Why Are Physicians Burnt Out?

Yeah, the paddle Yeah. So, so what were you saying about the paddle? >> No, the the paddle that I just bought, uh, you know, it's, uh, I think it's going to help me improve my pickle ball game a little bit because, uh, the games are getting intense now. Uh, the everyone that plays with us is getting better and better and, uh, so you have to keep up with that. So, I've been looking at the the right kind of paddles and and see which one will help me be better.

But, I don't think it's the paddle, man. I think it's the players. >> Very very cliched. Very well said. I'm not I'm not a pickle baller, so I'll just live vicariously through you and apparently through your paddle. >> Yeah. I mean, you you gave up after your first try when you just realized you're not very good. And then uh >> I know. I just I just don't have the athletic prowess of the pickle. >> Yeah. I mean, >> it's a good outlet, right? I mean, it's just it's just a fun activity.

Um we all we all need something like that. >> Yeah. I know. It's one of those things where um you know you you need something for yourself a little bit. You get tired throughout the week that you know you work uh from early morning at 7:00 a.m. and work all day and then that pickle ball night can be just a little change in the in the weekend. That's why I've been trying to go and it's exercise too. I mean it's a good workout.

So it's been an excuse where I do my uh you know strength training sessions but my cardio sessions one of them is pickle ball. It helps me helps me with this burnout, man. But this this week's been tough. This week's been tough. I've been trying to get myself um go through the motions and trying to get through the week. But uh it's been tough because I haven't had a break. Uh you know, I uh worked not this weekend, but the weekend before.

And this past weekend, I spent a lot of time just catching up on all the notes from the past couple of weeks that I was really behind on. So spent this past weekend really catching up. This week was the first week that I've been I've been caught up with my notes, but it never ends. >> Yeah, I hear you, man. I mean, especially the weeks you're on call and the weekends for call, then it just kind of it's a continuous two weeks of work. Um, you don't get a break.

You don't get to kind of like chill and decompress. You're always a little bit on the hook. Um, so I I think having an outlet like that is nice. And I was joking that, you know, pickle ball, whatever. I mean, everyone has their thing. Um and you know this whole topic of burnout and getting exhausted and being frustrated um with work and the responsibilities, the clinical duties plus so much of admin level work um that's more and more common right now in medicine and in our practices.

I I think that's a big portion of the burnout too because the burn it's almost like an emotional thing like it's a drag. You got to do it. It's like swimming uphill upstream um trying to do all of that stuff and also take care of the patients and then also have time for yourself. There's a lot of different things. >> Yeah. You know, it's it's different. We always think about the grass is always greener on the other side.

Uh you know, there's when you're a resident or fellow, there's definitely an component of a burnout because you're a trainee and you're working long hours and you're responsible for a lot of teaching and a lot of patients and you're spending a lot of time in the hospital. So, it's easy to burn out during that time. But uh when you go on to start practicing uh and start your own practice or working in your um field that you you're in now uh there's a lot of pressure every day.

There's literally um you know lives of people and people need stuff from you. They need your help and it weighs in on you as you know all physicians are human beings as well and just that pressure of making sure you're making the right decision. Truly the decision fatigue is a real thing. Um, you know, all day long from 7:00 a.m.

when you wake up, you're making decisions what medication to start, um, what procedure to order, what imaging study to order, uh, when you're doing a procedure, what is the best way, what is what to do next. Uh, and throughout the day, there's a component of decision fatigue that by the end of the day when you get home, you just don't want to make any more decisions. Um, you know, I don't know how if you feel that way, the the whole idea of decision fatigue. >> Yeah, man.

I mean it's certainly a thing you know like I when I run through my day um you know like yesterday as an example I had eight surgeries yesterday and I pretty routinely on a surgery day I'll see clinic patients sometimes in between cases so you know I'll have two or three clinic patients scattered trying to you know you try to think ahead that okay this case is going to take me maybe an hour this next one will take me maybe 35 40 minutes and the turnover time in between before the cases start to the next one maybe I'll have 10 15 minutes I can see a patient in clinic in that time.

It just helps you see more patients total in clinic, a quick posttop visit or something. But, you know, timing that is also a decision. Figuring out, okay, this case took a little longer or there was more of a delay. Now, the clinic patient is waiting upstairs. So, during the course of the day, trying to stack all of that and do it in sequence and time it well. That adds a lot of stress. Um, for sure. And also frustration.

You're you're more likely because now you're thinking, okay, that patient's been waiting for this amount of time upstairs or this clinic encounter is taking a little longer. I got to get back downstairs. are waiting for me to start the surgery. Um, and it's normal to get a little frustrated or you're waiting on an X-ray that isn't done and they're ready to roll in the O.

So, that that's a very common thing that I experience in an average day in an average week is having to kind of juggle and balance back and forth, back and forth, like do I add more patients in the day? Do I add more surgeries or maybe do a few less in a day? But then that means patients are waiting longer, right? patients are coming to see you and very few patients are coming in wanting a delay and wanting to do a surgery months out. Every patient is like how soon can you do it?

When's your next availability? And so you want to offer that to patients. You want to be able to do that. Um but sometimes you just can't without compromising on things.

So those are the types of decisions, you know, like you're alluding to that in an average week and an average day kind of bear on me and I think bear on a lot of people with a busy practice is how do you try your best to adequately give your time, the most limited resource to your patients while not kind of just fatiguing yourself and burning yourself out. >> Yeah. I mean, you know, the goal is to make sure the patient is well taken care of. Uh they're satisfied, they're happy.

