorite conversations.

Free Resources Link

What would you do if your job ended tomorrow? Even though you might want to say, “Take this job and shove it,” that won’t help build stepping stones to your next job.

In this episode, we discuss: what it’s like for physician coaches who regularly work with docs in this situation, getting fired,  dealing with unexpected events that shake up professional stability, planning for career disruption, the importance of networking, and finding your clinical practice N plus one.

💡 Check out our Free Resources specifically designed to address pain points in medical practice💡

Guest Bio: Health Joliff, DO, is dual-boarded in Emergency Medicine and Medical Toxicology. He is a certified executive coach and can be found at Physician Coaching Solutions. 

We Discuss:

• We plan for what happens at the bedside. Why don't we plan for what might happen to our careers?
• What happens to the majority of docs who come to coaching wanting to get out of medicine
• The importance of clinical medicine + 1
• Networking doesn't have to be a massive labor. Small steps can make a big difference.
• Great doctors getting fired
• First steps after losing employment: be humble and don't burn bridges
• Strategies for bringing up having been fired in an interview
• The therapeutic power of venting (versus dumping)
• Should you accept your group's director position?
• The distinction between imposter syndrome and inexperience
• Your contract has not been renewed
• You are a new resident, and your health system suddenly closes
• An older physician plans to retire in a year and is uncertain what to do next
• Your first job out of training will likely not be your last

Mentioned in this episode:

Physician Coaching

I work with physicians to help them flourish in medical practice. If you're feeling stuck, burned out, or in trouble at work because of communication or conflict, check out our FAQ page for more info.

Physician Coaching FAQ

4 Free Resources specifically designed to address pain points in medical practice

Scripting your least favorite conversations.

Free Resources Link

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Many of us have ideas that could make a great business. Most of the ideas, however, never see the light of day. It can feel like a big leap from physician to entrepreneur. So how do you do it? We speak with Dr. Jason Hine, the founder of SimKit, and see how he went from community emergency medicine doctor to successful business owner. 

In this episode, we cover how Jason started his business, accounting for the knowledge gap between clinician and entrepreneur, setting boundaries, why saying hell yes has a critical proviso, the inevitable oscillation between passion and money, and a marketing exercise that’s critical to walk through before you even consider jumping in on a new product or business.

💡 Check out our Free Resources specifically designed to address pain points in medical practice💡

Guest Bio: Jason Hine, MD, is an emergency physician in southern Maine, where he is the Director of Education for his community hospital. He is a graduate of Tufts University School of Medicine and completed his residency at Temple University Hospital, where he served as chief resident. His interests include procedural skillset decay and the role of academics in improving the recruitment, retention, and satisfaction of community physicians. He is the founder of SimKit, a medical education company focusing on delivering convenient and effective hands on procedural skills practice.

We Discuss:

• Sharks and boulders
• Build a business plan early
• Effective resources and dead-end rabbit holes
• The first thing to consider before starting a business: the pain point and value proposition
• Getting out of the Lone Wolf mindset and forming an advisory committee
• What challenge surprised Jason as he got the business rolling
• How do you pay your advisory committee before your business makes money?
• What it means money-wise to give someone equity in your company
• Negotiating equity stake and why contracts are by nature adversarial
• The tipping point from dreamer to doer
• A self-reflective prompt that puts endeavors in proper perspective
• It might be a hell yes for you but a no for your family
• Protecting immutable boulders
• Logistics of setting and keeping boundaries
• Nothing super cool happened because someone just wanted to make a bunch of money
• Finding your ideal customer before the product even exists
• A marketing exercise to do when a product is still an idea

Mentioned in this episode:

Physician Coaching

I work with physicians to help them flourish in medical practice. If you're feeling stuck, burned out, or in trouble at work because of communication or conflict, check out our FAQ page for more info.

Physician Coaching FAQ

4 Free Resources specifically designed to address pain points in medical practice

Scripting your least favorite conversations.

Free Resources Link

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Success and happiness are often determined by where we place our focus: within ourselves or on external factors. Mastery lies in asking the right questions, and understanding the locus of control is a key part of this. Those who focus on what they can influence are generally happier and more successful. In this episode, we explore the philosophy behind the locus of control, its impact on burnout, the importance of small bets in making significant changes, and state vs. trait gratitude. Finally, we delve into practical strategies to cultivate a more resilient mindset

💡 Check out our Free Resources specifically designed to address pain points in medical practice💡

Guest Bio: Dan Mccollum, MD is an emergency physician and Director of Teaching and Learning at the Medical College of Georgia. Hear more of Dan on Stimulus episodes #1 Verbal Judo #14 Stoic With A Capital S, #25 Digital Minimalism, and #59 Aim to Be A Zero.

