Your work world is built on endurance, intensity, and mastery. The culture is 'always on,' and you were trained to perform in conditions no one would call normal. The work is supranormal. It sits at the edge of reasonable and regularly exceeds what is sustainable by most standards. High performers like you often find themselves on an above-the-fray pedestal, expected to be tireless and self-sacrificing. Supranormal work can unlock extraordinary performance, but the cost adds up if it goes unchecked.

In this episode, we look at where this culture came from, the cortisol spikes that shape your days, the hidden curriculum of self-sacrifice, and the countermeasures that keep you from burning out. It is a straight look at the supranormal experience and what it takes to do this work without losing yourself to it.

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• Why medical culture expects you to perform inside conditions no one would call normal

• What makes supranormal work different from ordinary high-stress work

• How the “always on” ethos formed and why it persists

• The hidden curriculum of self-sacrifice and the pedestal of being above the fray

• Cortisol spikes, sympathetic load, and what chronic activation does to your body

• Why self-preservation feels selfish in medicine and why that belief is wrong

• The roots of modern training from monastic care to Halsted’s cocaine-fueled stamina

• Why emergency medicine is an outlier in burnout, longevity, and physiological strain

• The concept of parasympathetic nurturing as a countermeasure

• How mindset changes biology and shifts performance

• What it takes to last in supranormal work without losing yourself

What if the best decision is to not decide at all? We waste valuable mental energy overthinking simple choices, especially when the outcomes are nearly identical. That kind of cognitive drain reduces our capacity to think clearly when decisions actually matter. In this episode, we explore how to reduce cognitive load, identify low-risk choices that can be automated or ignored, and recognize when deliberation is just noise. Finally, we break down how framing, values, and the right question can make even complex decisions frictionless.

Guest bio:  Dan Dworkis MD, PhD is an emergency physician who is a clinical professor of emergency medicine at USC Keck School of Medicine. He’s also host of the Emergency Mind podcast that focuses on helping individuals and teams perform better under pressure and the author of The Emergency Mind: Wiring Your Brain for Performance Under Pressure. 

We Discuss:

• The Three Types of Cognitive Load
• Harvesting Free Rolls
• Applying Dominance and Cutting Through Decisional Noise
• How to Stop Fretting Over Equivalent Decisions
• Navigating Equipoise
• Making Big Life Decisions

Mentioned in this episode:

5 Free Tools To Make Medical Practice Easier

Scripts for your least favorite conversations.

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March 1-4. Change how you see yourself, experience your work with joy, and build mental excellence.

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As students navigate an increasingly complex, competitive, and costly path to medical school, parents often find themselves uncertain about how to help without hindering growth. Meanwhile, institutions maintain opaque admissions practices, amplifying anxiety for both students and families. In this episode, we explore what parents need to know to truly support, not sabotage, their aspiring doctors. Finally, we pull back the curtain on everything from shadowing to AI in essays, offering a brutally honest look at what really matters in the application process.

Guest bio:  Dr. Ryan Gray, a former Flight Surgeon in the United States Air Force, is the founder of Medical School Headquarters and Meded Media, where he has become a leading voice in guiding pre-med and medical students toward careers in medicine. He is the author of The Premed Playbook series, including Guide to the Medical School Application Process, Guide to the Medical School Personal Statement, Guide to the Medical School Interview, and Guide to the MCAT. Dr. Gray also hosts several popular podcasts, including The Premed Years, OldPreMeds Podcast, The MCAT Podcast, and Specialist Stories.

We Discuss:

• Support vs. Sabotage
• The Myth of the Perfect Applicant
• Why Checklists Aren't Really Checklists
• What Shadowing Really Tells You
• What's the Deal With Volunteering Hours?
• Service for the Right Reasons
• Why Pre-Med Doesn't Mean Pre-Doctor
• Using AI When Writing Med School Essays
• Compressing Preclinical Education
• The Price of Applying and the Sneaky Secondaries
• Why Don't Schools Post MCAT Cutoffs?
• How to Write a Good Letter of Recommendation and When to Say No
• Thank You Notes
• Letters of Intent
• Should Premeds Attend Non-Interview Info Sessions?
• Why Clinical Hours Are Non-Negotiable

A broken system won’t fix itself, and no one is coming to the rescue. Medicine is fraying under the weight of burnout, misaligned incentives, and systemic inertia. Yet, hope isn’t lost. Change is still possible, but it won’t come from the top down. In this episode, we explore how grassroots leadership, inner work, and community involvement can become the antidote to despair in modern medicine. Finally, we dig into the personal cost of service and the tools we need to heal ourselves while fighting for change.

Guest bio:  Dr. Andrea Austin is the inaugural Emergency Medicine Program Director at Sacred Heart in Pensacola, Florida. As a Navy veteran, her military service taught her how to perform under pressure and lead teams in high-stakes environments. She brings that same focus to her work in medical education, physician well-being, and healthcare systems change. Dr. Austin is the author of Revitalized: A Guidebook to Following Your Healing Heartline and host of the Heartline: Changemaking in Healthcare podcast.