Uh I'll speak from my end you know being in private practice and building my own practice. I'm uh in a very competitive market. I'm a cardiologist in a very um you know in demand area where there's a lot of other cardiology practices. So I have to make sure I'm on top of my game and providing the best service for my patients because my goal is to build my business as well and along with providing the best kind of care for the patients. So my day starts early in the morning at 7:00 a.m.

uh when I get to the hospital and you know a lot of times I have procedures uh planned uh from 7 to 9 um and in within that time I also round my hospital patients as well that the ones that are admitted to the hospital and I try to do that between 7 to 9 but then when you're doing procedures if some procedure runs unfortunately longer uh then you're worried about your clinic patient that's your clinic is starting at 9:00 and you don't want to be the doctor that makes their patient wait for too long and the patient's time is valuable as well.

So you want to don't you don't want to rush through the procedure and you want to make sure you do the right job. Uh but uh then you have you want to get to your clinic as well. And you know for some people for example my hospital that I go to is not that close. It's not in the same location as my clinic. So I have to get in my car and then drive. And then on the drive uh to work there's sometimes traffic. You know it's early in the morning. It's 8:30 night.

So getting through the traffic >> uh getting through the traffic uh getting getting to my clinic and then seeing those patients uh you know the the clinic part and the medicine part is the easy part I feel sometimes but it's it's making sure that you're managing your time right and pro and providing satisfactory service to everyone that's just to comment on that I think that that's a really good point and kind of like something you mentioned earlier the difference in this fatigue and this sense of burnout between training and practice.

I I what you just said I agree so much that it's a lot of logistics when you're in practice is figuring out where you're going to be and when. Can you time it right? Who's waiting for you? Who's not? Who's depending on you? Who's not? When you're in practice, it's all on you. That managing the logistics in addition to the patient care is a huge factor that weighs on you.

When you're in residency, there's much less of that because so much of it is kind of already set in place by the attendings you're working with, by the hospital service. You're mainly doing the patient care aspect, which of course has its own frustrations and worries and stresses because you're in training. You don't really know everything. It's not like we know everything as attendings, but we have more knowledge, have more experience.

So, at least for me in training, the patient care aspect and being competent and doing my job well, that was a stress for sure. But the logistics is not really on you. That's that's more so already set for you. Whereas for us now in practice, like you're mentioning, it's all on you. Are you able to juggle doing the procedure at X hospital, getting in your car, fighting traffic, hoping there's no accident, getting to the clinic, seeing the patients on time, they're waiting, now they're upset.

How do you manage that? You have to be right on your game for your clinic patients because they're waiting to see you. They have important results. You got to go over all that stuff. So, I I I hear you completely. >> Yeah. And then, you know, there's uh there's a whole idea like, you know, sometimes you've had a stressful morning. You you've gone through a bad procedure which was a little tougher and you got through it. You saw you're rounded on your hospital patients.

Sometimes you're satisfied with the care you provided. Sometimes you're like, "Oh, maybe I could have done this or I could have maybe spent more time with the patient." And then you get to your clinic and then there's a line of 20 patients that you to see that day. Uh and that's 20 meetings that day. Now, the way I describe a physician's workday is you're um you're having 20 meetings where you're the one who sets the agenda. You ask most of the questions. You make the plan.

You provide the advice. You are the secretary that's documenting everything that's going on, the procedure. You're doing the orders. Um meanwhile, while you're seeing all these and having these 20 25 meetings a day, uh there's other people that need stuff from you. They they maybe need you to sign things. They maybe need you to call the insurance company for a prior authorization or peer-to-peer. Uh there's a pharmaceutical rep waiting for you to sign things.

So, it's it's a day where a lot of people demand your attention. It weighs on you. I mean, you know, physicians are humans, too. Uh uh and sometimes we're on our agame and sometimes are ready to go and uh you know, do well and sometimes there's tough days. Sometimes you've had a bad night the night before. You didn't sleep well and you're tired, but you still have to go through and make sure you're there for the patients who are very anxious about the results.

I mean, when people come to me for advice regarding their heart, they're very anxious uh in terms of the heart cuz you know, there's a lot of life and death situ uh issues related to that. So, you have to make sure you're there for them, you're providing them comfort, you're giving the right kind of advice. Plus on top of that now you have to document every single thing you've done and said and remember and that that just takes a toll on you know your stress levels.

Uh >> yeah man the the documentation for sure I mean and that that's a wellstudied thing too. I mean the amount of increased demand on documentation the increased alerts that you see before you can close out an encounter, close out a note, sign a prescription, the increased just number of screens you see increased number of clicks. It makes everything take longer for one. It's more extra I mean it's kind of extra nonsense in a lot of ways that you have to deal with.

Um it just takes longer the increased amount of clerical level work, increased time on a computer screen rather than in front of the patient. All of that stuff are known contributors to burnout. I mean we we all experience it every day. Um, you know, one other interesting thing, homayu, is that like the um the amount of different directions you're pulled in, so much of that is kind of not in your control or not at all how you planned your day to go, but it just it just happens.

It happens all the time. Like just like you're saying, I mean, I'll be seeing a patient in that same clinic encounter of like 8 minutes, 10 minutes, whatever. I'll get a phone call from a resident, two texts from a resident with X-ray pictures and an MRI 10-second video clip that they took on their computer. a rep is texting me for an implant for tomorrow. Like, hey, is this what you need? Which laterality is it? This, and that non-stop.

And so, as soon as I get out of the patient room, I'm on my phone. This, this, this, this, or there's four Outlook emails. Okay, one of them I got to answer because it's about approval for this other anchor I need to use on another day. You know, it's just non-stop. Um, and it just makes your mind constantly have to retain a sharp focus throughout the day. There's not like a break. There's not really a moment to sit and chill and like relax. You're just constantly going.

You have to be on your form. It's very mentally taxing. I mean, at the end of the day, when I'm done, I'm driving home, you're just like, "Oh, thank God that day is over." >> Yeah. I mean, that but sometimes when you come into work, that day has already been tough, right? When you start your clinic, maybe an afternoon clinic, you've had a tough morning, but now you have to walk into a patient room, smile, be there for them, comfort them, uh, and put on your best act, right?

