Podcast Episode 12 | Behind Physician Burnout

With Dike Drummond, MD

About the Prosperous Doc® Podcast

The Prosperous Doc® podcast by Spaugh Dameron Tenny highlights real-life stories from doctors and dentist to encourage and inspire listeners through discussions of professional successes and failures in addition to personal stories and financial wellness advice.

Shane Tenny, CFP® is our podcast host and Partner at SDT. He has lectured numerous times for hospitals and physician groups and, most importantly, helped hundreds of clients develop strategies to navigate through turbulent times toward their financial goals.

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Intro: 00:02 From Spaugh Dameron Tenny, it's White Coat Wellness, a show for doctors who are ready to improve their financial wellness. We know you work hard to help your patients, but you can't be at your best if you don't have your own finances in order. In White Coat Wellness, we highlight real life stories from physicians and dentists to educate, encourage and inspire you to personal and professional and financial wellness. Now from Spaugh Dameron Tenny, please welcome your host, Shane Tenny.

Shane Tenny: 00:31 Welcome back to another episode of White Coat Wellness. I'm Shane and glad to have you with us. Whether you're working out or driving down the street, or just inviting us into your day, we appreciate you being here. If you're a new listener, definitely invite you to subscribe. That way you'll be on the cutting edge of the new episodes we release about every two weeks or so where we're telling real life stories of your colleagues around the country pursuing professional, relational, financial wellness in their lives.

Shane Tenny: 01:01 And on that topic, physician burnout is definitely one that has been a headline nearly every day and it's been frequently mentioned by guests on this program. And today we're going to just dive right into the issue with the physician burnout prevention trailblazer, Dr. Dike Drummond. He's a Mayo-trained family doctor, professional coach, a trainer whose sole focus for the last eight or nine years has been addressing the modern burnout epidemic among physicians. Dr. Drummond is the CEO and founder of the HappyMD.com, an organization focused on tackling physician burnout head on. The HappyMD.com receives over 25,000 website visitors a month. They host an online community of over 18,000 docs from 60-something countries around the world, I think. And he's coached over 30,000 physicians from hundreds of organizations. Dike, it is great to have you on our White Coat Wellness show today. Thanks for being here.

Dike Drummond: 02:04 Right on. Great to be here, Shane. Thanks for inviting me. I appreciate it.

Shane Tenny: 02:06 Absolutely. Well, I know you've got a lot of information to share and a lot of passion around this topic, can you just start by giving us a little bit of your background? How did you get drawn into medicine? What were those early years like for you?

Dike Drummond: 02:21 My story is a little bit different. Everybody's got a different story, but mine is multigenerational, so for me my grandmother, my mom's mom, in the 1930s went to the University of Illinois and wanted to be a doctor. She would have been one of the first female doctors around if she had accomplished that feat, but she came back as a teacher, which was a common diversion for somebody wanting to be a helper. My mom, when she went to the University of Illinois in the '50s wanted to be a doctor, came back a teacher. And here I was, three generations in, the firstborn male grandchild. And so, from the time I was born, I was going to be that doctor, but in my family it wasn't something they were verbal about. They didn't say, "Dike, you were always going to be a doctor." I thought I had an interesting idea as a senior in college and said, "Hmm. This biology honors degree is perfect for premed. I'll apply to some schools and see if I get in."

Dike Drummond: 03:13 And I got into Mayo and graduated in 1984. And went on to be a full family service doc in a little town called Mount Vernon, which is halfway between Seattle and Vancouver, BC on Interstate 5. If you've ever been to or heard of the American San Juan Islands is where you get off to go to that [inaudible 00:03:30] terminal. So, there I was a full service family doctor for 10 years and I loved it. I feel like being a family doctor is half detective, figuring it out, half teacher, teaching the person how to take care of themselves. Always felt like my three office doors in the back corner of our little wing were like Forrest Gump's box of chocolates. You just never know what's in there. I was a physician leader in our 40-doctor multispecialty group, chairman of the executive committee that kind of stuff. And a full-service family doc, so I can hire as producer. Loved it, loved it, loved it.

Dike Drummond: 04:03 Until I didn't. And for me - I've never heard anybody tell this particular story, again, everybody is different - for me it was a very powerful physical sensation that started when I was 40 in 1999. Over about three weeks, when I'm right in the office, it felt like somebody has put me in a choke hold. And in the UFC, they call this a rear naked choke. They get on your back, put their elbow around your neck, choke you out. I didn't know what it was. I thought my battery's are run down. By the way, that's one of the misperceptions of burnout. We can talk about later if you like.