Books mentioned in this episode

• What My Bones Know by Stephanie Foo

• The Case for a New Residency Program
• What It Means to Be a Change Maker
• Working Within the Domains of Change
• Overcoming Social Loafing in Medicine
• Rethinking Suicide Risk in Emergency Medicine
• The Call for Psychiatric Fellowships in EM
• Reclaiming Wellness Through the “Heart Line”
• The Inner Work is the System Work
• Building a Portfolio Career

Mentioned in this episode:

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March 1-4. Change how you see yourself, experience your work with joy, and build mental excellence.

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How can a person who’s clearly lucid still be deemed incapable of making their own medical decisions? The answer lies in the misunderstood yet critical distinction between competence and decision-making capacity. While these terms are often used interchangeably in clinical settings, they carry vastly different meanings in law and medicine—differences that can determine whether a patient is treated, restrained, or left alone. In this episode, we explore how doctors can (and should) assess capacity, the legal boundaries of competence, and how not to get destroyed on the witness stand. Finally, we unpack a story involving a dog, a scrotum, and a tour of Colorado’s emergency departments.

Guest Bio:  Rich Orman began his legal career as a public defender before moving into private practice. He soon joined the district attorney’s office, where he spent most of his career and ultimately rose to the position of deputy district attorney. Over three decades in the courtroom, he tried some of the most complex and high-profile cases in the state. After retiring from law, Rich turned to filmmaking. He is the writer and director of the critically acclaimed Boundary Layer.

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

• What Competence Actually Means in Legal Terms
• Defining Medical Decision-Making Capacity
• Real-Life Dilemmas in Emergency Medicine
• The Right Terminology in Documentation
• What Physicians Get Wrong in Court
• How to Testify Like a Pro
• How to Handle Yes/No Cross-Examinations
• One Legal Nugget You Should Never Forget

Mentioned in this episode:

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Decision Making Capacity Free Template

Need to document decision-making capacity quickly and accurately? I created this free resource so you don’t have to waste time looking up the elements each time. It’s an example of how it can be done—use it as a guide and make it your own.

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Ever walk out of a shift and feel like the hospital came home with you? In medicine, the mental residue can cling long after the work day is done. One way to address this is boundary rituals, deliberate actions designed to process the day and allow you to leave work at work, be more present when you get home, and possibly even sleep better. As a bonus, the ability to disengage from work is one of the strongest predictors of reduced burnout.

In this episode, Mohamed Hagahmed, MD, shares how he creates this boundary—through small rituals of gratitude, stillness, and reflection. From growing up as a refugee to serving as a sideline physician for the Pittsburgh Steelers, Dr. Hagahmed’s path has been shaped by resilience, culture, and care. He explains how he learned to stop carrying unfixable wounds home, why kindness is clinical armor, and how tiny acts of self-compassion can protect meaning in medicine.

Guest Bio:  Mohamed Hagahmed, MD a Clinical Assistant Professor of Emergency Medicine at the University of Pittsburgh, Associate Medical Director at the Center for Emergency Medicine, and EMS Medical Director for several systems in Western Pennsylvania. On top of that, he works in high-acuity emergency departments across the region. He’s a graduate of Johns Hopkins Bloomberg School of Public Health, passionate about resuscitation, critical care, and toxicology education. And he’s the creator and host of EMERGE in EM, a podcast focused on emergency medicine education and global health empowerment.

We Discuss:

• Growing up as a refugee and finding purpose in emergency medicine
• The toll of moral injury and why staying closed and rigid nearly broke him
• Small rituals that help shed the emotional residue of a shift
• Using gratitude and stillness as tools for resilience
• How changing clothes, music, and even snacks can protect emotional health
• Turning frustration into advocacy for immigrant health and systemic change
• Advice for new attendings on protecting the threshold between work and home

Mentioned in this episode:

5 Free Tools To Make Medical Practice Easier

Scripts for your least favorite conversations.

Free Resources Link

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The best communication in high-stakes environments isn’t complicated. Quite the opposite - it’s structured, clear, and consistent. Small, deliberate shifts in how we transfer information can dramatically improve patient safety, team efficiency, and workplace culture. In this episode, we explore three simple but transformative communication habits that reduce errors and build trust among teams. Finally, we share practical tools you can use today to tighten your communication and improve safety without adding extra workload.

We Discuss:

• The Three-Way Repeat-Back: “That’s Correct” Changes Everything
• Phonetic Clarifications: Stop the “Norman” Problem
• Numbers: Say the Digits
• Whiteboards: The Cheapest Safety Tool in the Room
• Checklists: Mastering the Basics
• Cheaper Than Dirt, More Precious Than Gold

Mentioned in this episode:

Free Tools To Make Medical Practice Easier

No fluff. Just good stuff.

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UnBurnable - Our Cohort-Based Burnout Prevention and Cure Course

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Stressful events can hijack cognition, cloud judgment, and leave emotional residue that can fuel long-term burnout. For acute care clinicians, those moments of emotional overwhelm, when heart rate spikes and the thinking brain goes offline, can have consequences that last far beyond the shift. While long-term resilience is essential, it’s often the just-in-time strategies that determine whether we break down or rise to the moment. In this episode, we explore the physiology and psychology of real-time emotional regulation with Scott Weingart, MD, co-creator of the Beat the Stress Fool protocol. Finally, we uncover how practices like gratitude flooding and negative visualization can inoculate against burnout and offer emotional integrity in the most harrowing moments of care.