You cannot be a grouchy doctor. I mean, a lot of people are, but I don't want to be that guy. I want to be there for the patients and provide the right sure kind of comforting words for them. Um, and sometimes you're just not in the mood, you know, unfortunately that's you're human. Like sometimes you're just tired and sometimes your mind is in different places.

maybe, you know, um, since I run my own business, I mean, you know, things can be good for a while and you're you have employees that are working and they're doing the job, but then all of a sudden you realize that your important vital employee that was there for a long time and stable.

Um, she or he are leaving now and you have to find someone new and you're trying to interview people and you're not finding someone and you know their date for them to come to leave the the practice is coming soon. So there's that pressure where you're thinking about maybe what's going to happen once they leave. And then once they leave and you hire someone new, there's a whole pressure of making sure they're trained because they're definitely going to miss things.

They're not going to do the things the way they were. So there's a whole disruption in flow. Now uh you know uh now you have to worry about you have to worry about patient satisfaction. Now when there's disruption flow, some patients don't get the calls they need. They don't get the the the call back that was supposed to go to them. So they're upset now. uh and and and then you have to make sure you have to understand from their perspective that they're not seeing this side of us.

They're not seeing what goes behind running a medical practice or being in medical practice where you're being pulled in so many directions and you have employees and there's some good employees and then then there's some employees you have to train a little bit more. Uh and not everyone might be doing the right kind of the the job that you up to your standards up to the pra the standards you've set for your practice.

But you have to manage expectations for your patients as well because uh they they don't need to know that side of the internal side internal process of the practice right you have to keep a good front and and in the competitive setting that I'm in I'm I'm practicing you have to worry about your patient reviews you know a bad a couple of bad reviews online can can be devastating for a practice um you know can make patients patients question if they should go to your practice or not.

So, it's a it's a lot of things and they weigh in on you and that's why physician burnout is real. Uh, and a lot of physicians are leaving private practice. Um, they're leaving practice completely. A lot of physicians are moving on to non-fysician non-patient care jobs.

you know patients physicians are going to work for insurance companies or pharmaceuticals because uh patient care is not easy and the way our system is set up in the way our medical uh you know incentives are the way there's it's not the same kind of satisfaction that you maybe used to get in the past um you know >> yeah man I know for sure that customer service aspect it's very real whether you you like it or not I mean it it is a customer service mentality in a way because you have to keep the patients happy and you have to do the right thing for them.

But it's not just like you mentioned earlier, it's not just being grumpy, telling them the facts, telling them, "Hey, we need X study Y lab and then leave the room." I mean, it's it's a bit of a performance and you have to build rapport, you have to be affable, you have to be charming and at the same time convey the message, interact with them, make them feel special and welcome in your clinic.

Uh because you are distinguishing yourself from the competition, you are distinguishing yourself from other cardiologists in your case, other orthopedic surgeons in my case. why is a patient going to come to me electively, you know, because not everything we do is emergency and trauma where a patient doesn't really have a choice. Uh patients in those settings are kind of trapped at the location that they show up to.

Um but a lot of patients for elective conditions, they they can go elsewhere and that's your business. I mean, that's who is going to spread your word of mouth that, hey, this doctor was nice, they were charming, they were kind because bedside manner is such a huge factor. Um, you know, one one other interesting thing I think is the amount of stuff that's not really in our control.

Like you were talking about um with your practice, your employees, like if you have an employee who's leaving in upcoming days and the appending doom around that, right? Or someone new coming in, the amount of time it takes to onboard them and the wild card, are they going to be good or not? Are they going to be jing with the rest of your clinic staff? You really don't know. And those are factors not really directly under your control.

Same thing like I like just yesterday again when in one of the cases like any case that you use in the O implants you're dependent on the sterile processing department SPD to sterilize the implants properly to package them appropriately so that when they're brought into the room and you check them everything is good because if it's not good it's a minimum two if not three hours to reprocess them that's a huge delay it throws off the entire day it's a domino effect and that happened to me yesterday >> I was But, you know, it's unfortunately it happens often enough that it's like, "Oh man, it just kills you." And now already with eight cases coming up, this is the third case in the day.

And I was just like, "Oh my god, I'm not going to get home until like 9:00 p.m. tonight." You just know like this is just horrible. And now what do you do? You just sit there and brood. You get upset. But who do you really get upset at? There's no recourse. It's just someone didn't do their job appropriately. And that happens to everybody, right? No one is perfect.

But when it happens to you and it screws up your day and it also screws up the day for the six subsequent patients that are waiting for you to finish that case and then do the next do the next do the next and now you have to factor in timing. Is the patient already blocked? You know does the block have a duration? Can you just move them to the end of the day so that the sets are done and then you do it or is is it a little time sensitive? Which patients can be moved which are not?

Which are diabetic and need to eat? Now they're sitting NPO they can't eat anything since you know all these little factors like start coming into your mind. you start worrying about it and now your mind is a little off compared to the mindset you were in to just get in execute the surgery and move on. But that that stuff happens all the time. >> Yeah. And it's not it's not like um in that case sorry to interrupt you but in that case it's not like oh St. Luke's Hospital or Bentop uh was late.

No, Dr. Ahmed was late to the surgery and he you know was delayed in the surgery. So he I he had to reschedule my surgery. It comes on to the physician. It comes on >> It really does. It to I mean the the responsibility is always on us no matter what. I mean like you know it's kind of like um you know in like the like especially like the mid 2000s this this is a segue but like you know Google as an example as a company Google had an extremely extremely positive social acceptance across the board.

Um and you know there was a lot of interesting articles about why compared to other companies like Microsoft and Apple which overall consumer uh opinion on those companies Microsoft and Apple compared to Google all in the same space doing very similar things. Google was vastly superior in how people viewed Google and Microsoft and Apple were not.