Dike Drummond: 04:37 I took a 30-day sabbatical. Shaved my head, did a bunch of yoga, didn't do any health related stuff, hoping that I would be better when I came back and I wasn't. It was the very same morning that I started seeing patients again that feeling returned, so what I did, and I don't recommend this as a transition strategy, is I walked into the CEO's office at lunchtime that day and I signed my resignation. I walked away from my medical career.

Dike Drummond: 05:03 Again, that's not a great transition strategy, but it's a common sentiment if you're really burned out. Fight or flight, get out of there. Preserve yourself. So, if anybody on this podcast, listening to this podcast, is feeling that way, like you have to quit and you're considering walking away from your medical career, I don't recommend that you do that. What we've developed is a coaching capacity where we can, in a free phone call, talk to you about what options are there and show you some other ways forward because me walking away like that set me up for about a decade's worth of struggle. I put food on the table as a walk-in clinic doc and ultimately my now ex-wife and I, - and I can complete that circle for you in a second - my now ex-wife and I actually started a training company where we faculty to the US Navy's Lean Six Sigma Black Belt certification program. And Lean and Six Sigma are things that are used in healthcare for process improvement.

Dike Drummond: 06:01 In 2010, that business and that marriage went away. I was burned to the ground for a second time. And I had been a coach for about a decade. I got certified as a coach right after I quit practicing medicine. So, I opened a little website that was supposed to be just for me to build a coaching company and I called it The Happy MD and it's supposed to be an oxymoron. It has a little smiley face yellow ball in a field of blue frowny balls. That's my logo across the top of the page.

Dike Drummond: 06:34 But 2010 is a restarter and that's an auspicious date because that's when EMR started to really kick in and overload the doctor's burnout started, [inaudible 00:06:42] a lot of interest happened around burnout. So, we've been riding a little bit of a wave. At this point, 10 years later, I've got about 3,000 hours of one-on-one coaching experience. We've recruited six other physician coaches into our coaching pool to handle the demand. I've trained about 30 to 1,000 doctors on four continents for 175 organizations how to recognize and prevent burnout. And we've also installed wellness programs in half a dozen companies around the country.

Dike Drummond: 07:12 And so, what I've done is focused on helping people recognize and prevent burnout for the last 10 years. I've got my 10,000 hours under my belt. I'm super driven about the whole issue because fundamentally it doesn't have to be this way.

Shane Tenny: 07:29 Yeah. So, you've just laid out an enormous trailer to the conversation that we're going to be having here. And now I got to ask you to rewind because I'm struck by something that I think is a really important part of your story. I want to make sure that I'm hearing it right and make sure that our listeners are, which is you were loving your practice.

Dike Drummond: 07:52 Oh yeah.

Shane Tenny: 07:53 You were in a large group, you were in leadership position, you were loving the patients. And then, it sounds like the symptoms that you began to manifest came acutely and from nowhere. Is that accurate or were you progressively feeling overwhelmed, stressed, burned out, that sort of thing? Talk a little bit about that.

Dike Drummond: 08:12 I don't recall it being that way, but again, my history is multi-generational. I came upon medicine almost as an afterthought, as a senior in college, but it had been my grandmother and my mother's core desire. So, at the age of 40 in 1999 when this all happened, my grandmother and my mother were dead.

Dike Drummond: 08:33 And the other thing that happens, and it's one of the contributing factors to burnout in primary care doctors, is the primary care doctor often will have a connection with a passion and excitement. They'll feel most involved in their practice when they're occasionally seeing things they've never seen before. So, for us, this is cool. I've never seen this before, which in some cases because the psychology is different between a specialist and a primary care doc, primary care doc can rely on the relationship with the patient to bring them back if we don't get the diagnosis right first time. We're okay with that. We like to see new things. A specialist would like to be able to wrap their brain around a confined body of knowledge, and maybe get more routine things. They like routine rather than that excitement or new things.

Dike Drummond: 09:27 So, for a family doc typically about 10-12 years in, depending on how many patients you see a day, what will happen is the frequency of those new patients, like I said, you've never seen before, will start to drop off and you'll start to get bored with your practice. So, my Forrest Gump's box of chocolates sensation had started to taper. At the same time, my mother and my grandmother died, and it was just this perfect storm where, yeah, I really loved to be a doctor. And for whatever reason, that chapter in my life closed. And it closed. The lid cracked down on it. It didn't take hardly any time at all.

Shane Tenny: 10:07 In 1999, the topic of burnout didn't have as much global awareness as it has now. What was it like socially for you among your peers, your family, when you said ... going to the CEO's office and saying, "I can't take it. I'm out." That sounds like a big change. A big stressor.

