Stimulus.

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.

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.

What is it about your work that still lights you up inside? At the center of every profession is a core - the reason we chose it in the first place, the part that feels meaningful no matter the chaos around it. When we reconnect with that core, even amid challenge, fulfillment often follows. Sometimes, though, that spark fades. Sometimes the core of what we love evolves, shifts direction, or gets buried under layers of stress and routine. In this episode, we explore how to evaluate your relationship with the essence of your work and how small (or big) recalibrations can realign your day-to-day with what matters most. Finally, we share strategies to clear out the noise, fuel the flame, and shape a career that energizes rather than drains.

Burnout isn't just emotional, it's financial. Many doctors put off financial planning until they're deep in debt, stuck in lifestyle inflation, and too burned out to pivot. In this episode, The White Coat Investor Jim Dahle lays out how to build a burnout-resistant career by making smart, intentional money decisions, whether you're a student or a seasoned physician.We delve into frugality (the useful and the absurd), how burnout can quietly become your biggest financial threat, what makes a solid investment plan, the waterfall method of managing your money, and why many doctors end up wealthy on paper but broke in practice. Plus: when hiring a financial advisor is the smartest move you can make—and when it's the worst.Guest bio: Jim Dahle, MD, FACEP is a practicing emergency physician and the founder of The White Coat Investor. After early experiences with predatory financial advisors, he taught himself personal finance and saw firsthand how financial literacy transformed his life. Motivated to help colleagues avoid similar pitfalls, he launched The White Coat Investor—then the only unbiased financial education resource for physicians. More than a decade later, Dr. Dahle continues to lead the organization as CEO, columnist, and podcast host, staying true to its mission: “help those who wear the white coat get a fair shake on Wall Street.”We Discuss:Financial goals as the “game,” not competition with othersEmbracing frugality (and where it can go too far)Burnout as a major financial riskStrategies to reduce burnout, including working less and managing spendingUnderstanding your financial “basement” (minimum monthly needs)Lifestyle creep and how to monitor itThe “live like a resident” strategy post-trainingNet worth versus income, and why physicians sometimes retire brokeThe financial “waterfall” (how to prioritize where your money goes)Why trying to beat the market usually backfiresWhole life insurance: the hype versus realityCreating an Investment Policy Statement (IPS)Real estate investing: REITs versus hands-on ownershipDesigning your life and shifts as a financially independent physicianThe "night shift marketplace" modelWhen to work with, or fire, a financial advisorCase study: mid-career physician financial planning

Making a major career shift is never easy, especially when you've dedicated decades to a profession that has become part of your identity. The decision to leave clinical medicine can be fraught with self-doubt, financial considerations, and the lingering question - what comes next? But at some point, the balance shifts, and the cost of staying outweighs the fear of leaving. In this episode, we explore what it takes to walk away from a stable medical career, redefine success, and craft a life that aligns with evolving priorities. Finally, we dig into strategies for managing stress, investing in personal growth, and finding fulfillment beyond the bedside.

Delivering the news of death is one of the hardest yet most overlooked skills in emergency medicine. Many learn by watching others or through trial and error rather than structured training (or just make it up as they go). This lack of preparation can lead to discomfort, stress, avoidance, and even systemic failures in how death notifications are handled. In this episode, we explore the critical components of death communication, how to navigate these difficult conversations with clarity and compassion, and why avoiding or mishandling these moments can have lasting consequences for both providers and families. Finally, we discuss the emotional toll of secondhand grief and the importance of proactive mental health care for those on the front lines of healthcare.

Leadership impacts everyone—whether you're steering an entire organization or simply navigating team dynamics. It's an essential skill, yet it often feels elusive, even for experienced professionals. While every leadership challenge is unique, the core principles remain universal. In this episode, we break down eight critical leadership principles drawn from years of experience, hard lessons, conversations with seasoned experts, research, and coaching leaders at all levels. Plus, we share actionable strategies to help you refine your leadership, whether you're guiding thousands or leading a small team.Want more? Subscribe to our free newsletter, Doctoring Done Well. Every other Saturday, straight to your inbox—strategies to work smarter, lead better, and build a career that lasts.We Discuss:Don't Worry About Leading, Worry About ListeningThis is Not Your Dumpster FireSlow Your RollYou Will Have to Be a Judge, Even When You Don't Want to BeModel the ValuesWith Behavioral Issues, Build the Pathway, Not Just the ExpectationYou Don't Know What You're Doing—And That's OKPeople Do Things for Their Reasons, Not YoursMentioned in this episode:Awake + Aware Bend May 5-7, 2025 | Our in person live event Ready to reset, recharge, and level up? Awake + Aware is a game-changing 3-day workshop where you will learn how to stay cool when the pressure's on and lock in the mindset you need to flourish. Space is limited.

Violence has a cadence, a rhythm that disrupts the normal flow of life. When an act of violence erupts, the first sign is often a sudden, unexplainable shift in the environment—an eerie silence, a heightened energy, or a gut feeling that something is wrong. But when does that uneasy feeling cross the threshold into immediate danger? In this episode, we explore the critical decision points in an active violence situation in the healthcare/hospital setting, the moral and ethical dilemmas of medical providers staying versus escaping, and tactical strategies for survival. Finally, we break down the "run, hide, fight" approach and how to act decisively when every second counts.Guest bio: Mike Shertz, MD is an emergency physician who spent 13 years as a Green Beret and a Special Forces medic. He is the founder and purveyor of Crisis Medicine, which teaches tactical casualty care to medical professionals. Check out this video that we did together in 2019 on how to place and remove a tourniquet and this one on how to pack a gunshot wound with combat gauze. Want more? Subscribe to our free newsletter, Doctoring Done Well. Every other Saturday, straight to your inbox—strategies to work smarter, lead better, and build a career that lasts.We Discuss:Recognizing an Active Violence SituationMoral Dilemmas: Stay or Escape?Perspectives on Risk and ResponseTactical Survival: Run, Hide, FightPost-Shooting Medical Response

Dealing with an angry, upset patient can feel like walking into an emotional storm. The frustration in the room is palpable, and even the most experienced clinicians can feel thrown off balance. While medical training equips us to handle complex diagnoses and emergencies, it often falls short when it comes to managing interpersonal conflict. That's where the Universal Upset Patient Protocol comes in—a straightforward, highly effective framework designed to de-escalate tense situations, restore trust, and protect your own emotional bandwidth. In this episode, we explore Dr. Dike Drummond's original protocol, breaking down each step with specific language to use in the heat of the moment. Finally, we'll add a few practical tweaks to help make these conversations even more natural and effective in real-world practice.

What defines the unique mindset of an emergency clinician? It's not just the fast pace or the chaotic environment—it's the deliberate, top-down thinking that prioritizes patient safety over diagnostic certainty. This approach, though deceptively simple, often flies in the face of traditional medical training, which emphasizes comprehensive differentials and exhaustive workups. In emergency medicine, knowing what the patient needs often matters more than knowing exactly what they have. In this episode, we explore the emergency medicine mindset, the pitfalls of the bottom-up approach, and why experienced clinicians focus on acute interventions and dangerous conditions. Finally, we discuss how humility and strategic communication with patients can make all the difference in mitigating risk and building trust.