And one of the main findings of this study was that Microsoft the face of Microsoft in people's minds even though Bill Gates had long since left was like Bill Gates was a person a single individual you could tie to. You knew what he looked like. You knew what he behaved like. You heard him talk. And same thing with Apple. It was Steve Jobs who was controversial figure. He was somewhat of a rude figure. Google, there wasn't really a face. No one knows what Larry Page and Sergey Brand look like.

They're never in the public eye. Google is nothing but a playful, goofy font that's colorful. That's all Google was. And everyone was like, "Wow, I use it every day. I love Google." Even though Google has a ton of nefarious practices that anyone can Google and is aware of. You know what I mean?

So it just shows like I and you all of us as physicians we are the face of the patient's healthcare experience regardless of how many things are not under our direct control we're at the end of the day the ones the patient thinks is somehow going to take charge and do it that that that's a very real thing you know it's uh it's funny because every time uh so and you don't have control sometimes right for example if you work are working at a hospital that has some issues going on there's some turnover number of employees and the systems are not that well set up.

The incentives are not that well set up. Uh that's out of your control but still it comes on to you that Dr. Naki or Dr. Ahmed uh are associated with that hospital and that's that's kind of like this Google and Apple thing where the patient just sees you as that face and you're interacting with them. They don't know all the other people that are part of the team that are making that machine work. Uh it's you.

You're the face and it all comes on to you and that's something that weighs on you as well. uh you know throughout the day.

Um it's uh >> you know it's um it's it's tough because you want to um you know make sure you're the best representation uh of that organization as well but sometimes the organizations that you're associated with are not providing you the right support right I mean it's different let's let's we can talk about the different perspectives we have like you work with a bigger institution you are with working with bigger hospital I'm more uh in the smaller setting with my clinic and having a little bit more control over uh my surroundings and and so how how do you think it's different like you know there's uh in terms of uh the amount of patients you can see in the day how many pat how many and your other colleagues I mean they're required to see or uh there's a pressure to perform certain amount of surgeries uh is there a difference between employed physicians versus private practice physicians versus self-employed physicians what do you think >> you know it's a it's a great question I I absolutely absolutely think there's a difference in in all of the above.

Um, but it really depends on the model, you know. I mean, basically, as a doctor, you're either self-employed or you're employed. And within each of those categories, there's a lot of different ways you can be self-employed, a lot of different ways you can be an employee. You can be an employee like I am with academic medical center, do a lot of patient care, a lot of complex cases, a lot of referral cases from the community, teach residents, teach medical students, I teach fellows.

So you have a lot of extra responsibilities beyond just the direct doctor patient relationship. You're still an employee, right? There there's expectations like any employee employer relationship whether it's in medicine or hotel space or retail. There's some certain expectations like I have to take call. It's not really my choice. I have to take blank amount of call to cover the hospitals. I got to teach the residents and the fellows. I mean I enjoy it. That's why I went into academics.

If someone doesn't enjoy it, then they would look at that as drag. Um, in terms of my schedule, um, the number of patients I see in clinic, the number of cases I do, that that's a blessing for me that I'm not really like dictated to do a certain number. Like there's not a volume metric that is being assessed and I have to hit certain minimums. Um, I I'm pretty busy because I like to be busy. Um, you know, like my average clinic, I see 40 45 patients.

um and probably do like 15 or so, maybe sometimes 20, but on average maybe 15 surgeries a week. Um but those and those are decent numbers. I'm not crazy busy. Um a lot of physicians in private practice and orthopedics are way busier than I am volumewise. Um but I don't have someone breathing down my neck to hey see more people or hey you got to do more surgeries.

However, there are employed models for sure where that's the case or there's even set numbers like we expect you to see 45 patients every clinic if you're not seeing them you get asked like why what was the reason why are your numbers down or even more so not just set numbers but something that happens too in some settings is you'll just have patients added on to your schedule unbeknownst to you'll just show up in the morning you check the schedule okay I have 38 patients today you check it a few hours later it was 46.

How did these extra patients get added? Like you had something scheduled that evening, you had a kids game. You had a parent teacher conference. Now, you're going to miss that because someone else who is not running your practice, who's not seeing your patients, can just add people to your schedule. >> That that's a thing that happens all the time. Every now and then that happens to me, not that regularly because I'm pretty subspecialized.

I I mainly just do upper extremity, but people that are more general, they can get stuff added into the clinic all the time because patients call. Patients want to get in and the people answering the phone line want to make them happy. There's metrics in how quick a patient calls and from that phone call to get them seen. So those are real things.

Those are real frustrations that a lot of my colleagues have, not just at my institution but at any employed model because it's basically the inability to control your life, right? That that's something that is opposite of like your model in private practice. >> Yeah. Yeah. I mean it's it's interesting, right?

There's a lot of there there's the academic model and especially the more you subsp specialcialize I think the more freedom uh sometimes you tend to have and academic settings tend to be a little bit more physician friendly in the sense that there's a lot more teamwork a lot more residents maybe not as much uh volume sometimes not maybe not in your case but in some cases uh that I've seen in academic practices but then there's completely employed models where a corporation owns a owns a practice and uh physicians are working for them and there's 10 physicians sitting in one room seeing patients one after another.

Each has a patient load of 35 to 40 patients and they're told that you know you have to see this patient 15 minutes and when they request uh that can we extend this visit to 30 minute visit instead of 15 minutes they're told no because you have to see this patient 15 minutes and sometimes I've been told by a lot of friends that when we see a complex patients coming in and we request uh that can we make this into a 30inut visit the the the admin staff tells them no it cannot be you have to see this patient in 15 minutes, but sometimes you still end up spending more than 15 minutes with that patients because they're complicated and then you're behind and then you it's never enough time to catch up with the with the your clinic load.

Then your clinic is running behind. The staff is mad at you uh because you're the doctor that runs behind. Now you're running late. Uh you had your kids soccer game to get to and you're at five it's 5:30 and 6. You're still seeing patients. You have orders to write. You have notes you have notes to write. you have um patients, you have patient results to call in, you have a prior authorization or peer-to-peer uh to work on. So, uh those things weigh on employed model.