Dike Drummond: 10:30 People thought I was crazy. I wondered I was crazy. Lunatic, right? To give your 20s up and you only practice for 10 years and now you're gone? Really? Most doctors at some point in time have to make a decision whether or not they're in this for the long run. And that decision more typically comes in your 40s and 50s. Most financial planners will say, "Hey, you're in the cat bird seed on a still what is traditionally high income. I wouldn't throw that away without some plans, some financial plans, to take care of yourself and your family and your legacy." But for me, I knew that I couldn't physically continue to do what I had been doing. It felt like an act of self-preservation.

Dike Drummond: 11:15 What's interesting is there is a common perception that doctors are leaving the profession in droves. That's absolutely not true. If you ask doctors if they'd like to find another way of making a living, a bunch of them will say yes. But they're not leaving. For most people I'm the only person that they know that actually has created a parallel career to their clinical activities down the road.

Dike Drummond: 11:40 And just to be clear, burnout was studied and known to be 1 in 3 among physicians prior to the early 2000s to 2010 or so. The thing that's driven a lot of the interest in burnout is, number one, the contribution of digital overload in the EMR to a physician's workload when the organizations they work for don't staff up for that workload. And two, all of a sudden the majority of American doctors are employees, so their employers have to worry about how to tend to a group of doctors. And doctors are not easy to tend to. It's not easy to keep them happy and productive.

Shane Tenny: 12:18 Let's elaborate on this a little bit. I've got two questions forming in my end, and maybe you just answered back a bit. One is: for all our sake, what is burnout? Can you give us a level stat there? What is burnout? And then, if you were talking to your 40-year-old self and knew then what you know now, what would you have told yourself?

Dike Drummond: 12:40 So, burnout. Classic symptoms of burnout, there are three. And they go like this. One, exhaustion. Physical and emotional exhaustion. In your head, you typically hear a voice that says something like this in English. "I'm not sure how much longer I can keep going this." Symptom number two is compassion fatigue. It's when you lose the ability to be empathetic for your patients and you finally become cynical and sarcastic. And symptom number three is what's the use? You begin to lose the connection with the purpose in what you do. And so, if somebody is feeling, "I'm exhausted, I'm not sure how much longer I can keep going like this. I'm cynical, sarcastic, and complaining about my patients. What's the use of my work? I'm really not making a difference."

Dike Drummond: 13:30 Usually their energy is in the downward spiral and you may actually have a ... This is very common fantasy. I want to put it out there because it's a big red flag for anybody who's listening here. You may actually, on the way to work, have this voice in your head go, "Maybe if I'm lucky I'll get hit by a car on the way to work, and I won't have to see patients today." Most doctors will chuckle when I tell them that, but that's a really big red flag. That your energy reserves are in such a negative state that you'd rather give a soft checkout and avoid seeing patients today rather than continuing to do what you do.

Dike Drummond: 14:09 So, that symptom complex, and you don't have to be suffering from all three. Most of the people that hire me as a coach, what they tell me is "I'm exhausted. I hate my practice, but I still love my patients." So, what they're doing is they got symptom one and symptom two, but they still see purpose in what they do. And they still can connect with the patient now and then. It gives them some juju, some good energy.

Dike Drummond: 14:37 That constellation of symptoms in a physician has been absolutely and rigorously linked to a number of terrible things; terrible things for patients and terrible things for the doctor. So, for the patient, burnout has been linked to low patient satisfaction, medical errors, malpractice suits, low care quality, staff turnover, doctor turnover. For the doctor it's linked to depression, alcohol, drugs and suicide. As a matter of fact physicians have double the rate of suicide of non-physician people. Regardless if they're men or women, their rate is double. At the point where you made the choice to become a physician, you doubled your suicide rate. So, that's burnout and that's why it's important.

Dike Drummond: 15:30 And your second question again was?

Shane Tenny: 15:31 Well, the second question you list these three.

Dike Drummond: 15:35 What would I say to myself?

Shane Tenny: 15:36 Yeah. Absolutely because your manifestation was very physical and acute. In fact, it sounds like it significantly contributed to by the external factors of your mother and your grandmother passing and those sort of things.

Dike Drummond: 15:47 Well, and again, those didn't occur ... This little game of what would you do if you could go back. Well, hang on, first of all, I'd forgive myself.

Shane Tenny: 15:57 Yeah.

