My Podcast Appearance on Dr. Bill Lombardi’s Journey to Better

It was a thrill to appear on legendary cardiologist Dr. Bill Lombardi’s podcast The Journey to Better. I was honored to be invited onto the show to discuss mindfulness, goal setting, and combating burnout.

Dr. Lombardi is one of the highest-volume operators for complex PCI and chronic total occlusions in the world. He has been open about his own struggles with well-being in this high stakes and intense field of cardiology. His episodes will resonate for cardiologists, but also for any physician who has experienced the struggles, highs, and lows of caring for patients in today’s world.

Creating Action Steps for Process Goals

In a previous article I explained the difference between outcome goals and process goals. Simply put, outcome goals are the big results you want to achieve. And process goals are the small and meaningful steps you take to achieve those larger goals. These are the actions and behaviors that are within your control.

Process goals are typically SMART goals. That means that they are

• Specific

• Measurable,

• Achievable

• Relevant

• Time-bound

So how do you get started with creating your own process goals? In this article, I’ll walk you through the process. As the Chinese philosopher Lao Tzu said, “The journey of a thousand miles begins with one step.” Think of each process goal as one of those single steps.

The template I outline below is a great place to begin. Set a timer for 15 minutes, 30 minutes or an hour, and just start writing. By the time the timer stops, you’ll have created something that you can build on.

Getting Started with Process Goals

1. Get a Notebook: An analogue, hand-written journal tends to work best. That way it doesn’t get lost in the ether of your computer and your on-line life.

 2. Define Your Outcome Goal: Start with a clear understanding of what it is you want to achieve, but be comfortable with the idea that this goal might change. Your outcome goal will guide your process goals and ensure they align with your overall objective.

 3. Break It Down: Identify the smallest and most specific actions that will get you closer to your goal. These should be easily defined and actionable steps that you can incorporate into your daily or weekly routine.

 4. Make it SMART: Ensure your process goals are Specific, Measurable, Achievable, Relevant, and Time-bound. This framework will help you stay focused and track your progress.

 5. Monitor, Reflect, and Adjust:  Review and update your notebook daily. Check off your small process goals as you achieve them, and reflect on the direction you are heading. Be open to making adjustments as needed to either stay on track or to change course.

6. Bonus Step: Create Weekly, Monthly, One Year, Three Year, and Five Year Goals. Write these down in your notebook and refer to them on a specific day every week. These larger outcome goals will often change over time, but they will help you to stay aligned with what matters most to you.

If this all seems a little theoretical, here’s an example of how this process might look.

Outcome Goal: Find a New Job

Process Goals:

• Clarify your values.

• With your values in mind, create a list of 3-5 things that matter most to you when thinking about your ideal job.

• Update your CV and LinkedIn profile to reflect your skills, experiences, interests, and values.

• Decide if there are new skills you’d need for your dream job and create a process goal plan to acquire them.

• Create a list of 3-5 places you’d like to live.

• Contact 3 colleagues in your field who might be able to help you.

• Research and attend relevant events in your specialty over the next 3-6 months to learn about opportunities and meet people who may be interested in working with you.

• Research and identify potential medical practices or institutions that align with your values and professional goals.

  • Identify people who are decision makers for the practice.

  • Check LinkedIn to see if you have any colleagues in common.

  • If so, can you be introduced? An email to your colleague can help get the wheels in motion.

  • If not, send a well-crafted email or direct message, or make a phone call to someone in the practice who might be in a position to invite you for an interview.

• Prepare for interviews by creating your personal elevator pitch

• Develop a list of potential questions you might be asked in an interview, and create a set of answers.

• Practice for interviews with a friend or coach.

Focusing on process goals rather than outcome goals can be transformative. By taking control of the actions within your reach, you’ll create a sustainable path to your own success, reduce stress, and live a life that aligns with your values and your ambitions. You’ll be able to overcome the inertia that might be holding you back, and you’re likely to find some surprises and unexpected opportunities along the way.

DISCLAIMER: As an Amazon Associate I may earn from qualifying purchases, which means that if you click on one of the product links, I’ll receive a small commission. This helps support the website, for which I am grateful! Please do your own research before making any important decisions.

If you’ve enjoyed this article and would like to stay in the loop for more insights on creating a sustainable, fulfilling, and happy life as a physician, sign up for my newsletter or reach out on my website. I’d love to hear from you.

And if you’d like to schedule a complimentary introductory meeting with me, click the link below.

Define Your Values to Create Your Ideal Life a Physician

Your values are integral to your identity. They are a very personal and multifaceted set of foundational qualities that have the power to provide a guiding light, leading you towards a life that feels in harmony with your true and ideal self. While they are a fundamental aspect of the complex person that you are, external pressures, social circumstances, and even inertia mean that it’s common to live out of sync with your values. But once you give your values a name, the way forward becomes far more clear.

Most of the time we can distill our core values into a set of five or six concepts that give our life meaning and purpose. In this article I’ll guide you through a simple exercise that can help you to get clarity on your own values. From there, you may begin to see patterns of alignment, or perhaps misalignment, in your life.

Through this process of awareness, you’ll find that your decisions become more clear. You’ll begin to feel the confidence to say “yes” to the opportunities that serve your higher purpose. You’ll find a way to energetically reach towards the next foothold, even when it’s challenging. And you’ll feel more certain when you say “no” to those choices that are not the right fit.

First, Define Your Values

The first step is to define your values. This might seem a little contrived, because you may feel as if you know yourself well enough to understand what matters to you. But putting a name to your values, and seeing them written out in black and white, can be surprisingly enlightening. For the purposes of this exercise, a value is a single word that encompasses an idea or belief in a certain way of being in the world. I’ve created a list of values for you to get started with. You can find them here.