We Discuss:

• Waiting room medicine has become the norm. It's not ideal. So what do you do about it?
• The power of placing small bets
• Stoicism and the philosophy behind locus of control
• Some things in the world are up to us; others are not
• Sextus, "The crowd is irrelevant."
• What is the locus of control?
• Shades of gray in the locus of control
• The Stoic approach to patient complaints
• Taming the blame ogre
• Domains of control and the paradox of varied strength
• The Stoic approach to patient complaints
• How a mishandled aspirin overdose led to a major recalibration of control locus
• A tactical approach to developing an internal locus of control
• The 'Good' reframe
• The five slices of gift exercise
• The jar of awesome
• Power of an end-of-day debrief
• Trait vs. state of gratitude
• Not every approach is for everybody
• Book recommendations for operationalizing an internal locus of control

Mentioned in this episode:

4 Free Resources specifically designed to address pain points in medical practice

Scripting your least favorite conversations.

Free Resources Link

Physician Coaching

I work with physicians to help them flourish in medical practice. If you're feeling stuck, burned out, or in trouble at work because of communication or conflict, check out our FAQ page for more info.

Physician Coaching FAQ

Never Lame. Never Spammy. Always Fresh.

If you’d like a few minutes of career-elevating curated kickassery delivered to your inbox, sign up for our newsletter.

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Medical debt has a strange and storied history in America. Stretching back to colonial times, physicians and patients alike have grappled with its harsh realities. In recent years, hospitals have resorted to selling medical debt to third parties, who then aggressively pursue patients. In today’s episode, medical historian Luke Messac, MD, PhD, guides us through the past and present landscape of medical debt, examining perspectives from patients, providers, hospitals, and governments. We delve into a form of indentured servitude in the name of debt clearance, the birth of nonprofit hospitals, a pivotal shift in the 1980s, feasibility of operating healthcare under free market principles, medical economics in the 1600s, hospitals suing patients, and the emergence of medical debt as its own thriving industry.

💡 Check out our Free Resources specifically designed to address pain points in medical practice💡

Guest Bio: Luke Messac MD, PHD emergency physician and medical historian whose research focuses on health care's history and political economy. Luke is an attending physician at Brigham and Women’s Hospital, an Instructor in Emergency Medicine at Harvard Medical School, and the author of two books, No More to Spend: Neglect and the Construction of Scarcity in Malawi's History of Health Care and most recently, Your Money or Your Life: Debt Collection in American Medicine. 

We Discuss:

• Hospitals suing patients over debt
• The Service Credit Program | Indentured servitude in the name of debt clearance
• Nonprofit hospitals were born out of the almshouse tradition, where charity care was part of the mission
• The 1980s were a turning point for medical debt in the United States
• With cuts in government medical spending, hospitals cut costs by limiting charity care and aggressively pursuing unpaid debts
• Why healthcare cannot operate in a pure free market
• Hospitals used to refuse care to patients and the courts supported it
• Patient dumping and the rise of EMTALA
• Collecting money from patients has been an issue for hundreds of years
• In the 1600s, doctors could be arrested for charging too much
• Debtor's prison
• Does suing patients to recover medical debt improve a hospital's bottom line?
• In the early 2000s, Yale New Haven Hospital put liens and foreclosing on patients' homes as part of a debt collection strategy
• Medical debt collection has now become a thriving industry
• How third-party medical debt collectors operate
• RIP Medical Debt buys and forgives medical debt
• Is buying and forgiving medical debt better or just forgiving it upfront?
• Dollar For is a nonprofit focused on helping patients navigate financial assistance programs
• Some hospitals are making financial assistance easier to access
• State legislation is starting to address medical debt collection
• National approaches to medical debt
• Medical debt is prevalent around the world, but the US stands apart among wealthy countries
• The consequence of copays
• Paul Farmer and caring for the destitute sick. 
• The jungle hospital that's carrying out Paul Farmer's vision in Guatemala
• Rudolf Virchow - Physicians are the natural attorneys for the poor

Mentioned in this episode:

Physician Coaching

I work with physicians to help them flourish in medical practice. If you're feeling stuck, burned out, or in trouble at work because of communication or conflict, check out our FAQ page for more info.