Mastering nonverbal communication can be an elusive task, but the fact remains: what's unsaid leaves a significant footprint in any interaction. Nowhere is this more palpable than in the medical exam room, where trust and connection between physicians and patients often hinge on subtle, nonverbal cues.So, how can one build trust through facial expressions and tone of voice alone?In this episode, we break down how to silently establish rapport, effective use of pauses, the curious role of your eyebrows, impact of end-of-sentence inflection, how to convey uncertainty with confidence, and why learning a patient's eye color can pay dividends.

What's the biggest mistake people make about meditation? Thinking they're bad at it. Why do they think this? Because they've tried meditating, and their mind just won't shut up!It's a common misconception that meditation means clearing your mind of all thoughts. But in reality, meditation has little—or nothing—to do with that. If your mind wanders or feels like a crowded room full of shouting voices when you close your eyes, you're not alone. That's exactly what's supposed to happen!A wandering mind isn't failure—it's expected, even for seasoned meditators.In this episode, we break down the exact steps of how to meditate, what to do with a wandering mind, and why a flurry of thoughts—popping up like popcorn—doesn't mean you're bad at meditation. In fact, it means your mind is working exactly as it should. Ultimately, meditation isn't about thinking less; it's about changing how you engage with your thoughts, making it a skill you simply can't fail.

It started in medical school, when I witnessed the stark reality of the hidden curriculum: a transgender patient referred to as "it" by an attending physician. Over the years, I saw more subtle but no less harmful behaviors—snickers, misused pronouns, quiet biases. I often felt lost in how to respond.Today, transgender identity feels more politically charged than ever. But beyond the politics, what's it like simply to be transgender? What challenges do transgender patients face—physically, medically, socially, and emotionally? And how do you navigate a world that sees you differently after transitioning?In this episode, Dr. Jailyn Avila shares her story. We cover the deeply personal aspects of transition, from conversations with her wife and kids to navigating professional dynamics as an internationally recognized expert. Dr. Avila offers candid insights into her experience as a physician presenting as both male and female, practical advice for providing better care for transgender patients, and strategies for addressing pronouns and mistakes with grace.

Why do our minds seek explanations for everyday patterns, even attributing a cause where none may exist? "Regression to the mean" offers a statistical lens on why extreme experiences naturally revert to the norm. In medicine, this concept reveals why critical observations and repeated assessments are essential to avoid overreactions to abnormal results. In this episode, we explore the nuances of regression to the mean, breaking down its impact on medical decision-making, patient assessments, and even how we view high-stakes scenarios in healthcare. Finally, we delve into how understanding this principle can enhance clinical judgment and reduce unnecessary interventions.

Being a patient can feel like a lonely experience, especially when you sense your doctor is disconnected. A rushed or disengaged interaction can leave patients feeling unheard and uncared for, no matter how clinically skilled the physician is. At the same time, doctors struggle with overwhelming workloads, which can lead to unintentional detachment from those they treat. In this episode, we explore five ways to build connection in the exam room quickly, why small gestures matter, and how intentional preparation can change the entire dynamic. Finally, we dive into the emotional complexities of patient care and the essential role of listening and presence in preventing burnout. Our conversation centers around the ‘Presence 5 Practices' from this article.

Holding onto a grudge can feel strangely delicious, but that sense of righteousness often comes at a steep cost. In this episode, EMRAP founder Mel Herbert joins Rob to unpack a rift that's lingered for over half a decade—and explore the way forward to healing. We also break down why achievement does not demand extraordinary genius or talent but a shift in how we view our perceived mediocrity. Why the idea that we need to be exceptional to succeed fuels imposter syndrome and keeps us from valuing the potential in our "average" qualities. We examine the pressing challenges of modern medicine, where corporate pressures often clash with the need for human connection, and how clinicians can reclaim compassion and autonomy. Finally, we address the role of forgiveness and communication in personal and professional growth, revealing how setting boundaries and letting go of resentments can transform relationships and renew purpose.

It's often not the big power moves that change our lives; it's the small, intentional actions. By focusing on micro-skills, even the most ambitious goals become achievable.In this episode, we talk with Drs. Adaira Landry and Resa E. Lewiss about their new book, MicroSkills: Small Actions, Big Impact. We explore how financial literacy, self-presentation, concise communication, and allyship can be developed as essential micro-skills for a successful career. We also navigate workplace dynamics, including recognizing and addressing issues like mansplaining and bropropriating. Finally, we discuss the nuances of learning when to say “yes” or “no,” and the art of timely, respectful communication.

Ready to reset, recharge, and level up?Join us at our live event - Awake + Aware, a game-changing 3-day workshop from May 5-7 in Bend, Oregon. Learn how to stay cool when the pressure's on and lock in the mindset you need to flourish. Space is limited.

How do you handle your authority being challenged under stress? Even minor communication missteps in high-pressure environments like medicine can create lasting rifts and missed details. While the instinct to push back is strong, it's rarely the best response.We share a story of miscommunication between a resident and a nurse, highlighting the importance of humility and inquiry in clinical settings. We examine why leading with curiosity instead of ego can save time, build trust, and improve patient care.

It's hard to be a good boss and even harder to work under a bad one. This episode breaks down how to begin as a new leader with little to no experience, the critical errors leaders often make, and what to do when your boss is suboptimal. We explore how quick fixes, lack of empathy, and poor communication can alienate teams and stifle growth. Leaders who ignore the importance of relationships, skip proper onboarding, or impose their own agendas without collaboration set themselves up for failure. We also discuss how future writing can help leaders clarify their vision and avoid these pitfalls. Finally, we offer strategies to recognize and correct these missteps, creating a more effective and cohesive leadership style.

Navigating the complexities of taxes can be daunting, especially for medical professionals with unique financial situations. From maximizing retirement contributions to understanding the benefits of Health Savings Accounts (HSAs), strategic tax planning is essential. In this episode, we explore various tax strategies that physicians can leverage to optimize their financial outcomes. Finally, we delve into practical tips for managing multiple income streams and setting up your business on the right side of the IRS.

A cautionary tale about how I mismanaged my own physician burnout for many years, doing the easy thing instead of the right thing. More coaching goodness with a side of practical nuggetsYouTubeInstagramOur bi-weekly newsletter with short form, evidence based articles you won't find anywhere else.

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.

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.

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.

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

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.

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.

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.