Dike Drummond: 15:57 Because I didn't know then what I know now. Now, certainly from this position of 20 years later, yeah, I can go back and give a lot of advice, but I didn't have those tools back then. Burnout was not something that was acknowledged in the workplace. There wasn't any focus on it. And again, our culture as doctors, people didn't reach out to me and ask me how I was doing. They just were thanking their lucky stars it wasn't them. Pretty straightforward stuff, right?

Shane Tenny: 16:30 Yeah.

Dike Drummond: 16:31 So, knowing what I know now, I'm glad I did what I did. I got out of there. Took me 10 years to figure out, to be handed from a divine source the work that I do today took me 10 years to put myself in that place. And the struggles I've gone through since I've quit practicing medicine are all things that I use today, every single day, in the work that I do. What I do as a coach, consultant, as a helper in this particular field is often known as wound work. There's two things you can do when you've been wounded. You can be ashamed and you can hide away. Or you can say, "Look, I have survived a wound and it looks like you have the same wound. I'd love to share with you my journey so that hopefully it will help you with yours. And that's what I do."

Shane Tenny: 17:27 Yeah. Absolutely. I've got a couple more thoughts about this that I want to run by you right after this quick break.

Will Koster: 17:37 I'm Will Koster. On this episode's White Coat Wisdom, I want to introduce a few topics around paying for college. As opposed to saving for college, which typically involves ideas like 529 plans, strategies around paying for college can often be overlooked. What do I mean by strategies around paying for college? Did your student fill out the FAFSA or the Free Application for Federal Student Aid? No? Why not? Didn't think you would qualify for aid because you make too much money? Are you sure about that? Do you know what your expected family contribution is? Most families underestimate their ability to qualify for aid, especially when sending their students to elite private schools with astronomical price tags.

Will Koster: 18:21 I bring up these terms and concepts like the FAFSA and expected family contribution to point out the bigger fact that strategizing around paying for college can be just as important and consequential as saving for college. Let me leave you with a few ideas to think about.

Will Koster: 18:40 Did you know that the way that you have your assets and income structured can affect your ability to qualify for aid? Do the parents own the 529 plan or do the grandparents? It can make a big difference when qualifying for aid. How about this one? Did you know that some schools require the student to fill out the free application for Federal Student Aid or FAFSA before they're eligible for merit-based scholarships? Now that I have your attention, remember this key takeaway. Strategies around paying for college can make a big difference when extrapolated over four plus years and multiple children. Might be worth finding someone who can help.

Will Koster: 19:21 For this episode's White Coat Wisdom I'm Will Koster.

Shane Tenny: 19:26 So, Dr. Dike Drummond, thanks for your pretty vulnerable account of your own journey through burnout and what you're doing today. You were describing a few minutes ago how your work as a coach, I guess around the 2010-'11 timeframe has coalesced almost with a perfect storm through the mandatory adoption of electronic medical records and other type factors. I guess I'm curious, is physician burnout an issue that is unique within the US or is it affecting providers globally?

Dike Drummond: 20:02 It's affecting providers globally. My experience in other countries is that everybody else is having at least as much struggle as we are. And many areas are much worse because in the United States of America at least we still have a reasonable size healthcare sector to our economy. We're still 17% of the GDP. We still spend five times as much on healthcare as any other country. But if you take money out of the system and you take doctors' salaries down to that of a mid-level government employee, like in the NHS in England or if you go to South Africa, if you go to a second or third world country and imagine being a doctor, it's just awful.

Dike Drummond: 20:52 So, I always think about the healthcare issue with burnout in the United States being sort of environmental [inaudible 00:20:59] in the United States. If we can't be environmentally responsive, no one can because we don't have people burning out for us to plant sugarcane, right? So, if we can't figure out burnout here with 17% of the GDP involved in healthcare delivery, then nobody's going to be able to do that.

Dike Drummond: 21:17 I know from my experience 23 years of playing competitive rugby I know how to lead and motivate and go to battle with the team. I know that what we're looking at is just a massive failure of leadership in the healthcare niche. Didn't have to be this way. It just happens that way. It's more than EMR. It's actually like you said a perfect storm.

Dike Drummond: 21:40 For me it appears as a tidal wave of demand for what we do, but the perfect storm is one, digital overload. The workload for a physician to cope with a digital overload, which comes from multiple different folk locations. It's not just EMR. I have clients who have scribes who do all their EMR work, but it's still not enough because they've got patient portals and you got all these quality indicators you got to do. And you've got texts and you've got emails and you've got all this stuff coming at you from different directions.