Go through the list and circle the values that speak most strongly to you. Don’t overthink it. Your values may change over time, and that’s completely normal. There are no right or wrong, or good or bad, answers.

Once you have circled your top values, write them out. Take a good look at what you have written and see if you can narrow them down into five groups. From there, discover what themes emerge. These are your core values.

Next, Put Your Values into Action

Now, thinking about your core values, consider how you might choose to elevate these values in your daily life. Don’t try to make sweeping changes. Instead, think of small actions or choices that might more completely align your values with your life.

If there is a big disconnect between your values and your life, it might be time to reconsider your path. It is often challenging to get a handle on these ideas and put them into practice. If so, a physician coach can be a great ally. Through coaching, you will generate greater self-awareness and discover options and opportunities that more completely align with your unique set of values.

If you’re not ready for coaching, but want some clarity, consider downloading my free Values Workbook. It’s free when you sign up for my newsletter.

An earlier version of this article appeared on this website in January , 2023.

If you’ve enjoyed this article and would like to stay in the loop for more insights on creating a sustainable, fulfilling, and happy life as a physician, sign up for my newsletter or reach out on my website. I’d love to hear from you.

And if you’d like to schedule a complimentary introductory meeting with me, click the link below.

Getting Unstuck: How a Simple Mind Shift Can Move Your Life Forward

If you’re a physician, you’re probably juggling patient care, administrative tasks, and personal responsibilities like a boss. But when you feel the need for something beyond the daily routine, it can feel daunting.

Whether it’s getting up to speed with a new procedure, launching a research study, trying to get some time for self-care, or considering making a complete change of practice or location, it’s easy to feel like you’re stuck in an endless loop, unable to break free.

In my practice as a physician coach, I frequently encounter these common challenges. It can seem overwhelming from the inside looking out. But there is a way through, and it begins with understanding why you feel stuck.

In this article, I’ll explore common reasons that physicians feel immobilized, and I’ll offer you some strategies that will get you moving forward with purpose.

Break the Cycle of Repetition

Doing the same thing over and over, expecting different results, is not only the classic definition of insanity but it’s also a common trap. Whether it's procrastinating on completing notes, avoiding difficult conversations, or never saying no, these habits can perpetuate your feelings of frustration and stagnation.

Routine can be comforting, since you know what to expect, but it may also be a barrier to growth. When you’re caught up in an endless cycle of repetitive tasks, it’s easy to lose sight of what matters the most to you.

Strategy: Starting small can open up a crack that allows you to see a little more light. As simple as it sounds, begin by introducing small changes in your routine. This could mean taking a different route to work, setting aside just 10 minutes a day to walk or stretch, or incorporating new learning into your practice. Sometimes, the smallest adjustments can lead to significant shifts in perspective and outcomes.

Spring Free of the Inaction Trap

If you don’t take action, you will not get yourself unstuck. It’s that simple. But the fear of making the wrong decision often squashes the potential for change. That doesn’t mean it’s not important to think through your decisions. Be thoughtful and judicious, but don’t get stuck in an infinite cycle of analysis. Realize that taking action can mean taking the smallest of steps.

Strategy: Embrace the concept of ‘progress, not perfection.' Understand that inaction is a decision in itself, and it can be more harmful to your wellbeing and your future opportunities than making an imperfect decision. Start with very small, manageable actions that align with your goals and gradually increase the stakes as you build confidence.

Unaddressed Issues

Not dealing with problems as they arise means that they are given free rein to accumulate. Eventually these unresolved issues may begin to feel overwhelming. And as a consequence, this drag on your energy will make it harder to move forward. Whether it's patient care issues, administrative challenges, or personal matters, avoiding problems doesn't make them disappear.

Strategy: Commit to a proactive approach. Tackle important issues as they arise. You don’t need to solve every pressing problem on the fly. But by putting it in its place, it won’t be overlooked. That could mean delegating, scheduling committed time to address the issue, or even saying no. This not only prevents important issues from escalating but also builds a habit of facing challenges with purposeful action.

The Burden of Incomplete Tasks

Like unresolved issues, incomplete notes and tasks can be a significant source of mental load, leading to a feeling of being perpetually behind and unable to move forward. This is a very common issue for physicians, and one of the most important ones to get a handle on quickly. Your own well-being as well as your patients’ care depends on it.

Strategy: Get those notes done. Use templates, smart phrases, and any other resources available to you to make your notes concise, accurate, and useful. Prioritize and delegate the other tasks crowding your in-box. Addressing each task once and moving on, keeping your responses brief and succinct will help you get through your list. Consider adopting time management techniques, such as the Pomodoro Technique or time-blocking, to efficiently tackle your workload.

The Value Dilemma

Objectively, you probably know you’re valued. Despite the turmoil that many physicians face every day, your patients need you, and the work you do makes a difference.

But it’s easy to undervalue yourself, undermining your self-confidence. You’re not alone. Not believing in one’s own value is a common issue that affects how many doctors perceive their abilities and their worth. And as a result, you may miss opportunities, fail to stand up for yourself, put up with toxic working conditions, or take on projects that go against your won best interests.   

Strategy: Practice self-reflection and affirmation. Remind yourself of your achievements and the unique value you bring to your patients and the medical field. Journaling can be a very useful exercise. Keep a folder or a box with notes from patients and others who express appreciation and give yourself a few moments to revisit this when you’re feeling down.

Seek feedback from peers and mentors when you need it and consider engaging with a coach to build self-confidence and set achievable and meaningful goals.

Conforming to Expectations

Playing to other people's narratives is a common trap that can lead you down a path that doesn't align with your values or aspirations, leaving you feeling stuck in an unfulfilling or ill-fitting role. This is another theme that plays out for so many physicians. It often begins with family expectations, and it may eventually become a way of life.