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. 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 websiteThe Flameproof CourseThis is the hidden anti-burnout curriculum we all should have learned in training. Cohort 3 begins Sept 10, 2024. Get the deets We DiscussWhat 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 cultureUnderstanding the cultural context of frustrating behaviorsShifting from 'why me' to 'of course'How to create a framework for cultural knowledgeWhat happened to Raj's practice when he started interviewing local Pacific Islander community leadersHow to have patients feel seen, heard, and known in the point of careCultural competence vs cultural safetyWhat 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 nonjudgmentalWhy social determinants of health in documentation might be a good thingRumi's The Great WagonMentioned in this episode:Out On Time CourseFinishing shifts with a stack of charts to complete gets old fast. It also contributes to burnout. Join us for 'Out on Time,' a comprehensive 10-week six-session course where you'll learn how to walk out the door unencumbered. This is the only Out On Time that will be fully live, so don't miss out! The course begins on August 15, 2024.Out On Time Course1 on 1 Physician CoachingLove medicine, but the job itself leaves a lot to be desired? I work with many doctors in your shoes and help them rediscover the joy of being a physician. Learn more about 1-on-1 coaching4 Free Resources specifically designed to address pain points in medical practiceScripting your least favorite conversations | The Driveway Debrief | My 4 favorite documentation templates | The quick and dirty guide to calling consults 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. For full show notes of this episode and all sorts of other goodies, visit our podcast websiteWe Discuss:What does it mean to kick the can down the road?How procrastination shows up on a clinical shiftWhy does procrastination happen?It doesn't take much dread for can-kicking to occurAvoidance AwarenessDecisional InterrogationKicking the can because deciding will set off a cascade of more workAvoiding the infinite test of timeIdentify how, when, and where you'll make high-level decisionsLong term guests | How is it that decisions can finally be made when the shift is over?ChunkingZero in on your critical decision pointsKicking the can at work: pick one thing and identify YOUR decision pointsPreloading accountabilityPerfectionists get caught in a tree when they're actually in a tunnelMentioned in this episode:Out On Time CourseFinishing shifts with a stack of charts to complete gets old fast. It also contributes to burnout. Join us for 'Out on Time,' a comprehensive 10-week six-session course where you'll learn how to walk out the door unencumbered. This is the only Out On Time that will be fully live, so don't miss out! The course begins on August 15, 2024.Out On Time Course4 Free Resources specifically designed to address pain points in medical practiceScripting your least favorite conversations | The Driveway Debrief | My 4 favorite documentation templates | The quick and dirty guide to calling consults Free Resources Link1 on 1 Physician CoachingLove medicine, but the job itself leaves a lot to be desired? I work with many doctors in your shoes and help them rediscover the joy of being a physician. Learn more about 1-on-1 coaching

How do you build a team in the critical first moments of a crisis? The balance between rapid response and thoughtful planning is delicate, especially when understanding what defines a crisis and acknowledging when you're in the midst of one. This conversation delves into the complexity of emergency team dynamics, emphasizing that the composition and organization of these teams are deeply influenced by their members' specific skills and contexts, with lasting implications long after the crisis has passed.We introduce 'Name, Claim, Aim'—a straightforward, three-step framework designed to streamline team organization under pressure. It's about rapid situational assessment, clear role delegation, and setting concise objectives. The discussion extends to effective leadership in high-stakes situations, including establishing command, ensuring effective communication from the start, and striking the right balance to encourage team input without compromising decisiveness.Exploring the subtleties of crisis leadership, we'll discuss the strategic balance needed for effective oversight and the practicality of 'Name, Claim, Aim' as a distilled version of more complex crisis management theories tailored for the immediacy of emergency care. The conversation will also cover the practical implementation of this framework, from team huddles to understanding the profound impact of the first few seconds on the trajectory of team success.This episode builds on episode 115 - Zero Warning | Frameworks for no notice critical patientsGuest Bio:Lon Setnik, MD, is an emergency physician practicing in New Hampshire and the associate director of clinical programs at the Center for Medical Simulation. Lon is a Stimulus fan favorite. Here are some of his most popular episodes:Listening to Understand versus Listening to WinFeedback can be hard to give and harder to receive. Here are techniques to do both betterTake the Suck out of Documentation | Making the most of scribes, documenting in the room (and in front of the patient), efficient workflowsLove medicine, but the job itself leaves a lot to be desired?I work with many docs in your shoes. To learn more about 1-on-1 coaching, start here.For full show notes of this episode and all sorts of other goodies, visit our podcast websiteWe discuss:The tension between planning and actionWhat defines a crisis?How do you know when you're in a crisis?Teams are contextual in their skill setsHow you organize a team in a crisis has ripples after the event has endedThe three steps to organizing teams in a crisis: Name, Claim, AimHow to declare yourself as a team leaderModeling closed-loop communication from the first moments of team formationThe balance between being a tyrant vs an effective leader and how to avoid suppressing speaking-up behaviorsThe two pillars of Aiming what we want to achieve and who is going to do what to get us thereName, Claim, Aim needs to be fast and efficient; otherwise,...

Will you have enough money to retire? What does that even mean? In this pod, our guest physician financial coach, Elisa Chiang, M.D. Ph.D. breaks down Trading time for money and money for timeWorking harder vs creating valueThe FIRE (Financial Independence Retire Early) movement and why it doesn't always mean living by austerity rulesThe risk of relying solely on retirement accounts to fund your post-career lifeHer biggest financial mistakeHow identity influences spending habitsIncorporating real estate into an investment portfolioGuest Bio: Elizabeth ‘Elisa' Chiang, M.D. Ph.D. is a board-certified ophthalmologist and fellowship-trained oculoplastic surgeon who found her way into personal finance and real estate investing during her MSTP program, aspiring for FIRE long before it became mainstream. Battling burnout from her work in a hospital system, she turned to real estate as her avenue to financial independence, complemented by her newfound passion for life coaching. With active involvement in rental properties and passive investments in syndications and real estate funds, Elisa now helps others achieve financial independence while embracing life's journey. Learn more at https://www.growyourwealthymindset.com/Love medicine, but the job itself leaves a lot to be desired?I work with many docs in your shoes. To learn more about 1-on-1 coaching, start here.For full show notes of this episode and all sorts of other goodies, visit our podcast websiteWe discuss:Why a high income does not equate to wealthWorking harder vs creating valueOnce debt is gone, attention to money can dwindle Finding a place to start investing can be overwhelming and lead to inertiaHow to navigate a scarcity mindsetHow identity influences spending habitsMoney can buy time, but there's a catchElisa's biggest financial mistakesHow to decide if a real estate investment is a good (or bad) dealElisa's big-picture financial strategyReal estate investing for positive cash flowIf you only think about maxing out your retirement account, you probably won't retain the same lifestyle when you stop workingBeyond real estate investing, what are other areas for investment to produce cash flow?F.I.R.E Financial Independence Retire Early | Survival, Regular, and Fat FIREHow to figure out how much FIRE money you'll need to stop workingWill my retirement funds actually last? Rate of withdrawal and sequence of returns risk Fat FIRE | Spending more in retirement than you did while workingMentioned in this episode:4 Free Resources specifically designed to address pain points in medical practiceScripting your least favorite conversations The Driveway Debrief My 4 favorite documentation templates The quick and dirty guide to calling consultsFree Resources LinkThe Flameproof Course. Sept 10, 2024Real-time instruction with Rob Orman, MD, and Scott Weingart, MD. Specific tools and strategies for anti-burnout, career longevity, and self-mastery. From a recent Flameproof graduate, "I went from constantly dreading work and thinking of quitting to being able to enjoy shifts on a regular basis."Flameproof Course