Dike Drummond: 22:08 And EMR was designed by somebody who's never seen a patient. It's designed for ease of data entry. I don't know that we've seen any benefits from the big data that we're promised. But EMR and the fact that you typically don't own your practice anymore, you've got an administrative structure above you of non-physicians oftentimes that think that a spreadsheet can tell them what's going on in the frontline of healthcare. People who've never had anybody bleeding on their socks, right, or cough in their face, that kind of stuff, except their own kids. So, that's this loss of autonomy.

Dike Drummond: 22:48 And we have the acceleration of the advancement of treatment and diagnostic options. When you look at your television at night, all the different drug commercials that end in -mab. [inaudible 00:23:01] mab and all these crazy names, right? You've got Google in the pocket of every patient who comes into the office, so they're absorbing the true and false narratives about what they've got and how you treat it, right? You've got 25 different kinds of healthcare insurance that your patients use to pay for their treatment and I'm supposed to understand that stuff. By the way, go to a single payor country and just watch how they work. Go to Canada. They don't have a business office. They bill the government and they put it in their bank account a week later. Why do I need a business office? So, there's all of that.

Shane Tenny: 23:42 I want to pick up on a question. You bring up the topic of just administrative oversight. The shift within medicine from independent practices to now hospital-owned practices. Is there any data that you're aware of on the rate of burnout among private practitioners versus hospital-owned or group practices?

Dike Drummond: 24:05 Yeah. There is some data on that. I am not the person to ask the questions about it, but there was this study that I recall from a couple of years ago. The headlines off of that study in the press said that doctors were less burned out when they still owned their practice. Let me just point out, they don't teach you how to be a business owner in medical school. So, there is nothing to suggest that there is less burnout if you're also trying to run your practice.

Dike Drummond: 24:33 What I have seen is that I have seen a certain percentage of physicians in the past, these are people my age. I'm 61 at this point. These are boomer style people who did have business savvy and they were entrepreneurial and they were able to create practices that had a physician leader. But I find that those kinds of people appear to be becoming more rare.

Shane Tenny: 24:58 Yeah. I was going to say, running your own practice is its own level of stress.

Dike Drummond: 25:03 I'm talking about somebody who ... Like the practice I work for. It was four guys came back from Korea and made a group practice. 30 years later there were 40 of us. We still had physicians at the top. I find that story is not ... it was generational and it doesn't appear to be being repeated right now. So, I [crosstalk 00:25:23] the matter.

Shane Tenny: 25:24 Yeah. Now, among the causes of burnout, is it always - always is not a fair word to use. Is burnout a multi-factorial issue that needs to be thoughtfully considered or are there consistent themes or causes that you see as you've worked on the issue?

Dike Drummond: 25:45 Yes. It is always multi-factorial and there are themes. So, when I started to coach people ... After I'd worked with about 40 docs, I started to see super strong patterns in five distinct areas that I call universal causes of burnout. So, these are things that everybody has to understand and cope with. Again, you don't learn this in your education though, but it's what I teach. If outside of those five there are hundreds more things that could be your last straw, but everybody's got to cope with these five. I'm assuming you'd like me to go through them here?

Shane Tenny: 26:21 Most certainly.

Dike Drummond: 26:22 Okay. One, you chose to be a doctor. And the doctors who are listening right now, remember that point in time where you were at the fork in the road where you were trying to make a decision to go to medical school or not. You were thinking about going to medical school and all your friends were thinking about doing anything else. You're crazy going to medical school because you know it's going to be long and hard.

Dike Drummond: 26:44 And you may not realize this, but the choice to become a doctor means you chose to work with people who are sick, hurting, scared and dying, and their families members' crazed attempts to deal with that stuff for the rest of your career and that's not easy. And you're going to lose every patient you've got. You're going to kill some of them by your own hand even though you're not trying to. And you're going to be traumatized along the way. And oh by the way, you just doubled your suicide risk. So, that choice to be a helper, to be a light worker has consequences. Much of the time when you go into work, ust because of the nature of your work, you're not making widgets, selling hamburgers. My son's a digital artist. You're not making digital art. You're going to sick, hurting, scared, dying people and their crazy family members.

Dike Drummond: 27:35 That's one of the major stresses of burnout that nobody prepares you for. Talking to doctors about this is like talking to a fish about water. None of your patients want to come to see you. "Oh yes, they do. My patients love me." Your patients love you because they have a disease. If they could go back in time and not get the disease, they would gladly have never met you. They don't even want to come for a physical because you might do what. Now, you might find something. Now, do you find good things? Have you ever hold a winning lottery ticket out of a random orifice of one of your patients? Yes or no? So, that's number one.