Physician Coaching FAQ

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It's natural to feel guilt or shame when living in abundance while much of the world faces hardship. In this episode, Dr. Barry Kerzin, the Dalai Lama's personal physician and a Buddhist monk, shares his approach to managing these emotions with a simple yet powerful tool. He also discusses his journey to becoming a monk, life within the Dalai Lama's compound, as well as anger management, self-compassion, and impatience strategies.

💡 Check out our Free Resources specifically designed to address pain points in medical practice💡

Guest Bio: Barry Kerzin, MD is a US born and trained family physician who for the past several decades has resided as a monk in Dharamshala, India — home of the Tibetan community in exile. In addition to serving as H.H. the Dalai Lama’s personal physician, Dr. Kerzin is the founder of the Altruism in Medicine Institute, whose mission is to increase compassion and resilience among healthcare professionals and extended professional groups, such as police officers, first responders, teachers and leaders.

Self described as “
a doctor, a monk, a teacher, a lazy man. All of these things, yet none of these things,” you can follow Dr. Kerzin on Facebook, Youtube, Instagram or learn more about his story here.

He's also got a new app that you might be interested in -- AIMIcare.  This app is crafted to counteract the distressing prevalence of burnout, depression, and frustration among those facing the brunt of human suffering by instilling the virtues of compassion, mindfulness, and self-care

Download AIMIcare:  here

AIMIcare Mobile App Website: https://aimicare.altruismmedicine.org/

We Discuss: 

• How Dr. Kerzin made the trade from US-based family doctor to Buddhist monk and the Dalai Lama's personal physician
• Studying Tibetan medicine for the treatment of high blood pressure
• A day in the life of the Dalai Lama’s doctor
• What the food is like in the Dalai Lama's compound
• How Barry feels about being referred to as 'The Dalai Lama's Doctor'
• Two experiences in younger life that sparked Barry's spiritual quest
• The guilt of living in abundance
• The importance of generosity
• Self-compassion
• An approach to imposter syndrome
• Anger management
• Healthy self-confidence
• Using purpose as an antidote for impatience
• Having patience in the time-compressed reality of medical practice

Mentioned in this episode:

Never Lame. Never Spammy. Always Fresh.

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Physician Coaching

I work with physicians to help them flourish in medical practice. If you're feeling stuck, burned out, or in trouble at work because of communication or conflict, check out our FAQ page for more info.

Physician Coaching FAQ

4 Free Resources specifically designed to address pain points in medical practice

Scripting your least favorite conversations.

Free Resources Link

Non-compete clauses have plagued contracts for decades. It’s been analogous to asymmetric warfare, with employers holding the upper hand. 

All of that may soon be a thing of the past.

In this episode, we explore the Federal Trade Commission's recent ruling to ban these clauses and its implications for doctors and the healthcare industry. We'll also discuss the unexpected ways non-competes can protect smaller groups, the rise of independent contractor models, and the critical staffing issues in emergency medicine. A highlight of our discussion includes the lure and the trap of signing bonuses—what seems like a generous offer can sometimes come with subtle strings attached. Finally, we'll touch on the U.S. Senate's investigation into major staffing companies and the innovative emergence of empath units for mental health patients. 

💡 Check out our Free Resources specifically designed to address pain points in medical practice💡

Guest Bio: Leon Adelman, MD, MBA, FACEP, FAAEM is an emergency physician and co-founder of Ivy Clinicians, a software company that simplifies the emergency medicine job search through transparency. Dr. Adelman is the author and publisher of the Emergency Medicine Workforce Newsletter, which explores the business of emergency medicine.

We Discuss: 

• What is a non-compete clause?
• The Federal Trade Commission's ruling making non-complete clauses null and void
• Why employers and private equity are unhappy with the non-compete ruling
• The emergency medicine-specific burn point of the non-compete ruling: contract retention
• The unexpected way that individual non-compete contract clauses can protect a group from being replaced
• Why small groups like to use non-compete clauses
• How larger groups have moved away from non-competes and favored a 1099 independent contractor model
• Why the non-compete ruling is a massive win for independent physician practices
• The lure and the trap of physician signing bonuses
• A signing bonus is a loan, not a check. It's a loan you are paying back with time.
• What is the chance of someone not paying back the time attached to a signing bonus?
• There's a reason that some jobs offer a signing bonus and others don't.
• The US Senate Committee on Homeland Security and Governmental Affairs is investigating the staffing models of USACS, Team Health, Envision, and Life Point
• When private equity owns a hospital, it tries to lower expenses by decreasing staffing
• 48 states and the federal government don't require a physician in the emergency department
• Indiana and Virginia are the only two states that require a physician to be on duty in emergency departments
• Are Empath Units the solution to helping emergency department mental health patients?