Phantasia Kataleptike, a lesser-known gem from Stoic philosophy, offers a transformative approach to life's challenges. This practice of 'objective representation' strips away the layers of subjective judgment that often cloud our perceptions. Imagine the power of viewing a setback not as a disaster but simply as a fact of life, a moment ripe with potential for growth. How does this shift affect our inner turmoil? The Stoics had insights that might surprise you, blending ancient wisdom with actionable strategies for modern living. In this pod, we break down the essence of Phantasia Kataleptike and multiple methods for employing it as a tool for equanimity and de-catastrophization. Love medicine, but the job itself leaves a lot to be desired?I work with many docs in your shoes. To learn more about 1-on-1 coaching, start here.For full show notes of this episode and all sorts of other goodies, visit our podcast websiteThe Flameproof CourseCohorts 1 and 2 sold out. Cohort 3 begins Sept 10, 2024. This is the hidden anti-burnout curriculum we all should have learned in training. Get the deets Coming soon: Out on TimeStay out of chart debt. Document like a legend. Get home on time! We Discuss:Defining Phantasia KataptikeAcceptance of what isA dog and a cart | Epictetus' classic simileWhy the words we use impact us as much as (or more than) they impact othersThe lost shipThe A-hole in a JaguarOperationalziing Phantasia KataleptikeValence | Awareness of emotion and narrative The Dichotomy of ControlHow to Think Like a Roman EmperorActively de-catastrophizing Shifting from ‘what if' to ‘why did' to ‘so what?' to ‘what's next'The threat-challenge seesawWhat to do when the emperor banishes youThe counterarguments to Phantasia KataleptikeMentioned in this episode:4 Free Resources specifically designed to address pain points in medical practiceScripting your least favorite conversations The Driveway Debrief My 4 favorite documentation templates The quick and dirty guide to calling consultsFree Resources LinkOur Live Event. May 1-3, 2024 | Bend, ORAwake and Aware An in-person live workshop to help you put into practice the tools you hear on this show. Learn to keep cool under pressure, better manage stress, and thrive in what's an incredibly challenging line of work. CME? Yes! This is a CME event. Unplug, slow down, and dig in.Awake and Aware

Have you ever found yourself deep in “The Pit” where the mere thought of going back to work triggers an existential crisis? You wonder if your current job is the right choice. Sometimes, all it takes are a few adjustments to the current job and you'll feel fully refreshed and stoked to tackle that next shift. It may also, however, be time for The Trade.In this episode, we delve into the critical juncture many professionals, particularly physicians, find themselves in when their once-aspired career paths no longer bring fulfillment. We tackle:Whether to deepen commitments to your current role or brave the uncertainty of switching careersWhat it means to tolerate another yesterdayThe silent tax paid by grinding it outThe emotional and practical implications of making significant life changesHow a well-cultivated professional identity can become an albatrossA step-by-step guide on how to transition towards a more satisfying careerSo, whether you're a physician on the brink, a professional in a pickle, or just someone who enjoys a good existential quandary with their morning coffee, tune in. Let's laugh in the face of the status quo and ponder if the grass is greener, or if it's just astroturf.Guest bio: Lon Stroschein is the purveyor of the Normal 40 podcast and author of The Trade. In past career interactions, he was an aide to a US senator and brokered billion-dollar deals in the aerospace industry. He now guides professionals in finding their second-half stories. The Flameproof CourseCohorts 1 and 2 sold out. Cohort 3 begins Sept 10, 2024. This is the hidden anti-burnout curriculum we all should have learned in training. Get the deets Coming soon: Out on TimeStay out of chart debt. Document like a legend. Get home on time! Love medicine, but the job itself leaves a lot to be desired?I work with many docs in your shoes. To learn more about 1-on-1 coaching, start here.4 free resources specifically designed to address pain points in emergency medicine practiceThe Driveway DebriefScripting your least favorite conversationsThe quick and dirty guide to calling consultsMy 4 favorite documentation templateFor full show notes of this episode and all sorts of other goodies, visit our podcast websiteWe Discuss: Do I double down on what I'm doing right now or consider making a career change?Tolerating another yesterdayThe Pit: A Signal for ChangeRecognizing and Overcoming the Tax of DiscontentWorking yourself into The Box | We strive for years to get into it, but then it can feel like a trap. The two things that keep...

The interplay between the Default Mode Network (DMN) and the Task Positive Network (TPN) is crucial for our cognitive and emotional health. The DMN, active during restful states and wandering mind, facilitates introspection, memory recall, and creativity, serving as a foundational element in our mental processes. On the other hand, the TPN takes charge during focused, goal-oriented tasks, enabling attention, decision-making, and problem-solving. They operate in balance - when one is active, the other quiescent and this dynamic is essential for optimal mental functioning.However, imbalances in these networks can lead to mental health challenges. For instance, excessive DMN activity is linked to conditions like depression and anxiety, where rumination and negative self-referential thoughts prevail. In contrast, overreliance on the TPN without adequate rest can lead to burnout and stress.Mindfulness meditation offers a practical approach to equilibrating the DMN and TPN, promoting mental well-being by fostering a state of alert relaxation and enhancing self-awareness. Moreover, incorporating regular breaks into the workday, particularly those that allow for mental disengagement from task-focused activities, is vital for sustaining cognitive performance and preventing decision fatigue. Engaging in activities that stimulate the DMN, such as spending time in nature or practicing mindfulness, during these breaks can further enhance cognitive restoration and emotional balance.Awake and Aware | Our 2024 Live EventJoin us at Awake and Aware 2024, a transformative 3-day workshop from May 1st to 3rd in Bend, Oregon. Focusing on interactive experiences, this event offers a unique opportunity to reset, reflect, and connect with like-minded individuals. Limited slots.Website: Awakeandawarebend.comCME? Yes! This is a CME eventLove medicine, but the job itself leaves a lot to be desired?I work with many docs in your shoes. To learn more about 1-on-1 coaching, start here.4 free resources specifically designed to address pain points in emergency medicine practiceThe Driveway DebriefScripting your least favorite conversationsThe quick and dirty guide to calling consultsMy 4 favorite documentation templateFor full show notes of this episode and all sorts of other goodies, visit our podcast websiteWe DiscussWhat is the Default Mode Network?What is the Task Positive Network?Interplay of the TPN and DMNDefault Mode Network out of Balance | Mental IllnessThe Neurophysiology Behind How Taking a Small Step of Action Can Decrease Rumination and AnxietyThe Default Mode Network and InsomniaWhat Happens with the DMN in Meditation?The Task Positive Network's Role in MeditationWhy Your Task Positive Network is Begging You to Take a Break in the WorkdayHow to Take a Break That Effectively Recharges Your Task Positive NetworkMentioned in this episode:Our Live Event. May 1-3, 2024 | Bend, ORAwake and Aware An in-person live workshop...