Strategy: Define your own success. Take time to reflect on what success means to you, independent of anyone else’s expectations. Setting personal and professional goals based on your values and aspirations will ensure that your actions align with who you are and how you want to live your life.

Moving Forward

Feeling stuck doesn’t have to be a way of life. By understanding the underlying reasons and adopting targeted strategies, you can navigate your way out of the quicksand of stagnation.

Take the time to understand your value and remind yourself of the resilience that got you this far. Think of change as a catalyst. Create and then begin to implement a plan to take action, one step after another. Remind yourself that fulfillment is a process that can lead to unexpected growth and opportunities.

If you’ve enjoyed this article and would like to stay in the loop for more insights on creating a sustainable, fulfilling, and happy life as a physician, sign up for my newsletter or reach out on my website. I’d love to hear from you.

And if you’d like to schedule a complimentary introductory meeting with me, click the link below.

Coaching for Physicians: A Guided Journey to Goal Setting, Overcoming Obstacles, and Finding Fulfillment

If you’re curious about physician coaching, and want to know more, this article is for you. As someone who loves getting outdoors, I like to use the metaphor of a hike or journey when describing my coaching process. In this coaching journey, I serve as your experienced companion, providing support, insight, and encouragement, helping you navigate both familiar and new terrain, and celebrating with you as you discover your destination.

1. The Trailhead: Preparation and Goal Setting

 Just like preparing for a hike, the first step in coaching is to understand where you are right now and where you want to go. This involves an in-depth assessment of your current professional and personal landscape, identifying both the peaks (successes) and valleys (challenges) you face. Whether you’re dealing with burnout, challenges with time, professional transitions, or finding the right work-life balance, together we’ll set specific and achievable goals. You can think of this as choosing the right trail that aligns with your current fitness level and hiking experience. Don’t worry if this is all new to you. You may be surprised at the ways your strength and endurance will naturally grow along the way.

 2. Gathering Gear: Equipping for the Journey

After setting the goals, the next step is to equip you with the necessary tools and skills. This includes exploring techniques for time management, stress reduction, and effective communication. Similar to choosing the right gear for a hike, these tools are personalized to fit your unique needs and circumstances, ensuring you are well-prepared for the journey ahead.

3. The Hike Begins: Embarking on the Journey

With goals set and tools in hand, we begin the coaching journey. This phase is about action and moving forward. Regular coaching sessions serve as checkpoints, where we assess progress, celebrate achievements, and address any new challenges. The journey may involve steep climbs and unexpected obstacles, but with guidance and support, you keep moving towards your goals. 

4. Difficult Terrain: Navigating Challenges:

Just as a hiker encounters rough patches along the trail, you may face challenges in your professional journey. Burnout, difficult workplace dynamics, and balancing personal life are common terrains we navigate. Together, we develop strategies to overcome or get around these obstacles, building strength, creativity, and adaptability, much like a seasoned hiker learns to navigate through challenging paths.

 5. Scenic Views and Rest Stops: Reaching Milestones

Along the way, it’s important to recognize and celebrate milestones. These are like the scenic views or rest stops on a hike, offering a pause to appreciate how far you’ve come, recharge, and reflect on the journey. Although it’s tempting to keep pushing forward, these waypoints are crucial for maintaining motivation and perspective.

 6. The Evolving Trail: Continued Growth and Adaptation

The journey doesn’t end at the first summit. Like a trail that changes with the seasons, your professional life will continue to evolve. Ongoing coaching can help you adapt to these changes, develop new goals, and continue growing. The journey is continuous, and as your coach, I am there to guide, support, and celebrate with you every step of the way.

 7. The Lookout Point: Reflection and Forward-Thinking  

As you reach significant milestones, we’ll take time to reflect on the journey. From this vantage point, much like a lookout on a hike, we’ll assess the path taken, lessons learned, and obstacles overcome. From there, we’ll plan for the next phase of your journey. Together we’ll chart out the travels ahead, including strategies for keeping burnout and inertia at bay. As you move into the future, you’ll be empowered and well equipped to stay engaged, inspired, and energized.

---

If you’ve enjoyed this article and would like to stay in the loop for more insights on creating a sustainable, fulfilling, and happy life as a physician, sign up for my newsletter or reach out on my website. I’d love to hear from you.

And if you’d like to schedule a complimentary introductory meeting with me, click the link below.

Overcoming Your Roadblocks: A Physician's Guide to Navigating Change

Not too many years ago, most physicians in the private sector expected to settle into a medical practice straight out of training and to stay put until retirement decades into the future. The idea of moving, changing practices in the same town, or leaving before a ripe old age was almost unheard of. While change has often been part of the career path of academicians, physicians in all sectors are increasingly finding themselves dissatisfied, frustrated, or simply seeking something new.

In fact, a recent Mayo clinic survey reported that one in five physicians plan to leave their practices within the next two years, and one in three expect to reduce work hours. Burnout and perceived lack of appreciation by their organizations were the two primary issues cited in the study.

If you’re considering a move, this change can feel daunting. Physicians are often motivated by loyalty and compassion. But we are also creatures of habit.

For many of us, the roadmap was clearly defined: college, medical school, residency, maybe fellowship. As long as you followed this straight and narrow path, and nothing unexpected knocked you off course, you would make it down the road.

The promise at the end of the trail was a satisfying and gratifying professional life, with a high probability of a happy and fulfilling home life as well.   

Over the past decade, that promise has frayed. Burnout due to lack of autonomy, higher patient demands, a sicker and older population, falling reimbursements, the endless clicks and messages on the EHR: all have contributed. This new perspective means that physicians are more likely to seek change, or at least to consider it.