I'm personally lucky in the sense that I decide uh how much I want to work and how many patients I want to see, if I want to be on call or not. Uh that's the benefit of a self-employed model, but then I'm also beholden to patient demands, right? I mean, if a patient wants to be seen soon, I want to get them in because they need a care. They need some care and if I delay them too much, they might go on to a different practice.

So, I fill up the schedule because I want to get the patient into my practice as soon as possible and take care of them and see them and and and get to their needs rather than have them end up going somewhere else because some other doctor ended up seeing them before me. Um, so that's that's just the reality of having a business.

you know you you try to acquire the customer which is I don't refer like referring to patients as customer but uh you want to acquire acquire the customer as soon as possible uh and if that doesn't happen they go elsewhere uh and that's the pressure a lot of private practice physicians feel sometimes of making sure they keep hustling because you know sometimes you you're also beholden to the referring doctors a lot because there's a lot of referring doctors that want their patients to be seen they want the patients to get the best care they want to give them notes in time because they're seeing the patients soon and they want to see what you said to them.

And if you are someone who's not writing good notes, who is not sending good reports to them in a timely manner, they might stop sending you patients. So there's that pressure as well. Uh in in private practice, even though you I can make my own schedule, I can um decide how many patients I want to see, which weekend I want to work.

Uh, but there's the pressures of running the business, pressures of employees leaving, pressures of systems breaking down, the internet breaking down that morning, and now I can't write my notes or see patients. Maybe the treadmill on the stress test broke down, and now I lose a whole day of stress test, and now I have to reschedule those patients for a different day.

So there's just different demands, different types of burnouts that come with each model, you know, be it academics, be it a employed model, be it a self-employed model. Uh, and they all have their own ups and downs. >> You know, one thing that's interesting, I think, is that, you know, just in us talking and giving, you know, some examples. A lot of the examples we gave are basically they boil down to factors that are not us.

Like when we are not the rate limiting step in something like your treadmill breaking down that's not really on you but it ends up being on you or if I am one X-ray tech down in clinic someone called in sick and now instead of our normal cohort where someone down everything is going to be delayed that entire clinic day is going to be delayed um there's so many factors out of our control on a day-to-day basis and and that's something that in in general in uh employed models whether you it's me an academic someone who's pure hospital employed someone who is employed by a private practice but not a partner right just an employee of a large private group you are beholden to you know whoever whether it's a managing partner who happens to be a physician or more and more often especially in academics in hospital employed jobs um in these big groups that are really private equity firms that have acquired practices you're beholden to some business manager some BBA or MBA person who ultimately is in some way right your boss um yet is not a physician and really has no concept of medical practice or really what it entails to take care of a patient.

they are simply doing the business side of healthcare as like it's any other industry and that doesn't jive very well and you know th this is something that again it's been studied a lot if you look at like a graph you know over time the number of administrators in healthcare has greatly shot up I mean it's exponential growth since like the late 1980s early 1990s um and physician burnout has also similarly shot up very similarly to that I mean the rates of burnout are marketkedly high across all specialties in training and also practice.

Um, and I'm not equating the two that it's a cause and effect relationship. I'm simply making a comment that things that are out of your control, having additional responsibilities constantly placed on you, additional metrics constantly placed on you when your goal and what your expertise is as patient care is potentially being questioned or being subverted in a way to just see more and do more and have more volume and create more of an assembly line type model.

That doesn't happen everywhere, but that that is something that creeps into your mind a lot. Um, when other people are trying to dictate at least some element of your practice and your volume, that's it's a frustrating thing for sure that a lot of people experience. >> There's a there's a lot of frustrations with the health care system and the way it's run. There's definitely a shortage of physicians.

Uh, you know, we we've talked about the role of AI uh can play in the future maybe to take some load off of us. But then you also have to remember that you know when when we leave our work and leave our practice we go home and you want to be a good dad and you want to be a good husband and after >> and you want to be a professional pickle baller >> and a professional pickle baller.

So when you go home and you know you're you're now you get home and your son and your wife are there waiting for you to uh you know spend time with them. Sometimes you're, you know, I don't know if you feel this way sometimes, but you're just mentally exhausted, but you know, you only have a couple more hours with your kids and you want to make the most of that. So, you push yourself to spend as much time with them as possible.

You know, goof around with them, play with them, even though mentally sometimes you're very exhausted. On top of that, you also want to make sure you're taking care of your health. Um, you know, maybe making sure you're exercising and and preaching, uh, you know, everything you preach, uh, you're doing that.

So uh I think physicians have a life at work but then there's a life outside of work that uh they can sometimes you know take their frustrations from the day and and go on to the day and kind of you know deal with deal with frustrations at work at home and you know you try not to do that a lot of times but uh it's natural to come out. It's it's hard to deal with that, you know.

Um, and that's that's a common thing amongst physicians and that's why there's a high rate of divorce amongst physicians, >> you know, and I I'll just say that, you know, that family balance, it's very tough and it's it's so easy to just rationalize to yourself that, oh, but my job is so important. There's patients relying on me. Even though I'm home, I got to do this or I have to check this or I have to write this note or I have to send this med.

Um, and all of those you're basically each of those examples you're making a decision to prioritize something over your family. Um, again, regardless of how pressing it may be at the time or seemingly pressing, right? Um, it's a decision that each of us individually has to make and what our priorities are and what is important. I mean, I I try my best. Uh, I think I have gotten better about this. I've been very conscientious about it of basically like not doing any work once I get home.

Um, And the reality is I could not do that when I was in training. You just have so much stuff that you have to do. Um, and you have to study, you have to prepare, you have to learn and you do that outside of work. You have to do that on your own time. It's like doing homework when you're in school.

Um, once you're in practice, especially as you get more and more experience, you really like don't prepare for the next day in terms of like in an academic sense like I I already know how to do a shoulder replacement quite well. I'm not reading up on it the day before, but when you're in training, you're doing that a lot.