Moral injury, a term initially used in the military context during the Vietnam War to describe the psychological trauma soldiers experienced, has become increasingly relevant in medicine. In this episode, we discuss how moral injury manifests as psychological distress when healthcare professionals' actions, or inactions, contradict their moral or ethical codes, leading to feelings of guilt, inadequacy, and a sense of betrayal.Our conversation will navigate through the history of this term, its definition, relationship with burnout, PTSD, and moral distress. We'll examine real-life scenarios where healthcare workers face moral dilemmas, feeling trapped in a system that often works contrary to their values. Moreover, we'll explore individual and systemic actions that may help mitigate the impact of moral injury.Guest Bio: Kim Baumbach, MD is an Assistant Professor of Emergency Medicine at The Ohio State University and Assistant Director of the Kiehl Resident Wellness Endowment Awake and Aware | Our 2024 Live EventJoin us at Awake and Aware 2024, a transformative 3-day workshop from May 1st to 3rd in Bend, Oregon. Focusing on interactive experiences, this event offers a unique opportunity to reset, reflect, and connect with like-minded individuals. Limited slots.Website: Awakeandawarebend.comEarly bird discount code: FULLYAWAKE24. $100 off registration. Expires Jan 31, 2024CME? Yes! This is a CME eventººººººººººººººººººººººººººººººººººLove medicine, but the job itself leaves a lot to be desired?I work with many docs in your shoes. To learn more about 1-on-1 coaching, start here.4 free resources specifically designed to address pain points in emergency medicine practiceThe Driveway DebriefScripting your least favorite conversationsThe quick and dirty guide to calling consultsMy 4 favorite documentation templateFor full show notes of this episode and all sorts of other goodies, visit our podcast website

There's no getting around the surges and potential chaos of an emergency department. The good news is that these events are predictable, you know they're going to happen, just not when. So how do you prepare and then navigate the storm once you're in the thick of it?In today's episode, we start with a discussion with Thom Mayer, MD exploring strategies to steel yourself for the inevitable chaos, underscoring the importance of maintaining a positive, agentic, proactive mindset. Drawing parallels to General Theodore Roosevelt Jr.'s decisive leadership on D-Day, the discussion highlights the critical need for quick, confident decision-making. A key focus is on the concept of "energy packets," a methodical approach to managing the cognitive overload in the ED by strategically allocating mental resources to specific tasks. We also delve into understanding individual stress thresholds and how to manage stress without succumbing to a sense of helplessness. In the second half of the episode, Chris Hicks, MD gives his approach to managing high patient volumes, communication while managing critical patients, and how to address a direct challenge in the resus bay. Guest Bios:Chris Hicks, MDChris is an emergency physician and trauma team leader at St. Michael's Hospital in Toronto. He has innovated in several areas of resuscitation and psychological skills, including mental practice, stress inoculation training. These days he enjoys a quieter life, free from the problematic corporate jib-jab of academic deliverables. In 2018, as a partial rebuke of the status quo, Chris co-created and chaired resusTO, an inter-professional simulation-based resuscitation conference in Toronto with international acclaim. In 2020, he co-founded Advanced Performance Healthcare Design, consulting with hospitals and industry using simulation to inform the design of systems, spaces and teams. Chris is an avid speaker and lecturer, staunch #FOAMed supporter, occasional runner and cyclist, fledgling boxer, semi-retired pianist, and proud father of three lunatic boys.Thom Mayer, MDDr. Mayer is the Medical Director for the NFL Players Association, Clinical Professor of Emergency Medicine at George Washington University and a Senior Lecturing Fellow at Duke University. Dr. Mayer was named the ACEP Outstanding Speaker of the Year in the second year the award was given and has twice been named ACEP's “Over-the-Top” award winner. On September 11, 2001 Dr. Mayer served as one of the Command Physicians at the Pentagon Rescue Operation, coordinating medical assets at the site. Dr. Mayer has served on the Department of Defense on Defense Science Board Task Forces on Bioterrorism, Homeland Security and Consequences of Weapons of Mass Destruction. Dr. Mayer also serves as a Medical Director for the Studer Group.ººººººººººººººººººººººººººººººººººAwake and Aware | Our 2024 Live EventJoin us at Awake and Aware 2024, a transformative 3-day workshop from May 1st to 3rd in Bend, Oregon. Focusing on interactive experiences, this event offers a unique opportunity to reset, reflect, and connect with like-minded individuals. Limited slots.Website: Awakeandawarebend.comEarly bird discount code: FULLYAWAKE24. $100 off registration. Expires Jan 31, 2024CME? Yes! This is a CME event ººººººººººººººººººººººººººººººººººLove medicine, but the job itself leaves a lot to be desired?I work with many docs in your shoes. To learn more about 1-on-1 coaching, start here.4 free resources specifically

We all have an internal drive that propels us forward, inspiring us to achieve and create. Yet, there's also an innate anti-drive, a subtle yet powerful force that holds us back. This episode delves deeply into the nature of this anti-drive. We explore the foundations of resistance, drawing insights from Stephen Pressfield's 'The War of Art' and linking it to entropy and the Second Law of Thermodynamics. We'll examine why resistance occurs, how it manifests in both our personal and professional lives, and the various ways it can be hidden, even under the guise of positivity. We'll discuss practical strategies to overcome this resistance, ranging from the psychological tools developed by Phil Stutz to Stephen Pressfield's adopting a professional mindset.   Awake and Aware | Our 2024 Live Event Join us at Awake and Aware 2024, a transformative 3-day workshop from May 1st to 3rd in Bend, Oregon. Focusing on interactive experiences, this event offers a unique opportunity to reset, reflect, and connect with like-minded individuals. Limited slots.  Website: Awakeandawarebend.com Early bird discount code: FULLYAWAKE24. $100 off registration. Expires Jan 31, 2024 CME: Yes! This is a CME event. The Flameproof Course | Self mastery and anti-burnout This course will make you so burnout-resistant that when they tell you to see 5 patients an hour with only a rusty spoon in your pocket and a unit clerk at your side, you will just smile (results not guaranteed). The next cohort begins Feb 1, 2024. Learn more here.   Love medicine, but the job itself leaves a lot to be desired? I work with many docs in your shoes. To learn more about 1-on-1 coaching, start here.   3 free resources specifically designed to address pain points in emergency medicine practice Scripting your least favorite conversations The quick and dirty guide to calling consults My 4 favorite documentation templates   We Discuss: What is Resistance? The link between resistance and entropy  Resistance is always on patrol and ready to thwart creativity Where does resistance come from, and how does it work? The pain of leaving the comfort zone Resistance can be hidden in positivity action How to overcome resistance. Strategy 1 – Phil Stutz's The Tools Even the best feel fear, it can almost never be overcome  How to overcome resistance. Strategy 2 – Going Pro Why being process vs goal-oriented is a key to overcoming resistance but nearly impossible to execute fully  How criticism can be a manifestation of resistance Overcoming resistance in documentation habits Making your bed and small acts that squeeze resistance out of the picture