But the decision to embark on a new professional journey can often feel like traversing uncharted territory.

And the process of choosing a new path can be riddled with mental roadblocks. As a physician coach, I have found that guiding individuals through these challenges can be transformative, bringing new and unexpected possibilities to light.

Getting started can be the hardest part of the process, but once you begin, you’ll notice that the momentum will slowly build. In this article, we will explore actionable steps that can help you to overcome some of the mental barriers that may stand in your way.

1. Self-Reflection

Before embarking on a new professional path, it's essential to engage in deep self-reflection. Journaling for a few minutes every day can really help.

You don’t have to have a clear endpoint in mind to get started, but you do need to know what matters to you, and why. Consider the specific skills, interests, and passions you want to prioritize, and how you want your personal life to look. Take time to identify your values, strengths, passions, and personal goals.

Ask yourself:

• What are my core values and priorities in life?

• What aspects of my current role do I find most fulfilling and unfulfilling?

• What are my unique skills and talents?

• What are my long-term career and life aspirations?

By understanding yourself on this deeper level, you can better align your career choices with your values and objectives. For more prompts and tips to help you with this process, see my recent article about finding your “why”.

  2. Recognize Your Triggers and Limiting Beliefs:

As you work through self-reflection, you might encounter triggers and limiting beliefs that hold you back. If so, don’t be afraid to ask yourself probing questions such as:

• What specific thoughts or patterns arise when considering a new direction?

• Have you or someone else created any self-defeating narratives about your capabilities or limitations that might be influencing your mindset?

• What might these limiting beliefs be trying to protect you from?

• And how might they be proven wrong?

• If there are meaningful limitations that are keeping you from moving forward, how might you close gaps in your knowledge or skills?

When you pinpoint these mental roadblocks, you’ll take the first step towards disarming their power. Often a coach can be helpful when working through this process.

 3. Seek Guidance

Don't hesitate to seek guidance from mentors, career counselors, and trusted colleagues who have gone through similar transitions.

There can be great value in networking and connecting with others who have found fulfillment in their medical practice or who have ventured into alternative career paths. Their insights and experiences can provide valuable perspectives and inspire you to take bold steps in your own professional journey. Of course, you will want to be discerning about who you confide in, especially if you are leaving your current practice.

 4. Set Achievable Goals

Break your career change into smaller, manageable goals. This not only makes the process less intimidating but also allows you to track your progress. Create a timeline with milestones. These might include

• Gaining specific qualifications or licensure

• Attending relevant conferences,

• Researching places you might want to live

• Reaching out to potential employers or colleagues in your desired field.

Setting specific, measurable, attainable, relevant, and time-bound (SMART) goals can provide you with a clear roadmap and motivate you to move forward despite any mental hurdles.

 5. Embrace Setbacks as a Learning Opportunity

Rejection can sting. It's important to acknowledge that setbacks are part of any professional journey. Instead of seeing them as failures, view them as valuable learning experiences.

Approach unexpected challenges as opportunities for personal and professional growth. Be flexible and willing to pivot, if necessary, but don’t lose sight of your values and your “why”. The key is to use these uncomfortable experiences as opportunities to learn, adapt, and refine your approach.

 6. Get Comfortable with the Unknown

Fear of the unknown is a common mental roadblock for anyone making a career change. This may be especially true for physicians, since so much of our life has been neatly defined for us. Counteract this fear by engaging in thorough research into your desired path.

If you’re looking into a nonclinical job, understand the industry, its trends, and the challenges you might face.

And if you’re changing focus or practice, get to know more about the system, individuals, and culture you may be working with. Will you need new skills or certifications? If so, how and when can you achieve them? This knowledge will help you feel more prepared and confident as you take the leap.

 7. Keep an Open Mind

Maintaining an open mind is crucial during a career transition. Your initial path may evolve as you gain more insights and experiences. Embracing change and adaptation opens the door to broader opportunities. There may be something you may not have considered, but which may turn out to be a perfect fit.

Conclusion

Choosing a new professional path as a physician takes courage, contemplation, and perseverance. Know that you almost surely will need to step outside of your comfort zone to get somewhere new and more fulfilling.

By facing your roadblocks head on, you will build the skills and resilience you need to embark on this new journey. Remember that your background as a physician has equipped you with valuable skills, fortitude, and experience that are needed both in clinical medicine and in a wide range of connected fields.

Embrace the opportunities that arise, trust in yourself, and move forward towards a more fulfilling professional future that aligns with your values and your strengths.

Thriving Amidst Chaos: Prioritizing Health, Self-Care, and Mindfulness

In the constant press of your daily life, prioritizing health, self-care, and mindfulness often takes a backseat. But when you make the time to care for yourself, you’ll be better equipped to care for those who depend on you.

In this article, we’ll explore why self-care matters, including the impact of self-care on stress management, and I’ll give you some simple steps that will help you to thrive amidst the daily storm of clinical practice.

The Impact of Stress on Burnout

It’s common to think of stress as harmful and something to be avoided. But stress can affect your health positively as well as negatively.

Positive stress happens when you face a challenge or a deadline that you know you are capable of meeting. It might be a stretch, but you know it’s possible. And importantly, there is a reward on the other side.

While positive stress can propel you towards your goals, negative stress can lead to frustration and burnout. Negative stress is defined as those forms of stress over which you have no control. A boss (or spouse) who is never happy, a job for which you are never rewarded or thanked, and escalating demands at work without adequate time off to recharge are all forms of negative stress.

Constant and unrelenting stress can lead to burnout. The World Health Organization defines burnout as an “occupational phenomenon.” Burnout is characterized by

• Exhaustion and loss of motivation

• Cynicism and negativity

• Inefficiency

Given the current state of healthcare, it’s no surprise that over 60 percent of physicians reported at least one manifestation of burnout in 2021.