Um, so those types of responsibilities are less, but like you're saying, I I'll get a text or a phone call from the answering service that this patient's medication was sent to the pharmacy after surgery, but that pharmacy is out of oxycodone, one of the pain medications. They'd like to send it a different pharmacy. I mean, I I can only do that by now. I have to log in, do two-factor authentication, do this, get the information on my phone, and send it.

Uh, and stuff like that does happen all the time and you've got to do it. But that does take time away from your family time. You're so-called supposed to be off the clock, spending time with your young kid before they go to bed, actually interact with your wife during the week. Um, those things all pervade into your life and it's it's so easy to blur the lines and like your professional life just becomes you. Um I I think it's very important to draw a line somehow in somewhere.

Uh and for me that's just basically trying to leave everything at work and come home and just totally disengage from it. Um because otherwise you just can't. Yeah, you definitely have to create boundaries. I mean you know uh that's that's been my rule as well where I don't try to do uh you know too much work at home.

Sometimes, yeah, it happens that I get behind because during the day I'm so bogged down by so many decisions I have to make about the practice or talk to an employee or you know work on some stuff for the for the practice for the admin side of things that notes get left behind. So sometimes I've had to bring some work home and work on the weekend.

uh when but I I've made it to a point when when my son is awake and uh when my wife is um you know around I try not to do work and I try to find time once they're asleep or they're napping or something uh or they're busy with something else to then okay like this is not my time to just chill or watch a movie or TV show. Let's catch up on some work because they're busy right now or they're sleeping.

Uh, and that's it's but it's it's it's it's very important to create those boundaries where as as as soon as you get home there's there has to be a smile on your face and leave all those frustrations behind uh from work and be there for your family that's it's the most important because family for both of us it's it's our number one priority right I mean to be there for our family and and be good fathers to our kids uh uh that's that's a big priority for me so creating those boundaries is very important I It's also very important for us to find some uh creative outlets uh for uh kind of battling the burnout sometimes.

You know, for me, I've been a little lucky because I have a few different things that I do. um you know I I have my practice but I do a lot of clinical research and we have a a whole uh clinical research business that sometimes it's kind of fun for me to kind of step away from the practice and and do some work for the clinical research business with my with my brother uh you know have attend some of those meetings or meet with my research staff and plan for some of the clinical trials.

um you know meet with a lot of the pharmaceutical uh industry representatives or or sponsors or MSLs and um and talk to them about new therapies in the future that are coming out and learn about that uh and that change you know stepping away from the practice and focusing on the clinical research business sometime it's fun for me it it kind of disrupts the monotony of practice and you know brings something new in uh similarly this podcasting has been a nice creative outlet it as well where we kind of get to work on something more creative.

It it uses different I guess muscles of the brain that uh you know you think about different things the more creative side uh um and talk about these interesting topics and that's been a good outlet as well. >> Totally. The podcast has been fun. Um and it actually gets more and more fun the more we do it. you know, each of these episodes, I it just feels very natural just chatting it up and talking about these topics because these are things that we think about on a regular basis.

They're not like canned or uh done on purpose really other than just thinking about our thoughts and vocalizing them. And I think that is like real creativity, right? Like you just kind of enter a little bit of a flow state and you just let yourself go.

you let your mind explore things kind of like and for me like writing is a big thing some of it I publish uh but most of it I just write for myself a journaling I guess in a way but not really like a day-to-day thing more so like journaling about ideas or writing short stories um or like humorous musings of some event that happened like when we go on vacation I'll write some stuff about it you know I just think it's a fun activity to do it challenges your brain uh in some ways is um so you got to just find your own outlet like everyone has their own thing and to be frank if you don't have something hopefully more than one thing I mean it behooves all of us to find that because if you don't carve out you know talking about these boundaries now and talking bringing it to kind of yourself maybe a little selfishly speaking but all of us should and need to carve out some time some activity some space some whatever for you for us because if you keep giving giving giving and that's all you do to other people whether at your work, in your family life, in your friend group, but don't have any of your personal time, your personal pursuits, you kind of lose who you are as a person.

And who you are as a person is what drew your family to you. It it's what drew your friends to you. It's what made you successful in your career. You don't want to lose that. And you want to keep cultivating that because you really like you can't take care of others till you take care of yourself. You have to have a sound mind and a sound body and really be who you are. It's very important to do that.

So, I think any creative outlet, whatever it is, it doesn't matter as long as it's something that you really enjoy doing, it's critical to do. >> Yeah. I mean, I know a lot of physicians that are that are, you know, painters or they play music or, you know, I I personally love to cook and grill. I haven't had as much chance to recently cook, but I love doing that and that's something that's very relaxing for me as well, especially going out to the grill and and barbecuing something.

But you know uh one the outlets you know a lot of times you want to read stuff about medicine you want to educate yourself you want to listen to podcasts about healthcare but I personally try to avoid those now you know any TV shows about healthcare I just refuse to watch any any >> I don't watch any of those >> any any podcasts that are uh you know about two dogs talking about uh something in healthcare I avoid those uh because because because I don't want to go and revisit medicine when I'm outside you know I do listen to a lot of podcasts and that's a a fun creative outlet for me you know uh be it news be it uh learning about AI and listening about that um you know listening about uh you know the different psychology of human beings uh and and listening to podcasts about that that's been that's that's a that's a good creative outlet where it it distracts my mind from the business and the medicine side of things onto something and uh you know along with cooking and uh you know um listening to podcast or uh you know I wish I had something like writing I don't u but you know those those things can be fun and something that you definitely need to have for yourself but I think spending time with friends is also important there's everyone's different uh you know there's some people that that cherish that alone time and some people need uh socialization and seeing others there has to be the right balance but I think uh You have to be a well-rounded person to be able to kind of, you know, avoid that.