When a critical patient lands on your department's doorstep without prior notice, even the most seasoned professionals can find themselves momentarily at a loss — wondering what steps to take first and how to prioritize actions in those crucial initial seconds. What do I do first, what do I do next? What's REALLY important in the first few seconds? In this episode, emergency intensivist and physician coach Scott Weingart breaks down how to get your mind unstuck and move into action.    Guest Bio: Scott Weingart, MD is a physician coach and emergency department intensivist from New York. He did fellowships in Trauma, Surgical Critical Care, and ECMO. He is best known for talking about Resuscitation and Critical Care on the EMCRIT podcast , which has been downloaded > 40 million times.   Our 2024 Live Event Join us at Awake and Aware 2024, a transformative 3-day workshop from May 1st to 3rd in Bend, Oregon. Focusing on interactive experiences, this event offers a unique opportunity to reset, reflect, and connect with like-minded individuals. Limited slots.  Website: Awakeandawarebend.com Early bird discount code: FULLYAWAKE24. $100 off registration. Expires Jan 31, 2024 CME: Yes! This is a CME event.   REGISTRATION FOR THE FLAMEPROOF COURSE IS NOW OPEN This course will make you so burnout-resistant that when they tell you to see 5 patients an hour with only a rusty spoon in your pocket and a unit clerk at your side, you will just smile (results not guaranteed). The next cohort begins Feb 1, 2024. Learn more here.   Love medicine, but the job itself leaves a lot to be desired? I work with many docs in your shoes. To learn more about 1 on 1 coaching, start here   3 free resources specifically designed to address pain points in emergency medicine practice Scripting your least favorite conversations The quick and dirty guide to calling consults My 4 favorite documentation templates   We Discuss:  Temporizing vs. Stabilizing: Why Seconds Count but Don't Really Count The Emergency Action Drill Get Off the Spot: Taking Action to Get Out of the White Noise Beat The Stress Fool: Breathe, Self Talk, See (Mental Rehearsal), Focus with a Trigger Word Using Operant Conditioning to Train a De-escalating Trigger Word You Don't Need to Be Everything, Everywhere, All at Once: The Critical Steps to Start Unfreezing The transition from temporizing to definitive care in a trauma arrest Why ACLS Fails as an Emergency Action Drill: Strategy vs Logistics The Reason Why Cognitive Freeze Happens in a Zero Warning Critical Situation How to Craft Your Own Emergency Action Drills: The Difference Between Thinky Time and Pure Action Building an Emergency Action Drill from the Ground Up for a New Disease A Hospital's Resuscitation Readiness Contributes to an Individual Clinician Freezing in a Zero Warning Situation Making an Emergency Department Resuscitation Ready on an Individual Level Emergency Department Resuscitation Readiness on a Systems Level: The Four Steps to Become a Resus World Champion Potential Objections to Becoming Resuscitation Ready How to Communicate Uncertainty in a Critical Situation

The specter of medical malpractice lawsuits looms large for many clinicians, but according to Mark Brown, MD, JD, this anxiety may be disproportionate to the actual risk. In this discussion, we explore the contrasting nature of law and medicine, the unpredictable and capricious nature of legal proceedings, the systemic elements that fuel the high number of medical malpractice lawsuits in the United States, and several practices to reduce the risk of lawsuits.   Our 2024 Live Event Join us at Awake and Aware 2024, a transformative 3-day workshop from May 1st to 3rd in Bend, Oregon. Focusing on interactive experiences, this event offers a unique opportunity to reset, reflect, and connect with like-minded individuals. Limited slots.  Website: Awakeandawarebend.com Early bird discount code: FULLYAWAKE24 $100 off registration. Expires Jan 31, 2024 CME: Yes! This is a CME event.   The FlameProof Course: Next cohort begins Feb 1, 2024 This course will make you so burnout resistant that they can tell you to 5 patients an hour with only a rusty spoon in your pocket and a unit clerk at your side. And you will just smile (results not guaranteed). Learn more here.   Love medicine, but the job itself leaves a lot to be desired? I work with many docs in your shoes. To learn more about 1 on 1 coaching, start here   3 free resources specifically designed to address pain points in emergency medicine practice Scripting your least favorite conversations The quick and dirty guide to calling consults My 4 favorite documentation templates   Guest Bio: Mark W. Brown, M.D., J.D., holds a JD from Harvard Law School (1970), and an MD from Dartmouth Medical School (1982). His career includes roles in the Los Angeles District Attorney's Office, criminal defense practice, and teaching law at Southwestern School of Law. In medicine, he completed his internship and residency in Emergency Medicine at Presbyterian Hospital, San Francisco, and UCLA and is currently an emergency physician at Antelope Valley Medical Center and clinical faculty member at UCLA School of Medicine.    We Discuss:  The Fundamental Difference Between Law and Medicine Should you be worried about the National Practitioner Data Bank? Can Getting Sued Lead to Getting Sanctioned by the Medical Board? The Odds of Getting Sued Three Reasons Why The US Has So Many Malpractice Suits Should You Push For Settling a Lawsuit? The Plaintiff's Attorney Is Not Your Friend, Even If They Act Like It When the Doctor's Med Mal Fear Supersedes the Patient's Risk Tolerance What's Really Happening in a Deposition High Yield and Low-Cost Ways to Reduce Med Mal Risk and Anxiety There's a Big Ticket Item That Your Documentation Doesn't Capture What to do About Hindsight Bias

Just as none of us are born with the skills to build and sustain a campfire, neither do we have the innate knowledge to foster healthy relationships. These things are learned. In this episode, our guest is Ryan Cheney, an experienced psychotherapist and behavioral leadership coach, guiding us through the intricacies of healthy and unhealthy relationship dynamics. Our conversation will explore the importance of interdependence, the negative impacts of codependency, and the nuanced practice of attunement, including how to rectify misattunements. Further, we will delve into the role of healthy boundaries in building resilience and trust, how resistance and perfectionism can hinder growth, acceptance and self-awareness, and the difference between appeasement and compromise   Our 2024 Live Event Join us at Awake and Aware 2024, a transformative 3-day workshop from May 1st to 3rd in Bend, Oregon. Focusing on interactive experiences, this event offers a unique opportunity to reset, reflect, and connect with like-minded individuals. Limited slots.  Website: Awakeandawarebend.com Early bird discount code: FULLYAWAKE24. $100 off registration. Expires Jan 31, 2024 CME: Yes! This is a CME event.   REGISTRATION FOR THE FLAMEPROOF COURSE IS NOW OPEN This course will make you so burnout resistant that they can tell you to 5 patients an hour with only a rusty spoon in your pocket and a unit clerk at your side. And you will just smile (results not guaranteed). The next cohort begins Feb 1, 2024. Learn more here.   LOVE MEDICINE, BUT THE JOB ITSELF LEAVES A LOT TO BE DESIRED? I work with many docs in your shoes. To learn more about 1 on 1 coaching, start here   3 FREE RESOURCES SPECIFICALLY DESIGNED TO ADDRESS PAIN POINTS IN EMERGENCY MEDICINE PRACTICE Scripting your least favorite conversations The quick and dirty guide to calling consults My 4 favorite documentation templates   Guest Bio: Ryan Cheney MS, LPC, is a licensed professional counselor, wellness specialist, certified behavioral leadership coach, breath work specialist, and certified XPT (extreme performance training) coach.  He received his Master of Science in clinical mental health from Oregon State University and has dedicated himself to learning how to help others through continued research, education, and practice for over 15 years. He has worked in many settings, including community mental health crisis work, clinical outpatient work within medical settings, and as a clinical supervisor for Deschutes County Behavioral Health. He works in his private practice as a clinical mental health therapist specializing in trauma work and as a performance coach, helping others gain self-mastery and thrive. Connect with Ryan Here   We Discuss: The Campfire Metaphor for Relationships Interacting with Others' Campfires The Difference Between Healthy Interdependence and Codependency The Dynamics of Healthy Relationships Identifying Healthy vs. Unhealthy Relationships Blaming Never Helps, But It Sure Happens A Lot Understanding Resistance in Personal Growth and Relationships Resistance is a Struggle Against Acceptance Confronting and Recovering from Perfectionism The Impact of Attunement on Personal and Professional Interactions The Importance of Boundaries in Healthy Relationships The Distinction Between Appeasement and Compromise For Complete Shownotes, click here  