Mentioned in this episode:

Physician Coaching

I work with physicians to help them flourish in medical practice. If you're feeling stuck, burned out, or in trouble at work because of communication or conflict, check out our FAQ page for more info.

Physician Coaching FAQ

4 Free Resources specifically designed to address pain points in medical practice

Scripting your least favorite conversations.

Free Resources Link

Never Lame. Never Spammy. Always Fresh.

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Understanding cultural context in healthcare can seem overwhelming, especially when time and resources are limited. Why should clinicians invest energy in learning about different cultures? In this pod, we break down the differences between cultural competence and cultural safety, explaining why the latter is essential for patient care. We share practical examples of how understanding cultural context can improve interactions, strategies for making patients feel seen and heard, and the pitfalls of the term ‘non-compliant’. We also touch on how these practices can make your job more rewarding and prevent burnout. 

💡 Check out our Free Resources specifically designed to address pain points in medical practice💡

Guest Bio: Raj Sundar, MD, is a family physician and community organizer in Washington state. His podcast, Healthcare for Humans, “is dedicated to educating you on how to care for culturally diverse communities so we can be better healers.”

For full show notes of this episode and all sorts of other goodies, visit our podcast website

The hidden anti-burnout curriculum we all should have learned in training. Cohort 3 begins Sept 10, 2024. Get the deets

We Discuss

• What does it mean to care for diverse communities effectively?
• An argument for why it’s not the patient’s job to teach clinicians about their culture
• Understanding the cultural context of frustrating behaviors
• Shifting from 'why me' to 'of course'
• How to create a framework for cultural knowledge
• What happened to Raj's practice when he started interviewing local Pacific Islander community leaders
• How to have patients feel seen, heard, and known in the point of care
• Cultural competence vs cultural safety
• What does cultural safety look like?
• Why should I spend my energy on learning another's culture? If they've moved here, shouldn't they be the ones to assimilate into this culture?
• The language of noncompliance vs nonadherence vs nonjudgmental
• Why social determinants of health in documentation might be a good thing
• Rumi's The Great Wagon

Mentioned in this episode:

Physician Coaching

I work with physicians to help them flourish in medical practice. If you're feeling stuck, burned out, or in trouble at work because of communication or conflict, check out our FAQ page for more info.

Physician Coaching FAQ

Never Lame. Never Spammy. Always Fresh.

If you’d like a few minutes of career-elevating curated kickassery delivered to your inbox, sign up for our newsletter.

Sign up for our bi-weekly newsletter

4 Free Resources specifically designed to address pain points in medical practice

Scripting your least favorite conversations.

Free Resources Link

"Kicking the can down the road" is a common behavior that manifests in various ways, from delaying difficult patient decisions to avoiding complex tasks. We explore the reasons behind on-shift procrastination and strategies for overcoming it. Our discussion includes practical steps to recognize and address decision deferral, techniques for managing aversion to some decisions, and pre-loading accountability. We also highlight the importance of building decision-making resilience and creating systematic pathways to streamline the decisional process. 

💡 Check out our Free Resources specifically designed to address pain points in medical practice💡

We Discuss:

• What does it mean to kick the can down the road?
• How procrastination shows up on a clinical shift
• Why does procrastination happen?
• It doesn't take much dread for can-kicking to occur
• Avoidance Awareness
• Decisional Interrogation
• Kicking the can because deciding will set off a cascade of more work
• Avoiding the infinite test of time
• Identify how, when, and where you’ll make high-level decisions
• Long term guests | How is it that decisions can finally be made when the shift is over?
• Chunking
• Zero in on your critical decision points
• Kicking the can at work: pick one thing and identify YOUR decision points
• Preloading accountability
• Perfectionists get caught in a tree when they're actually in a tunnel

Mentioned in this episode:

Physician Coaching

I work with physicians to help them flourish in medical practice. If you're feeling stuck, burned out, or in trouble at work because of communication or conflict, check out our FAQ page for more info.

Physician Coaching FAQ

4 Free Resources specifically designed to address pain points in medical practice

Scripting your least favorite conversations.

Free Resources Link

Never Lame. Never Spammy. Always Fresh.

If you’d like a few minutes of career-elevating curated kickassery delivered to your inbox, sign up for our newsletter.

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