It’s important to remember that burnout is not your fault. It is a symptom of a dysfunctional system or workplace. But developing some tools to help you get through tough times can lessen the impact and improve your overall happiness and wellbeing.

Self Care and its Benefits

Self-care is not just about pampering yourself. It's about taking care of your mental, emotional, and physical well-being.

Committing to self-care enhances focus, improves relationships, reduces stress, and leads to less burnout. Acknowledging the mind-body connection is often the first step towards effective self- care.

Nutritional Psychiatry and Stress Management

The new field of Nutritional Psychiatry focuses on the growing body of research that strongly connects what you eat to how you feel. Without a doubt, mental health is complex and multifaceted. Diet is only one part of the big picture.

But when you’re famished and pressed for time, the quickest options can undermine you, sabotaging your best intentions and sapping your energy.

As it turns out, those ultra-processed foods that often pass for nutrition in the doctor’s lounge can raise your risk of anxiety, sleep disturbance, depression, food addiction, alcohol use disorder, and increased inflammation. Artificial sweeteners in particular have been linked to a greater risk for depression.

Instead, consider incorporating simple elements of the Mediterranean diet like fruits, nuts, whole grains, olive oil and fish. You probably know that the Mediterranean diet supports heart health and may reduce the risk for certain cancers. But this diet is also linked to improved symptoms of depression and better mental health and well-being. There’s also emerging evidence that a Mediterranean diet can improve perceptual performance.

It might take a little planning, but going Mediterranean doesn’t have to be complicated. Simply packing a nourishing lunch or advocating for healthier options at work can make a difference.

Exercise and Health

You already know that regular exercise will lower the risk of heart disease, cancer, bone disease, and dementia.

But research has also shown that exercise can reduce anxiety, improve sleep, and improve immune function. It doesn’t take a lot of exercise to reap the benefits. A brisk walk a few days a week is a great way to get started.

Mindfulness and Self-Care

"Mindfulness is the awareness that arises when we nonjudgmentally pay attention in the present moment.” These are the words of Jon Kabat-Zinn, PhD., Professor of Medicine Emeritus at the University of Massachusetts Medical School, and the godfather of mindfulness in healthcare.

Put even more simply, mindfulness is undistracted attention.

Practicing mindfulness can lead to

• Healthier lifestyle choices

• Less stress and anxiety

• Greater parasympathetic tone

• Better cardiovascular health

• Improved immunity.

Mindfulness doesn’t have to be about doing yoga or meditating. Instead, it’s about being undistracted, nonreactive, and fully present in the moment.

Getting started with mindfulness isn’t complicated. You don’t need a special cushion or a meditation app, although those can be nice. Simply set aside 3-10 minutes of quiet time each day to observe the present moment. Notice your thoughts and let them go, returning to the present when your mind wanders.

It is this practice of continually returning to the present moment that develops the “mindfulness muscle.”

When you practice mindfulness, you may find that your communication with patients and colleagues becomes easier and more engaged.

Create an Action plan

Creating an action plan will help you to set realistic goals and track your progress. Write out the steps that you need to take to commit to your self-care. And develop a plan that is realistic and actionable.

Enlisting a partner or friend with whom you can share accountability can help you to stay committed. Something as simple as a daily reminder on your phone may also keep you on track.

The ripple effect of taking your own self-care to heart will show up in your energy level, creativity, and relationships. You’ll develop a greater sense of self-compassion and equanimity. And in time, your path forward toward the goals that matter will become more clear.

If you’ve enjoyed this article and would like to stay in the loop for more insights on creating a sustainable, fulfilling, and happy life as a physician, sign up for my newsletter or reach out on my website. I’d love to hear from you.

And if you’d like to schedule a complimentary coaching discovery session, click the button below.

References

Adan, R. A. H. et al. (2019). Nutritional psychiatry: Towards improving mental health by what you eat. European neuropsychopharmacology : the journal of the European College of Neuropsychopharmacology, 29(12), 1321–1332.

Davidson, R. J. et al. (2003). Alterations in brain and immune function produced by mindfulness meditation. Psychosomatic medicine, 65(4), 564–570.

Ezzatvar Y, Ramírez-Vélez R, Izquierdo M, et al. (2022). Physical activity and risk of infection, severity and mortality of COVID-19: a systematic review and non-linear dose–response meta-analysis of data from 1 853 610 adults. British Journal of Sports Medicine 56:1188-1193.

Gilbert, D., & Waltz, J. (2010). Mindfulness and health behaviors. Mindfulness, 1(4), 227–234

Lane, M. M. et al. (2022). Ultra-Processed Food Consumption and Mental Health: A Systematic Review and Meta-Analysis of Observational Studies. Nutrients, 14(13), 2568.

Loucks, E. B.et al. (2015). Mindfulness and Cardiovascular Disease Risk: State of the Evidence, Plausible Mechanisms, and Theoretical Framework. Current cardiology reports, 17(12), 112.

Martinez-Gonzalez, M. et al. (2019). The Mediterranean Diet and Cardiovascular Health: A Critical Review. Circulation Research 124:779-787

Munoz, M.A. et al. (2009). Adherence to the Mediterranean diet is associated with better mental and physical health. British Journal of Nutrition. 101 (1821-1827),

Samuthpongtorn C et al. (2023). Consumption of Ultraprocessed Food and Risk of Depression. JAMA Netw Open. 2023;6(9):e2334770. doi:10.1001/jamanetworkopen.2023.34770

Shanafelt, Tait D. et al. (2022). Changes in Burnout and Satisfaction With Work-Life Integration in Physicians During the First 2 Years of the COVID-19 Pandemic. Mayo Clinic Proceedings, Volume 97, Issue 12, 2248 - 2258

Stubbs, B. et al. (2017). An examination of the anxiolytic effects of exercise for people with anxiety and stress-related disorders: A meta-analysis. Psychiatry research, 249, 102–108.