What: Awake and Aware. Our 3-day live event When: May 1-3 2024 Where: Bend, Oregon. USA Website: Awakeandawarebend.com Early bird discount code: FULLYAWAKE24. $100 off registration. Expires Jan 31, 2024 CME: Yes! Category 1 AMA continuing medical education credit  

Burnout is not a foregone conclusion. While individual efforts play a pivotal role, continually battling systemic challenges can be exhausting. In this episode, we delve into a simple and cost-effective systemic intervention that not only mitigates burnout but also enhances job satisfaction. We then discuss how you can recognize when your colleagues might be in distress, what to do about it, what to say, what not to say, and how to break through the stigma of seeking help.    Registration for the Flameproof course is now open This course will make you so burnout resistant that they can tell you to 5 patients an hour with only a rusty spoon in your pocket and a unit clerk at your side. And you will just smile (results not guaranteed). The next cohort begins Feb 1, 2024. Learn more here.   Love medicine, but the job itself leaves a lot to be desired? I work with many docs in your shoes. To learn more about 1 on 1 coaching, start here   3 free resources specifically designed to address pain points in emergency medicine practice Scripting your least favorite conversations The quick and dirty guide to calling consults My 4 favorite documentation templates   Guest Bio:  Dr. Tricia James is an internist and the Director of Wellness at Providence Portland Medical Center. A champion of local and regional clinician wellness, she is the first author of the groundbreaking HOSP-CPR study   We Discuss A study of two hospitalist groups. One struggled. One thrived. The intervention group's mandate was threefold: Listen, identify the pain points, find agency The Role of regular debriefing, sharing experiences, and addressing uncertainty Engagement levels were high The Intervention Group continued meeting after the study, and it helped. A lot It's not just talking about medicine and logistics. There's a sense of cohesion and mutual support: Outcome of the Non-Intervention Group Challenges in wellness funding The value of funding and compensation for wellness initiatives Approach to securing grants Data and stories are great for persuasion. But it's empathy and curiosity that will win the day.  Most start by approaching administration for grants The first step when creating an in-house clinician-run program to build agency and thwart hopelessness Staffing is a significant stress for many and can seem insurmountable. What can you as an individual do about it? Emotional suppression in healthcare professionals  Our tendency to conceal weakness How to identify when one of your colleagues is in distress Approaching a distressed colleague What to do if you ask a distressed colleague how they're doing and they repeatedly say, "I'm fine," but it's clear they are not It's not our job to fix our colleagues that we're worried about. But we can step in and offer an invitation. The hardest part about reaching out to offer support is trying not to fix it Importance of asking hard questions The internal and external barriers to seeking help when we're struggling | Tricia paid for counseling out of pocket, so no one would know about it Dr. James' vision for medicine  

What's the impact of private equity's increasingly large footprint in medicine? The results so far have not been promising.  We dissect: what is private equity, the recent bankruptcy of the largest emergency medicine staffer in the US and how that impacts clinicians, can corporations practice medicine,  the American Academy of Emergency Medicine has jumped into the fray, does profit-driven medicine ever serve patient care, HCA has been accused of naughty deeds, performance metrics versus the one metric that really matters, the No Surprises Act, and  physician unions. 3 free resources specifically designed to address pain points in emergency medicine practice Scripting your least favorite conversations The quick and dirty guide to calling consults My 4 favorite documentation templates Registration for the Flameproof course is now open The next cohort begins Feb 1, 2024. Learn more here. Love medicine but the job itself leaves a lot to be desired? I work with many docs in your shoes. To learn more about 1 on 1 coaching, start here   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. As medical director at Tennova Healthcare Clarksville and Johnston Health UNC (large rural EDs in Tennessee and North Carolina), Leon led emergency department teams to exceptional patient-centered outcomes. Leon is a graduate of Brown University, the University of North Carolina School of Medicine, the Harvard-Affiliated Emergency Medicine Residency at Beth Israel Deaconess Medical Center, and the University of Tennessee Haslam College of Business. Leon is married to an emergency nurse and has two adorable dogs.   We Discuss:  What does 'venture capital/private equity' in medicine really mean? The largest emergency medicine staffer in the US, Envision, recently went bankrupt. What happens with all of those clinicians and hospitals when the staffing company implodes? A corporation cannot practice medicine in most states in the US (but can in some!). The American Academy of Emergency Medicine is suing Envision and their corporate entity for the illegal corporate practice of medicine Is there a functional difference between the old-school CMG (contract management groups) and modern-day private equity-owning medical groups? Does profit-driven medicine ever serve patient care? HCA has been accused of funneling patients into end-of-life care to improve hospital mortality metrics.  Has private equity made universal healthcare impossible in the US? The group you want to work for sees physicians as the business rather than an expense to minimize Quality of shift is a metric you rarely see on your monthly performance stats, but it should be at the top of the list Would you ever wash your rental car? The downstream of not having ownership in a group The No Surprises Act was set up to protect patients. It's kind of a mess.  Physician unions. Can doctors go on strike? Leon's guess outlook for the emergency medicine job market in the coming years  

In this real-life coaching session, we walk Dr. Brit Long through building a framework to help navigate being overwhelmed during the middle part of an emergency department shift. Since this session, he has become more efficient, gotten home earlier on a consistent basis, lowered his stress level, felt less burnout, and experienced more joy in his career.  Stay Connected Sign up for our newsletter here. Never spammy, always fresh. Our best stuff delivered to your inbox.  Elevate Your Career To learn more about 1 on 1 coaching, start here Registration for The Flameproof Course is Now Open The second cohort begins Feb 1, 2024. Learn more here.  Guest Bio Brit Long is an assistant professor of emergency medicine in San Antonio, Texa, and Editor-in-Chief of Clinical Content at emcdocs.net. He is one of the most published authors in the field of emergency medicine. In addition to that, he is a father of two and works in both academic and community settings. We Discuss:  The fundamental differences between the beginning, midpoint, and end of the shift Why mid-shift is so fraught What we usually do when feeling overwhelmed Why willpower will almost always fail as a sole strategy for keeping up with documentation The specific steps for navigating mid-shift overwhelm Early detection of overwhelm A mid-shift action plan How to keep up with documentation The real reason timely documentation is important Breaking through your comfort zone Brit's plan for triaging tasks  Why deferring charts is so seductive and a slippery slope  