Dike Drummond: 28:10 Second is, you spend your 20s trying to become a doctor. Now you're going to jam your practice into a job. It doesn't matter what job you take. You could be employed by a large group. You could have a solo practice that's concierge and takes cash. But jamming your practice of seeing people are sick, hurting, scared and dying into any job situation adds layers of stress to your day, like, the EMR, your call rotation, your compensation formula, your relationship with your boss. So, jobs always add stress.

Dike Drummond: 28:44 The third I've seen over and over and over again is poor leadership causes burnout. There's a phrase in industries outside of healthcare that says people don't quit the company, they quit their boss. So, we've actually have research data that shows that your relationship with your boss, if you have one, is a primary determinant of turnover and burnout. And so, one of the things I teach is how doctors can manage their boss because you didn't graduate from medical school to be stuffed in the middle of a bureaucracy with a whole bunch of layers above you. So, that's a skillset that's important to learn.

Dike Drummond: 29:17 The fourth cause is life because we all have a life. It would be nice to say, "Hey, after I go home from work, I can recharge every night because my life is just awesome" but everybody's also got a life. And so, just talk about kids for a second. Things change when you have your first kid or your eighth kid or you're an empty nester or what if you have a special needs kid or twins or triplets or twins and driver's ed? This is where money comes in. Money is a part of your larger life. If you're worried about money, you could be stressed that tips you over into burnout.

Dike Drummond: 29:51 By the way, my simple advice is I'm going to say two words. Those two words are net worth. And if you're listening to this and you're saying, "What's that?" Then you need to see a financial planner. Get a plan. Get a retirement trajectory because I work with a lot of doctors who are afraid of money because they've never sat down and looked at what's in all the buckets. When they do that, they typically feel better.

Dike Drummond: 30:17 So, the first four: the decision to be a doctor, your job, leadership, life. And the last one is the conditioning of our medical education system. We were selected - we selected ourselves to be doctors because we had certain personality traits that were different than our colleagues in high school. It's why we chose to go to medical school and they decided to do anything else. Then those character traits, I'll list them, are: superhero, lone ranger, workaholic, perfectionist. We have those traits and we use them to get the grades, to give us confidence to go to medical school. But as a doctor you're going to use those things every day for the rest of your life. And we tend to become superhero, lone ranger, workaholic, perfectionist. That has consequences. Workaholic only has one coping mechanism. What is it?

Shane Tenny: 31:09 Work.

Dike Drummond: 31:10 Work harder. Workaholics are typically not creative. We typically double down on the same thing, which is another way of saying do the same thing over and over again and hope for a different result, which is Einstein's insanity trap. Are you with me? So, doctors naturally and automatically when they fall into burnout double down and exhaust themselves. And we also learned that there is two prime directives, they're part of this programming.

Dike Drummond: 31:40 The patient comes first. Everybody acknowledges that. And I just always start my trainings by saying can the patient come first 24/7, 365 and you have any hope of being a normal human being? To which the whole audience says, "No!" And then, I ask, "Have you taken some off switch lessons on that so that you can turn that switch off when you get home?" And they say no. So, that's one of the big things we teach.

Dike Drummond: 32:05 And then, the second of the prime directives of healthcare is never show weakness. So, needing some time, needing to rest, needing to ask for a break, doctors will not do that because they're afraid it will be perceived as a sign of weakness. So, all of that, workaholic, superhero, lone ranger, perfectionist, patient comes first, never show weakness is our programming. And it is a proximate cause of burnout.

Dike Drummond: 32:37 And residency is not a place where you're going to take care of yourself. It's something you survive.

Shane Tenny: 32:42 Yeah. How are you and your fellow coaches of the Happy MD, how are you addressing this? What's the approach, what's the antidote that you are advocating?

Dike Drummond: 32:52 All of our coaches at Happy MD are physicians. Together we have a 173 years of cumulative practice experience. We're also certified by the ICSF executive coaches and we've also been handpicked and trained in these techniques by me, but the key is always this. When we meet someone, they're not doing well. A doctor asking for help from a coach by the way is a very extreme circumstance for them. It's not common for a doctor to ask for help because you would have to violate all of your programming of your medical education.

Dike Drummond: 33:27 Although, world class athletes have coaches all the time, so there is a difference in attitude, right? But when we meet people, they want to tell us all this stuff that sucks. All the things that are happening to them. And that's natural because they're in distress. What we do is we stop that right away. We say, "Look, I want to hear all this stuff that's happening to you, but I just don't want to hear that first." And what we do is we work really hard to torque the doctor's awareness to, in an ideal world, what would you like your practice to look like. And here's why.