World Health Organization: WHO. “Burn-out an ‘Occupational Phenomenon’: International Classification of Diseases.” World Health Organization, 28 May 2019, www.who.int/news/item/28-05-2019-burn-out-an-occupational-phenomenon-international-classification-of-diseases.

Yin, W. et al. (2021). Mediterranean Diet and Depression: A Population-based Cohort Study. International Journal of Behavioral Nutrition and Physical Activity, 18(1). https://doi.org/10.1186/s12966-021-01227-3

Young, H. A. et al. (2022). Mediterranean diet, interoception and mental health: Is it time to look beyond the ‘Gut-brain axis’? Physiology & Behavior, Volume 257.

Using the Language of Art to Create Work-Life Balance

This article was published in a slightly different format on KevinMD.com

Most physicians cite work-life balance as a top priority. Yet there is little clarity on what exactly work-life balance means.

Some prefer the term work-life integration, as if your work and your so-called personal life should be intertwined. Work-life integration is a common buzzword in managerial circles. For most physicians, however, this way of life is already a reality. Taking call, working late, and keeping up with CME and recertification already mean that much of what might be considered personal time is already filled with work commitments. And so what “work-life integration” often means is that there is really no distinction between the two.

Under this construct, work may be expected to run freely into family and personal time without boundaries. Yet in most cases, the river only flows one way. Bringing your home and personal responsibilities to work may be neither practical nor desirable.

For these reasons, I believe that work-life balance (WLB) is a better goal for physicians. But what does balance even mean?  You might be surprised to learn that art theory holds the answer.

Most people think about balance as a seesaw or a set of scales, with each element balancing the other to achieve a perfect equilibrium. This cliché is virtually impossible to achieve and may not even be desirable. Instead, there’s another more nuanced way to look at balance that I believe can help better inform your personal choices.

Before we go any further, it’s valuable to think about WLB as more than simply “work” and “life”. Work is an important part of life, and perhaps even a defining feature of the life you’ve chosen. But “life” isn’t just what’s left over after work. It can be useful to think about life as a array of different elements. Broadly speaking, these may include

• Family

• Friends

• Leisure

• Self-Care

• Anything else that’s meaningful to you

Equalizing all of these factors our using traditional concepts of balance is just not going to happen.

But if we borrow the concept of balance from art theory, it all starts to make more sense.

In art, balance can be

• Symmetric

• Asymmetric

• Radial

• Crystallographic (Mosaic)

---

Let’s take a little detour into art theory so I can show you what this means.

Symmetric

• Think of the typical balanced scale, or a mirrored pair.

• This is the traditional way that we think of balance.

Thomas Nordwest, CC BY-SA 4.0 <https://creativecommons.org/licenses/by-sa/4.0>, via Wikimedia Commons

Asymmetric

• The perception of weight across the composition may be balanced, but each element has a different size or mass.

• This form of balance tends to create more interesting and dynamic images.

Radial balance

• This type of balance uses a central focal point

• Rays, spirals, or ripples radiate outward

Fragment, Peru c. 1000-1476 AD, Kate S. Buckingham Endowment, Art Institute of Chicago

Crystallographic (Mosaic) balance

• A large number of elements share equal weight

• There is no single focal point

---

For physicians, an asymmetric concept of balance can be especially useful. Think about the way you might create a rock garden. With asymmetric balance, you have wide latitude to play with different scale and elements. Compared to the symmetric form of balance, where both sides hold equal weight, asymmetric balance falls apart when the elements are too similar.

In asymmetric balance there is usually a dominant element, with the other components playing a supportive or bridging role. Often two smaller elements work harmoniously to balance a larger one. In an asymmetric painting like Van Gogh’s Starry Night, there may be some tension, but the image still feels complete.

Starry Night, Vincent van Gogh, 1889. Public domain, via Wikimedia Commons

Asymmetric balance can be interesting to play with. Moving one element often means that the others must also be moved in order to maintain a sense of harmony.  This new configuration might strike a different chord and create different relationships between the pieces.

When thinking about your own WLB, asymmetric balance may be a good starting point to consider.  As your priorities shift over time, your vision of balance may also change. The asymmetric model is a way to conceptualize a personal definition of balance that works for you.

If you’re looking for practical tips to help you take action on WLB check out my recent article, which also appeared on Doximity. In the article I include nine actionable steps to get you started.

How do you begin to define your own WLB? Sitting down with pen and paper and sketching it out in words or pictures is a great way to get clarity on your own ideas and to create your vision for the future.

If you’ve enjoyed this article and would like to stay in the loop for more insights on creating a sustainable, fulfilling, and happy life as a physician, sign up for my newsletter or reach out on my website. I’d love to hear from you.

And if you’d like to schedule a complimentary coaching discovery session, click the button below.

References

Fallon-O’Leary, D. Work-Life Integration Is the New Work-Life Balance. Is Your Team Ready? CO. July 2021.

McManus, I. Symmetry and asymmetry in aesthetics and the arts. European Review, October 2005.

Meyer, I. Balance in Art – Exploring Different Types of Balance Artworks. Art in Context. August 2023.

Saley, C. Survey Report: Millennial doctors still finding jobs the old-fashioned way. CompHealth Blog. April 2018.

Vincent van Gogh, The Starry Night. MOMA.org , 2019.

Why Are We Afraid to Talk About Work-Life Balance?

This article originally appeared on Doximity, where I am a 2022-2023 Op-Med Fellow.