Unfortunately, a lot of physicians don't develop those social skills or hobbies throughout med school and and residency because the training is so grueling. And that's why we see so much of the physician burnout and physician suicides as well, right? I mean, it's it's a known fact that physicians have one of the highest suicide rates in the country.

uh which is unfortunate because >> it's it's kind of like a profession through like the length of training that almost forces you to become one track minded. Um it's almost like the extreme of completely dedicating yourself like a singularity of focus so that you can become excellent at what you do and yeah become an awesome doctor but you're still a person and you don't want to stop being an awesome person just so that you can be an awesome doctor.

that's only one facet of your life and I I I really think that's why if you're a onetrack-minded person maybe be not through fully fault to your own right I mean it's just the way training is it forces you to do that you have so many hours in the day dedicated just to just only that then you got to sleep and there's not much time left or energy left mentally and physically to do other stuff um but there's so many doctors like I have a lot of friends a lot of colleagues who are physicians various specialties that like don't really have strong friend groups and they kind of just interact with the people that they work with.

They don't have friends outside. And I think that's really important to not have, you know, like even the idea of an echo chamber is used like politically. But even like a professional echo chamber where you work only with each other, other physicians, you hang out only with other physicians, you only talk about healthcare and medicine. Like I I think that's it's not a healthy thing.

I think it's very important to have a diversity in all those things in interests of your own, in your friends interests, right? like you are the average of your five closest friends. That that's a that's a thing. Um you want that to be a diverse average. >> Yeah, it's definitely important to have conversations that are non-med when you're not at work. And even when you're at work, it's good to have chitchat about other things, you know, because uh as physicians, we're so living in a bubble.

you know, when I did my MBA for that year between during med school, I you know, like I think I mentioned before, I did an MBA program and that that year just blew my mind away because I realized that when you're going through medical training, whether you're premed or you're a science major, you're living in such a bubble where all you see is this set uh guidelines for yourself, you know, MCAT, med school, uh residency, step one, step two, fellowship, you know, whatnot.

you forget that there's other people living completely different lives. There there's people that take years off and months off and they go and travel and they work elsewhere and they they they experience new things and and and that makes you realize, hey, what what truly is the point of life? Is the point of life is to work yourself to burn out and and then just have no hobbies or is the point of life to experience things outside of what you do on a day-to-day basis?

You know, traveling is is very important to me. Uh, and that's why, you know, I've um I'm I'm I'm, you know, blessed to be able to travel. Uh, and you know, I try to take at least one week off every two to three months and and go somewhere new, go somewhere um where I can just disconnect and enjoy my time with my family because I think to be a good physician to do to be a good doctor, I need that, you know, reset, that refresh where I can go somewhere else, just disconnect from everything.

But you know uh it it's sad because as a as a solo physician in my practice sometimes when even I'm on vacation I have my phone and my teams and check in with my employees. Hey is everything okay? Does every anyone need anything? Even then it's sometimes hard to disconnect. I don't know if you felt that way as well but for me it's been hard to disconnect. Even on vacations, I try to do it as much as possible. And it's a good time for me to reset.

But it's when when you it's your baby and you've been working on this business, it's hard to completely disconnect even when you're gone for a few days. >> Yeah, man. The the practice doesn't stop. The practice doesn't take a vacation because, you know, like let's say I go on vacation on like a Saturday, right? But the previous couple weeks of patients that I did surgery on, you know, those 30 patients, you know, a handful of them are going to have questions. They're going to have issues.

They're going to be like, "Oh, my dressing came off, or I accidentally got my hand wet and you told me not to, or my splint is loose, or I fell." Things happen all the time. And oh my gosh, there hasn't been a single vacation since I've been in practice where I have not been contacted by my MA or one of the PAs or NPs or the resident. And all of it is the same. Hey, Dr. Ahmed. sorry that I bothering you.

I know you're on vacation, but it's like we recognize you're out taking some personal time, but it's not that we don't care. We just don't really care. Here's this issue. Please solve it. And you know, like we all delegate like someone in ourstead, one of my colleagues, and we all do it for each other that, hey, this is the person to go to if there's a question or an issue, but like that doesn't have people still text you. They still reach out to you.

And what are you going to I mean, I just text back like, "Hey, this is what I would do." Or, "Hey, let the patient know this." Or, "Hey, that that sounds fine. They'll be fine." Or, "Oh, that's that's a problem. They should come in and see someone." You know, I mean, you got to troubleshoot. You got to do damage control. You can't ignore that. Um, but it does. It's this idea of invasive. You're never really away. You're never really off.

I mean, you know, honestly, it's funny like thinking back about travel. Last time I truly disconnected completely, like a zero connection was back in 2011 when I went on vacation to Kenya on a safari and I chose to leave my phone and it was almost a month. It was a little shy of a month, like three, three and a half weeks, but I had no connection to anything. And it was awesome. Like you weren't worried about anything. You weren't checking anything.

But like I haven't really disconnected in that way since then. a long time ago. Um it just almost feels like you can't uh which is is not true. We just all are so tied to it and thinking that we have these crazy responsibilities and lives and need to know, need to check that message, check that email, but you you can do it. It's just it's very difficult. >> Yeah. You know, uh it's it's crazy.

I don't I don't think there's many other fields where things are like this where you know you cannot completely disconnect. You cannot completely shut down your computer and just go away. There's there's very few fields and I think medicine is one of them. And all this talk of physician compensation being too much or physicians are overpaid.

I can guarantee you if the physicians the way the health care system is in the US, if physicians were getting paid less, were making less money, no one would want to do this job.

uh and a big motivation and honestly I mean I love my job I love taking care of pe people but uh and this is what I work for all my life but if if the rewards weren't there the way our healthcare system and the incentives and and and how things are always working against you I don't think sometimes this job is uh you know uh even fairly compensated >> yeah I you know I I for sure it's a in society's eyes an unpopular opinion to say what you just said.