Dike Drummond: 34:03 Burnout has the highest investees. It's there to knock you onto a path with more purpose. It's there to help you live a higher quality life if you survive it, if you don't become ill because of it. And here's the truth at the point of contact that we meet people. I'm going to say this twice because it takes a minute to sink in. You can avoid everything you don't want and you still won't get what you want because there's only one way to get what you want and that's to figure out what that is and then go get it. So, they're almost opposites of each other.

Dike Drummond: 34:44 If you're talking about what you don't want, you're facing in one direction. You can avoid everything that you don't want and you still won't get what you want. Now I'm going to turn 180 degrees and face the other direction because what you want, to get what you want, you have to decide what that is and go get it. And doctors, ever since they started medical school, they've never thought about what they want. They've just done to what people expect of them or tell them they have to do. There's no doing what you want in medical school. You do what they order you to do. It doesn't even really matter what your grades are. You just got to follow orders because what do they call the person who graduates last from their medical school class? Doctor.

Dike Drummond: 35:25 So, what we do is we say, let's talk for a second about what you really want in your practice so we know what you would run towards. And now tell me everything that's going on. What we find is over six to eight months, 70% of people will recover from burnout without changing jobs. The 30% who have to change jobs to recover from burnout typically have a pretty obvious conflict with their boss. People don't quit the company, they quit their boss. And when we graduate somebody from a coach program, so they might come in with a satisfaction with their practice score of 2 or 3, and they're going to graduate at 6 or 7, and I ask them, "Look, what are the two or three things?" Because if what you need is a strategy, it's not a solution. It's never one thing. Burnout is always multi-factorial. You always have to put together a strategy of several different things to recover. When I ask them, "What are you doing differently now?" It's always just two or three very simple things. Super simple. They're amazed. Actually, they go, "Oh my God. That's all it was?"

Shane Tenny: 36:35 Let me piggyback on that. Is burnout something that can be treated or cured? Or is it just acknowledged and addressed?

Dike Drummond: 36:47 Yeah. I think it's the latter. It's not something where you get cancer, and then, you're in remission. What you have is burnout marks the important transitions of your life. So, let me just tell you what burnout feels like in hindsight. Have you ever had a time in your life when you were doing what everybody expected of you? Coloring within the lines, working hard, living up to other people's expectations, following the rules. And it got so uncomfortable that you had to make a change. As you look back today that change is responsible for who you are today. That turning point was burning point and it's when you decided to change your reality to match what you want to get out of your life, hopefully consciously. And it turned you towards a situation that had more purpose.

Dike Drummond: 37:41 The challenge is that happens in a crisis. And some people don't survive the crisis. Some people instead of turning towards the light, turn towards the darkness. We lose colleagues at that point.

Shane Tenny: 37:54 There's another phrase that I know has kind of come into the conversation over the last couple of years around moral injury. Can you talk a little bit about the connection there or is there overlap there, different concepts? What's your perspective on that?

Dike Drummond: 38:09 Well, I'm always wanting to facilitate a person recovering. There is always a big turning point when you recover from burnout. Exhausted, cynical, sarcastic, what's the use? And that big turning point is when you decide to take matters into your own hands. You say, yeah, the system sucks. Yeah, I hate my boss. And again, you may recognize this phrase, I'm mad as hell and I'm not going to take it anymore. You stand up for yourself. You make the changes that you can be responsible for and you pull yourself out of the whole. Moral injury is finger pointing. It is playing the victim. "It's not about me. That guy is abusing me" or "This system is unfair." Anytime I hear somebody talking about "the system" they're playing the role of victim. There is a system, it is unfair, and what are you going to do for yourself and for your family? Because pointing fingers and railing at the system doesn't work. I'm reminded of Monty Python and the Holy Grail. "Being oppressed." "Who are you?" "I'm your old king." "Well, I didn't vote for you." They're digging in the hole.

Dike Drummond: 39:29 So, moral injury is a different way of stating that you're in a victim role because you're pointing a finger and believing there's a perpetrator. One of the things I can tell you is with rare exception, the stresses that cause a doctor to burn out are not being deliberately pushed upon you. There's nobody plotting your demise somewhere in your organization. Now, they're clueless, but they're typically not vindictive and there are exceptions. There are plenty of bullies in healthcare. It's part of the culture of some of our training programs, but it's typically not that that's happening.