We wear many hats in life, and one of them can become disproportionately large: our professional identity. Don't get me wrong, being a physician is amazing and the associated identity is imbued with meaning and purpose. The challenge comes when identity becomes calcified and too narrowly defined. When that happens, it can limit us.  In this episode, we delve into the diverse and often unforeseen roles of a physician, the constraints placed on one's identity due to deeply entrenched beliefs about our own capacities, strategies to overcome limiting beliefs,  how the term "just" can undermine one's potential, the significance of embracing alternate identities, and the common thread between Ted Lasso and Deion Sanders.  Stay Connected Sign up for our newsletter here Read our last newsletter “The Kids Who Hated Math Have Something to Teach Us” here Elevate Your Career To learn more about 1 on 1 coaching, start here Guest Bio: Pranay Parikh is a principal of Ascent Equity Group, a real estate, private equity company, predominantly for physicians with over 310 million in assets. Pranay is also the purveyor of the Passive Real Estate Income Academy course, which teaches doctors to be able to find vet and invest in real estate syndications; part of the Passive Income MD podcast, and most recently The Effective Living Formula Course - doing more of what matters. (here's his free webinar) On the side, he is a hospitalist, nocturnist, husband, and father of two young sons. We Discuss: You are more than ‘just' a doctor Pranay's system for how he approaches life An over-the-top identity exercise What assumptions do you make about yourself? Unpacking the word 'Just'  Exercises to Overcome ‘Just'  The Power of Alter Egos Belief impacts outcome  

It's tempting to think of accepting the reality of the moment as acquiescence or giving up, but the opposite is true. Awareness and acceptance of what's going on inside of you and around you is a recipe for equanimity. With this equanimity, you are able to operate at a higher level as well as be an effective agent for change in the system. Sounds like a paradox! In this episode, we look at mindfulness as a tool for addressing and mitigating burnout, fostering self-compassion, promoting a sense of well-being, squashing imposter syndrome, restoring autonomy, working through our ‘specialness', getting out of a scarcity mindset, doubting self-doubt, and getting charts done so you can get home on time (yes, it's true!)  For complete show notes, click here.    Stay Connected Sign up for our newsletter here Read our last newsletter “The Kids Who Hated Math Have Something to Teach Us” here Elevate Your Career To learn more about 1 on 1 coaching, start here   Guest Bio Gail Gazelle, MD, MCC is an assistant professor at Harvard Medical School and Master Certified Coach for physicians. She is the author of Everyday Resilience. A Practical Guide to Build Inner Strength and Weather Life's Challenges, and most recently Mindful MD. 6 Ways Mindfulness Restores Your Autonomy and Cures Healthcare Burnout. To hear more of Gail, she's the featured guest on Stimulus Episode 27.    We Discuss What the heck is mindfulness anyway? The thinking mind can be overwhelming. Mindfulness training helps us gain autonomy. Apps and other methods to assist with meditation and mindfulness. Mindfulness helps in gaining awareness and insight into one's inner dialogue. Recognizing that we are not our thoughts helps restore autonomy and cure burnout. Imposter beliefs contribute to burnout and prevent recognition of our own accomplishments. Steps that can be taken to challenge and overcome imposter beliefs. Combatting the "special syndrome" experienced by many physicians? The role self-compassion plays in reducing burnout and improving motivation. Shifting from inner criticism to inner ally. How does the focus on comparison affect healthcare professionals' well-being? Practicing gratitude and abundance mindset shifts physiology and wellbeing Emotional reactivity and resistance to accepting reality impact healthcare providers. Mindfulness helps healthcare providers appreciate the present and avoid a "milestone mindset" There's often confusion between acceptance of the moment and acquiescence to an external issue that you want to change  

Investigative journalist Scott Carney is our guest as we dive into: Why you might want to consider getting in cold water, the technique for staying in cold water for more than a few seconds, how to take your first step into the freeze, brown fat, the power of lightly held beliefs, how people are dying with the Wim Hof method, and the law of speedy gains.    Shield yourself from bullsh*t Want to re-spark the joy in your practice, get home on time, unstick what's feeling stuck, or even just build a shied for all the BS you face in a workday? Start here to learn more about 1 on 1 coaching. You'll be glad you did.   Guest Bio: Scott Carney is an anthropologist, investigative journalist, author, and a seeker of both the fringes of human experience and the core of what makes us human. Scott has written four books to date, including The Vortex, The Enlightenment Trap, The Red Market,  What Doesn't Kill Us, and The Wedge, and produced the recent film The Rise and Fall of the Wim Hof Empire. Scott's work has been featured in many magazines — Wired, Mother Jones, Playboy, Foreign Policy, Men's Journal, and National Public Radio. He has won the Payne Award for Ethics in Journalism and is a multi-finalist for the Livingston Award for International Journalism. You can find all his goodies on his website.   Check out our new (free!) Mini Book Scripting Your Least Favorite Conversations   We Discuss:  The mindset method for staying in cold water Detailed steps for entering cold water The benefit of breaking through walls and physiologic control using ice water exposure The power of lightly held beliefs Cold exposure as a lightly-held belief People are dying using the Wim Hof method The Bitcoin Enema Does Brown Fat matter? The law of speedy gains  

The Drama Triangle identifies our roles in dysfunctional interpersonal dynamics. It can be a potent tool for understanding conflict and miscommunication within personal and professional relationships. In this episode, we break down the core components of the Drama Triangle, strategies to disentangle ourselves from ‘drama', and explore practical tools to identify and navigate the dynamics of our own interactions. Check out our new (free!) Mini Book on Scripting Your Least Favorite Conversations   Kickassery Want to re-spark the joy in your practice, get home on time, or just unstick what's feeling stuck? Start here to learn more about 1 on 1 coaching. You'll be glad you did.   In this podcast, we discuss: What is the Drama Triangle? The Empowerment Dynamic Recalibrating from drama to neutrality

How do you make important decisions? Do you go by your gut, some sort of defined process, or perhaps a combination of the two? When we're offered an opportunity to participate in something that seems amazing, it's almost always associated with a cost. That cost is time. Every ‘yes' is accompanied by even more ‘no's'. In today's episode, we take a look inside a real coaching session that addresses just this scenario. Our client is a physician who wants to develop a decision-making process so that he can derive meaning from his professional life and not take on projects or jobs that on the surface sound intriguing but may end up draining rather than fueling him.  Client Bio: Josh Russell MD is the editor-in-chief of the Journal of Urgent Care Medicine and is double board certified in Palliative Care and Emergency Medicine. Apart from his clinical practice, he is a writer, educator, entrepreneur, and trivia enthusiast.   For full show notes visit our podcast page Interested in one-on-one coaching? Learn more at roborman.com Subscribe to our kickass newsletter here