For many physicians, work-life balance (WLB) is the elephant in the room. According to CHG Healthcare, in 2018, 63% of physicians finishing residency programs cited WLB as their number one consideration when choosing a job. In 2022, it was 85%.

Dissatisfaction with WLB is strongly correlated with burnout, and is a common reason that many physicians choose to leave their current practice.

Although women physicians tend to rate WLB as somewhat more important than men, among millennials it is a top priority for both genders.

Yet physicians often avoid raising this crucial issue with potential employers and even colleagues for fear of being judged.

This fear of judgment is based in reality: providing the best and most timely care to patients often requires self-sacrifice. We all know that medicine is demanding; we must expect to occasionally, or even often, put personal needs aside in order to care for patients whose needs can’t wait.

But it’s not uncommon for physicians to fall prey to the notion that consistently putting aside their own, or their family’s, well-being is necessary to answer the “calling” of medicine. Perhaps in taking on this mantle of self-sacrifice, the idea of wanting something more, or even something different, can seem disrespectful to the “priesthood” of medicine.

For physicians whose work requires collaboration and partnership with others in the profession, openly wanting more from life may also stir up fears of being perceived as weak, lazy, or not a team player.

While respecting these valid concerns, I believe that if you conquer the angst of admitting that you want more out of life and make an effort to seek WLB, you will find that your relationships, your sense of fulfillment, and ultimately the care you give your patients can flourish.

Research shows that not only do people who make time for family, hobbies, and health feel a greater sense of balance, but they may also become better physicians for it.

• A British study found that employees who engaged in creative activities were more likely to discover creative solutions to problems at work.

• A study of nearly 300 ICU staff members, including physicians, found that those who engaged in hobbies experienced less post-traumatic stress.

• And a Duke study found that higher WLB measures among hospital staff, including physicians, correlated with greater patient safety and improved teamwork.

On the opposite end of the spectrum, not attending to life outside of work can have serious effects on both. A study of members of the American College of Surgeons published in 2012 found that those with conflicts between work and home life were more than twice as likely to experience burnout and depression. In this study, “home” was defined broadly as “personal responsibilities,” and included personal relationships, parental responsibilities, and spousal factors. Experiencing this conflict also meant that the surgeons surveyed were more likely to leave their current practice. Although work-home conflicts might be considered a subset of work-life balance, the implications of this type of conflict are significant.

And yet, balancing your life is easier said than done.

Each of us has a different story. Personally, as a cardiologist I was able to find WLB, although it required a substantial degree of focus and dedication. While in practice, I wrote four books (admittedly health related), became a yoga teacher, and competed successfully with my horses. I also made time to travel and hike around the world.

However, these efforts were not without sacrifice: I had to give up significant income in order to take a half day off a week to train with my horses. And I usually chose to take most of my allotted (uncompensated) vacation time.

Finally, though I was fortunate enough to have an organized system of cross-coverage with my partners, the time off nevertheless meant that I was often catching up on EHR responsibilities late into the evening, sometimes even from the other side of the world.

Still, I believe the loss of income and long nights catching up on charts was worth it. Not only was my life richer, but my diverse experiences and friendships made me a more compassionate and open-minded physician. My patients were always curious about my adventures, and often felt more connected to me when they realized that I shared some of their own interests. And having the opportunity to “fill my cup” gave me more energy and enthusiasm for my work.

Your personal definition of WLB may change over time, depending on your personal commitments.

Admittedly, part of my ability to find WLB earlier in my professional life may be attributed to my decision not to have children, a situation that likely differs from that of many readers. My mother, a physician and parent of five, had a far more difficult time finding balance, and in truth I don’t believe that she was ever able to achieve it.

In the 21st century, there are more options for parents, but it’s still a complicated balancing act. If you’re a parent of young children, there are likely some hobbies and experiences that will need to be put on hold until the little ones are older. Instead, WLB for you may mean finding a way to create and protect family time.

So, how do you get started?

First, realize that there’s no shame in wanting or needing more. You signed up to be a doctor, but you may also be a friend, a spouse, a parent, or a curious human being who craves something new.

Next, create a plan that can get you the time and space that you need, while continuing to serve your patients and collaborate with your colleagues.

Below, I offer some things to consider while embarking on your new path:

1. Think about where you are in your practice. If you’re in training, achieving WLB for the duration of the program may not be a priority. If you are just beginning your career, it may take a few years to find your footing, and that’s normal. Whether or not they admit it, most physicians feel a little out of their depth when they first start out. Over time, you are likely to develop a range of practical skills that will make your day more efficient, leaving you with more personal time.

2. Realize that you might need to take a pay cut, or even a new position. If you need to take a regular day off, or even half a day, it may cut into your productivity. If you are not available, work may be shifted to your colleagues. Sometimes that’s welcomed, but many times it may not be. Weigh the risks, benefits, and the possible outcomes and make your decision from there.

3. Get help. It might cost you something, but could you benefit from a personal assistant, a babysitter, or a scribe? Just a few hours of help each week could free up important blocks of time that you could use to pursue a passion project, or to be more present for your family.

4. Consider your commute. Could you be using the time to enjoy an audiobook, catch up on CME, or learn something new? Or maybe even consider moving closer to work to create more free time in your day.

5. Learn to say no. Sometimes being on that committee or taking on a new project may be just the thing to move you forward professionally. But if you find yourself taking on more responsibilities than you must, realize that you are giving up the precious commodity of time.

6. Give up your perfectionism. Take just 10-15 minutes a day to get started on a new hobby, a quick yoga class on your iPad, or a morning walking meditation. You don’t have to go all in all at once.