Dike Drummond: 40:10 So, what I always go is somebody comes into the coaching and they're railing at the system or they're railing at "the man" or they're railing at insurance or they're railing at Obamacare or they're railing at Epic or whatever EMR they have. I say, "Okay, yeah. So what do you want to do about that? How are you going, even with the baby steps, to take matters into your own hands?" Because there's always wiggle room for what you do in your own self interest. When you know which direction you're headed in, which is why this ideal job description is super important. It's the target that you aim yourself at.

Shane Tenny: 40:44 I've got time for one more question. I want to ask you, you launched a program I think last year called the Quadruple Aimed Physician Leadership Retreat. Can you tell us a little bit about that?

Dike Drummond: 40:57 Well, inside organizations that employ doctors burnout is a leadership issue. It's how do the leaders of the organization create a work environment and a culture that is supportive of the wellness of the doctors. And what we're missing is wellness leadership. People who know how to do that. So, we created a retreat three years ago called Quadruple Aimed Physician Leadership Retreat. What we do is we teach people how to be wellness champions. So, in three days, we teach them how to take care of themselves, recognize and prevent burnout for themselves so they can model and mentor a state of wellness. We teach them how to do the same thing on their teams and we also teach them an organization strategy to prevent burnout.

Dike Drummond: 41:42 We've presented it five times. We got a 167 graduate students. Great work all over the world and we have two dates in 2020. If you go to the Retreats tab at thehappymd.com, the retreats tab, you'll see our 2020 dates and they're ready to be booked right now if you're interested.

Shane Tenny: 42:00 Excellent. Well, in fact, we'll make sure and link to that in the show notes. So if you're listening to this and can't remember the exact name, you can just scroll down and find on the show notes and we'll link to Dr. Drummond's site there on thehappymd.com.

Shane Tenny: 42:14 Dike, I'm going to wrap up here. I so appreciate your time, your thoughtfulness, your leadership on the issue. I think literally the lives that you are saving and changing through the work that you're doing. Thanks for being here today.

Dike Drummond: 42:28 Absolutely my pleasure.

Will Koster: 42:33 I'm Will Koster. On this episode's White Coat Achievements, a segment where we highlight noteworthy achievements by our friends and colleagues. We're highlighting the story of an anesthesiologist who has found some awesome side gigs. Physician side gigs are a popular pathway for doctors who want to pursue passions outside of their day-to-day life in medicine. The physician side gigs Facebook community is 51,000 members strong and counting.

Will Koster: 42:59 Today's White Coat Achievement goes to Dr. Navin Goyal who got his start in the entrepreneurial world by co-founding a company, Smile MD, a mobile anesthesia company with two of his best friends. He now maintains a partner role in a private anesthesiology practice and continues to dive into venture capital. Dr. Goyal is the co-founder and CEO of Loud Capital, an early stage venture capital firm. Since launching in 2015, Loud Capital has managed three early stage venture funds, raised special purpose funding for more than a dozen high growth ventures, and deployed private growth capitals to hundreds of small businesses around the country. Loud Capital is headquartered in Columbus, Ohio, but has presence in Atlanta, Beijing, Chicago, New York, and Taiwan. In October of 2019, Loud Capital announced an exciting new partnership with the Chicago Bulls to host a pitch competition for entrepreneurs. The winner will receive a $50,000 investment from Loud Capital, as well as business development services. Kudos to Dr. Goyal for making things happen in the venture capital world. And bringing other physicians alongside him on his journey.

Will Koster: 44:10 If you'd like to learn more about Loud Capital or Dr. Navin Goyal, please visit the links in the show notes. As always if you know someone who's wearing a white coat and achieving something noteworthy, feel free to drop us a line. We'd love to hear about it. Might even feature them on a future podcast. But again, this episode's White Coat Achievement goes to Dr. Navin Goyal.

Shane Tenny: 44:32 Thank you so much for joining us today and inviting us into your home. We've got more great episodes queues up ready to roll in the coming weeks, so please make sure and subscribe. It definitely helps you know what's coming through in White Coat Wellness. Definitely helps us move up the Google search rankings. You can also join us through our private Facebook group called White Coat Wellness. We've got a conversation that you can be a part of, share thoughts. You can also track us down through Twitter, Instagram as well. Or email me directly with any thoughts, comment, reviews, et cetera at shane@whitecoatwell.com. Thanks so much. We'll see you back here next time.

Outro: 45:07 This episode of White Coat Wellness is over, but you're not alone in your journey toward financial wellness. Spaugh Dameron Tenny has been helping physicians and dentists with their financial planning for over 60 years and we'd love to answer any questions that would be of help to you. Visit sdtplanning.com today and take your financial wellness to levels. Once again, that's sdtplanning.com and we'll see you on the next episode of White Coat Wellness.