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

Scott Weingart, MD, is an emergency department intensivist and physician coach based in New York. He completed fellowships in Trauma, Surgical Critical Care, and ECMO, and is internationally recognized for his expertise in resuscitation and critical care. As the creator of the EMCrit podcast, with over 40 million downloads, he has shaped how clinicians think and perform under pressure. Together, Scott and I co-founded Guidewire Coaching, where we create and teach tailored courses to address the real-world pain points of acute care medicine.

• Rapid stress reset with “Beat the Stress Fool”
• Breathing techniques that calm the nervous system
• Self-talk under pressure
• Mental rehearsal that ends in success
• Trigger words for fast de-escalation
• Gratitudinal flooding as a shield during emotional overload
• Real-time tools for grief resilience
• The quiet strength of negative visualization
• Teaching stress tools to trainees without pushback

Mentioned in this episode:

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UnBurnable - Our Cohort-Based Burnout Prevention and Cure Course

As physician coaches, my partner, Scott Weingart, and I have noticed a pattern: some doctors are thoroughly burned out, and some are on the path to burnout. Almost all were shortchanged in their medical training, having been molded into excellent clinicians but given virtually no tools for retaining joy and equanimity throughout their careers.

The UnBurnable Course

5 Free Tools To Make Medical Practice Easier

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No one enters medicine expecting to land on a performance improvement plan, yet for many physicians, it becomes a disorienting reality. A PIP can feel like both a warning and a test, raising existential fears about career, reputation, and future. Behind the formal language is often a complex mix of organizational risk management and legitimate behavioral concerns. In this episode, we explore what it really means to be placed on a PIP, how to navigate the process effectively, and why resistance is rarely a successful strategy. Finally, we share a structured approach to coaching through a PIP that can turn even the most fraught situation into meaningful professional growth.

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

We Discuss:

• Understanding the Purpose and Structure of a Performance Improvement Plan (PIP)
• Variability and Pitfalls in PIPs
• Why Coaching Matters During a PIP
• Common Reactions and Emotional Toll
• Structural Flaws That Undermine PIPs
• Negotiating and Responding to a PIP
• The Myth of Performance Immunity
• A Coaching Framework for Navigating PIPs
• Collaborating With Leadership
• Success and Long-Term Impact

Mentioned in this episode:

UnBurnable - Our Cohort-Based Burnout Prevention and Cure Course

As physician coaches, my partner, Scott Weingart, and I have noticed a pattern: some doctors are thoroughly burned out, and some are on the path to burnout. Almost all were shortchanged in their medical training, having been molded into excellent clinicians but given virtually no tools for retaining joy and equanimity throughout their careers.

The UnBurnable Course

5 Free Tools To Make Medical Practice Easier

Scripts for your least favorite conversations.

Free Resources Link

What if addiction isn’t about drugs, but about pain? Beneath compulsive behaviors often lie histories of trauma, anxiety, and unmet emotional needs, hidden behind layers of stigma and misunderstanding. In medicine, addiction is still often mischaracterized as a moral failing rather than a treatable illness with deep psychological roots. In this episode, we explore the personal and professional evolution of Dr. Casey Grover, an addiction medicine physician who reframed both his own struggles and the way he cares for patients. Finally, we uncover how shifting mindset and language can transform both clinical outcomes and clinician well-being.

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

Guest bio:  Dr. Casey Grover is a board-certified physician in Addiction Medicine and Emergency Medicine at Montage Health, where he also serves as Chief of Staff. He is the Physician Champion for the Monterey County Prescribe Safe Initiative, a program focused on reducing opioid misuse through education, safe prescribing, and improved treatment access. In addition to his clinical and leadership roles, Dr. Grover hosts the podcast Addiction Medicine Made Easy, where he breaks down complex topics to make addiction care more approachable for both providers and the public.

We Discuss:

• What is Addiction?
• When Food Becomes a Coping Mechanism
• The Stigma of Addiction
• The Neurology of Addiction
• Divided Views on Sobriety
• Why Some People Recover and Others Relapse
• The Reason Some Brains Get Hooked
• Addiction vs. Dependence — and Why Stigma Makes It Worse
• Building Trust with Patients
• From Frustration to Compassion: Reframing Patient Encounters
• Trauma, PTSD, and Personal Reckoning
• The Practice of Addiction Medicine

Mentioned in this episode:

UnBurnable - Our Cohort-Based Burnout Prevention and Cure Course

As physician coaches, my partner, Scott Weingart, and I have noticed a pattern: some doctors are thoroughly burned out, and some are on the path to burnout. Almost all were shortchanged in their medical training, having been molded into excellent clinicians but given virtually no tools for retaining joy and equanimity throughout their careers.

The UnBurnable Course

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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5 Free Tools To Make Medical Practice Easier

Scripts for your least favorite conversations.

Free Resources Link