7. Figure out where you’re wasting time. If you actually enjoy mindlessly scrolling your social media feeds, then maybe there’s no reason to stop. But if this feels like a compulsion, train yourself to put the phone away whenever possible and pick up a new project, go for a walk, or just sit with your family and read a book.

8. Sign up for a workshop. Take a couple of phone-free hours to learn something new about photography, bread baking, canoeing, knitting, bird watching, or anything else that catches your attention. No one will expect you to know what you’re doing, and you might discover a new passion and a new community.

9. Book a trip. Just go ahead and set a date perhaps six months out, put it on the calendar, and buy your ticket. The first step is often the hardest, but once you start, it’s easier for the rest to fall into place.

No matter what work-life balance means to you, realize that an ideal balance looks different for each person. It can change over the course of a lifetime.

The most important way to achieve it is to put your ideas into action. Your life will be so much richer if you consciously put in the effort, often in ways that you might not anticipate today. And you may find that in the process, you generate more joy, creativity, and resilience in your medical practice.

If you’ve enjoyed this article and would like to stay in the loop for more insights on creating a sustainable, fulfilling, and happy life as a physician, sign up for my newsletter or reach out on my website. I’d love to hear from you.

And if you’d like to schedule a complimentary coaching discovery session, click the button below.

References

Colville, G et al. Coping with staff burnout and work-related post-traumatic stress in intensive care. Pediatric Critical Care Medicine. July 2017.

Dyrbye LN et al. Work-home conflicts have a substantial impact on career decisions that affect the adequacy of the surgical workforce. Arch Surg. 2012 Oct.

Eschleman, K.J. et al. Benefiting from creative activity: The positive relationships between creative activity, recovery experiences, and performance-related outcomes. J. Occup. Organ. Psychol. April 2014.

Saley, C. Survey Report: Millennial doctors still finding jobs the old-fashioned way. CompHealth Blog. April 2018.

Saley, C. Survey: Work/life balance is #1 priority in physicians’ job search. CHG Healthcare. March 2022.

Sexton JB et al. The associations between work-life balance behaviours, teamwork climate and safety climate: cross-sectional survey introducing the work-life climate scale, psychometric properties, benchmarking data and future directions. BMJ Qual Saf. 2017 Aug.

Shanafelt TD et al. Burnout and satisfaction with work-life balance among US physicians relative to the general US population. Arch Intern Med. October 2012.

What the Failure of the ER Match Says About the State of Health Care

And How Physician Coaches Can Change The Story

When I was in medical school, the cool, smart kids went into ER medicine. It was a hotly competitive residency, and there was no guarantee that you would match. Now things are entirely different. Over 550 residency spots went unfilled by US med school grads in the residency match this month. Some centers had zero applicants match to their programs. Compare this to 2021, when only 14 ER residency spots were not filled.

The reasons? Just about any physician in the US can tell you:

• Disrespect fueled by social media personalities and irresponsible "news" outlets

• Dangerous working conditions

• Overloaded ERs being used as a source of primary care, often because people lack insurance or access

• Corporatization of medicine with a focus on numbers of patients seen and metrics that often don't relate to patient care

• Management of physicians by business people and those with less responsibility and training

• Intrusive, redundant, and burdensome EHR requirements

• Lack of adequate support staff

Some of my best friends are ER physicians. They are some of the hardest working people I know. These are the doctors who will save your life at 2 am, no matter who you are or whether or not you have insurance. And they are also the doctors that are tasked with waking up their colleagues at all hours of the night to request a consult or hospital admission. Most manage their work with grace, strength, and courage.

The steep decline in the desirability of ER residencies is a really scary trend. It’s easy to say that doctors can be replaced with mid-level care providers, but the truth is that the expertise, skill, responsibility and knowledge that an ER physician provides requires years of education, training, and commitment. Mid-levels can reduce some of the burden of less complex patients, but they are no substitute for a physician.

This sudden and shocking shift should be a call to action for hospital directors, ER directors, and the corporations and private equity firms who own and manage many of these practices.

As we wait to see how this recent revelation will impact the decisions and practices that affect ER physicians, it’s important that physicians take steps to stand up for ourselves and our profession. This is a new way of thinking about medical practice, but times have changed irrevocably. By learning how to work within the systems we now have, we can start to make important changes from the inside out. Ultimately, such changes will benefit not only physicians, but also their patients and indeed the very institutions and corporations that currently control our healthcare systems.

---

 How can coaching help? Well clearly, coaching will not fix the problem. Coaching means working with one physician at a time, very much like patient care. But coaching will help you clarify your goals, identify your frustrations and obstacles, and give you the tools to create your way forward. Will that be

• Negotiation, understanding your own value?

• Creating a streamlined workflow that will allow you greater efficiency?

• Acquiring new skills to make your time more effective?

• Courage to make a lateral move to a new facility?

• A switch to a different type of practice altogether?

• A change in working hours?

• Reframing conflicts so that you are able to create a more positive working environment?

• Honing interpersonal skills?

• Advocating for change in EHR management?

Regardless of your specialty, the healthcare world is shifting. The work you do matters. By recognizing your own worth and power, and by taking action that is beneficial to both you and your patients, you will be able to create a happier and more sustainable life.

If you’ve enjoyed this article and would like to stay in the loop for more insights on creating a sustainable, fulfilling, and happy life as a physician, sign up for my newsletter or reach out on my website. I’d love to hear from you.

My Podcast Interview with Dr. Naomi Lawrence-Reid

After appearing on a recent segment of TechLink Health’s Podcast, I was invited to interview Dr. Naomi Lawrence-Reid of Doctoring Differently. Dr. Naomi, as she prefers to be called, describes how she pivoted from full-time practice and found new opportunities to use her skills as a physician.

Her story is inspiring and engaging. You can take a listen right here.