And I agree with you completely because it's very easy to demonize physicians that doctors make so much money and they're complaining or, you know, doctors are the ones that are looting patients. They're they're dishonest, they're fraud, this and that. But if you look at the reality, I mean, you especially like I mean just in residency, you're basically paid minimum wage level salary.

And if you index the amount of time that a doctor spends in their day-to-day practice from when you actually wake up and get to work and you do the pre-charting, the pre-checking, you look at imaging before a surgery to prepare that day. Um, you do the day's work, even after, like we've both talked about, you're constantly on the hook. You're having phone calls, you're having texts, you're having uh notes to do when you get home. The total day's work is a lot. Um, and it doesn't end at 5:00 p.m.

It doesn't end. There's no shift end. Uh, for most specialties, you're doing it on the weekend. You have additional call responsibilities, but a lot of weekend work is not only call. Um, it's a lot of hours. I mean, many many physicians are working 60 plus hours of actual work in a given week, which is a lot more than a lot of professions. So, and then the responsibility like you're taking care of human beings. Mistakes happen, errors happen or people are disgruntled and that comes back on you.

I I think that in truth the compensation is going down for physicians and that that's been shown. I mean the the wages have not kept up with inflation. Um but the work has actually increased. It hasn't even remained stagnant. It's definitely increased. >> Yeah. And I might not have exact numbers on this, but physician compensation I think makes up for around 10 to 12% of all healthcare spending or maybe even less. I don't have the exact percentage on >> I think it was 8% the last I I I saw.

>> Yeah. And I think administrative administrative expenses was the single biggest chunk out of the entire bucket of healthcare expenses.

Yeah, it's insane because as there's an there's a pretty interesting graph I saw that the physician the the graph of the physician compensation was was flat and then the administrative cost in healthcare just ballooned and has gone at an exponential rate whereas physician compensation has stayed same and it's always the physicians are the ones that are getting blamed that you know they're making too much money or you know oh there's a rich physician now you know uh sometimes I wonder if I if I want my physician to be someone who's not getting paid enough, hate their life, uh are disgruntled, and showing up to do surgery on me.

Would would anyone want that? I don't know. I think I'd want my physician who's working on me on my bones or my brain or my heart to be well-rested, well compensated, and happy with life and happy to be there doing the job that he's doing rather than frustrated and disgruntled with the amount he's getting paid and the amount the the work he has to do.

So I think um I think there's a lot of a lot of uh space and improve there's a lot of you know space for improvement in in our healthcare system where we really have to reconsider this administrative cost and all these hospital expenses and and and truly see where the value in healthcare is coming from you know. >> Yeah for sure.

I you know I think it does in fact really directly tie in in a way to burn out too and this like emotional fatigue because when you're working this many hours and constantly on the hook mentally and then also have to juggle your outside life, your family life, your friendships, any hobbies if they exist. It really it doesn't leave time for development of a lot of so-called side hustles or ancillary income. Right?

So you're really very very strongly dependent on this one job as your income to support everything in your life and your family and schools and kids and vacations and all that stuff. Um whereas if you're in a career path that is a lot less time dependent actually allows complete disengagement when the workday is over weekends or weekends rather than continuation of the work week. It permits you to partake in those things.

It permits the development of real side hustles, real gigs because you have time. You have the time and the mental energy and emotional fortitude to pursue them because you're not just exhausted.

Um, and so I I think that's another piece of it too because as the laws increase and more and more restrictions are placed on physicians with things like prevention of physician ownership of hospitals, a lot of restrictions in many states on opening a surgery center and certificate of need and all that stuff. Can you have your own imaging center and not and refer patients to that?

A lot of those things have been shown to actually improve patient care, expedite patient care, and be more efficient and better resource utilization. Um, but still, they're regulated and really it's blocking physicians from partaking in these outside ancillary income streams that could really offload your practice, potentially allow you to have less stress to see just more people, more people, more people, um, and spend more time with patients.

But they for many cases are either not allowed or very restricted. >> Yeah. Yeah, man. I mean, you know, there's there's we can go on uh about this topic for hours and hours. There's so many things to discuss and there's maybe we'll we'll even do another episode about this diving a little bit deeper into other things. But this was a good therapy session. >> It was cathartic. Everyone needs a bit of catharsis. Find something. >> Yeah.

I think this was a this was a a little selfish of us to do this because this week I was feeling very burnt out as well. Um you know so I think this was a therapy session for me where I could just say the things that were on my mind. But I hope uh you know uh other people got some insight into how uh medicine works and what doctors are going through.

So maybe next time when you're uh waiting a little longer in your physician's office, just know that that's uh that's you know that there's been a whole afternoon and evening and morning that your physician has gone through and maybe they've had a bad day and you know physicians are humans too. So forgive us for our mistakes and maybe that day we were not on our agame but we will try our best to take care of you you know. >> Yeah. Yeah.

And I'll just leave with the comment that it's it's not only okay, it's uh it's important to talk about this stuff, you know, us doing it on the podcast, but like you know, we have conversations like this often with each other, with other colleagues and stuff. And it that commiseration and that it builds a sense of camaraderie.

And anytime you go through something together, even if you just talk about it, but you're still going through it on some emotional level with someone uh and they're appreciating your journey and vice versa, it's very important. It helps offload you. Um it's like uh you know the chicken soup for your soul. Uh it's good, but it's important to talk about it. It's not a taboo thing.

And that's important to keep in mind for everyone, especially the trainees who are listening, the the medical students, the residents, the fellows, >> that we've all gone through it. We're continuing to go through it and it's tough and it's okay to talk about. That's that's how things get better. >> Yep. And uh I'm still very thankful for everything I do and my career and my profession. So, still glad to be a physician, but I think things could always be improved. >> Yeah.

I'm thankful for you, bro. I'm thankful for you. >> Two docs, one mic. >> All right, guys. We'll see you later on Two Docs, one mic. Take care.