021 - Clips From the Most Impactful Episodes of 2021: Reducing Burnout For Physicians In Medical Practice or Residency Training

Wondering what you missed on the Practice Impossible Podcast in 2021? Here are Coach JPMD’s top picks for the most impactful podcast episodes in order to decrease stress and increase profits.

Click below to find more information on the top rated episodes of 2021!

Massage and Self-Care with Elena - Click Here
Roadmap to Financial Freedom with Sonja - Click Here
Preventing Burnout with Gabriella - Click Here
Is Medicare Advantage Right for You? - Click Here
Commercial Real estate with Dr. Singh - Click Here
Religion and Longevity with Zach - Click Here
Overcoming Shame with Dr. Shaw - Click Here
Podiatry in Managed Care with Dr. Jude F Pierre - Click Here 

 Discover how medical graduates, junior doctors, and young physicians can navigate residency training programs, surgical residency, and locum tenens to increase income, enjoy independent practice, decrease stress, achieve financial freedom, and retire early, while maintaining patient satisfaction and exploring physician side gigs to tackle medical school loans. 

Transcript

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Coach JPMD  0:08  
Welcome to the Practice Impossible Podcast with your host, Jude Pierre MD, also known as Coach JPMD. And that's me. We're so happy to have you and wanted to wish you guys a Happy New Year. Thank you for listening. Thank you for sharing. Thank you for making what I didn't think was possible, possible. And as I end the New Year, I wanted to use this episode to review the practice impossible podcast episodes, somewhat of a cliff note of the best of 2021 practice impossible podcast episodes. And before we begin that, I just wanted to kind of review what my why is. As you all know that I am a practicing internist, practicing in the Tampa Bay area, particularly well, actually, specifically in Spring Hill. And I'm human. I'm human with a family, with teenagers, with stress, with life events happening just like many of you out there. And one of the things that prompted me to start this journey of helping physicians to learn about the business of medicine was the statistic that I found so important. And it's related to my mission, really, my mission statement is to help populations live long by enhancing physician awareness of spiritual, mental, and physical health globally. And my vision is to increase the life expectancy of the human race by transforming how we teach physicians and other health care providers globally. One of the statistics that I learned early on in my journey was the fact that physicians commit suicide 1.8 times more than the general population. And that's just horrible. And what I found is that many physicians stress is related to the finances of their practice, their personal finances. And so what I wanted to share today is just some episodes that can encourage you inspire you to do the right thing for yourself and for your patients and for your family. So I created the Cliff Notes, Episode, let's this episode, and I want to share some interesting guest stories, and inspiring things that you can do as healthcare providers to stay sane. And live powerfully in this, this stressful, crazy world that we live in. So let's start with something fun, something fun that you can do for yourself, or that you can consider doing for yourself. And it's really a self care tip from my massage therapist, Elena. And we interviewed Elena in our third episode, episode three, and she shows a story about Tom Brady. So let's revisit the conversation.

Elena Vans Evers  2:48  
You know, what I find the most with my clients who are in doctors are they are wound up, I have one doctor who flies in here, like he's like flying into the ER, you know, it's almost like they can't bring it down a level. And you know, for the first 20 minutes of the massage they're normally like, you know, asking me questions, sometimes answering their own questions. It's hard to kind of bring bring them down, you know, and get that nervous response out of that, that flight system, right and get them to actually relax and to ground them a little bit, which is, you know, a little difficult, but it's easy to do. Once you once someone gets comfortable with me, it's easy to kind of bring them down a little bit and just just to get them to relax. And that way I can get into the massage and get in. It's not uncomfortable, but that's probably the biggest thing that I see with doctors.

Coach JPMD  3:45  
And I think we both know that massage does help with reducing stress and anxiety, reducing pain, improving circulation. So you know, did some research on it and, you know, why is it that physicians don't go to this modality more? Why do you think that is and you know, we we have high performing athletes who go to massage therapy regularly they have their own personal trainers, they have their their own set of crew that actually help them perform at the highest level. Why do you think that is?

Elena Vans Evers  4:19  
This is great. We can talk about Tom Brady, right? I mean, everybody, the entire football world is fixated on what this 43 year old can accomplish. Seven Super Bowls? I'm not a huge, huge football fan. But something that really stuck out to me during this process is he gave so much credit to the guy Alex who just takes care of his body. He accredits a lot of his longevity in his career to the person who I mean it's a part of the puzzle right is you know massage and nutrition and working out but he he gives a lot of admiration towards the person, Alex who takes care of his body, and he's getting massages every week. And, you know, I think I said this before, I think doctors are like high performing athletes. And I wish that they would treat their bodies a little bit more like it. Not even just for massage, but you know, all the other parts that go with it.

Coach JPMD  5:23  
Now, I don't know, a physician that has not faced a financial stress in their life. And in episode two, Sonja Palomino, my financial coach chats about having margin in your financial life, a forward looking budget, transformed my financial world, and I know that it can yours as well. So take a listen to this clip. Yeah, so are you saying a margin like an emergency fund or something that that you set aside or, because some people listening may not understand what that means? Because they've never had margin, or they never had money set aside. I think I know what you mean. But how would describe that in your world in the real world? 

Sonja Palomino  6:04  
Absolutely. Well, and there are a couple of different margins, from what we experienced back when we really didn't have much on back when we were almost losing everything, the margin that we had was, first of all, the right size, our expenses, we really had to, we had a significant overnight reduction of income. And that hit us just kind of right out of the blue. And the thing is, is that our margin, we had to create it ourselves, we had to go in and, and actually reduce our lifestyle, to a pretty basic level, because our income was very minimal coming in, compared to our expenses. Our home was on the line. Everything was on the line. I was pregnant with our second child at the time, so everything was hitting right at that time. And so when for us to create margin back then we had to go back to their basics. And we had to look for ways to see how can we bring additional income, though, really the foundational piece, which is the budgeting piece, we actually had to put that into play as well. Now then, once we became debt free, well, then the margin changed at that point in time. And then we have extra money, in which we are able to know build savings and dream and focus on you know, these these things that we wanted to focus on for our family at a completely different level of margin than then back when we didn't have anything, if that makes sense we really owed everybody else, most of our paycheck.

Coach JPMD  7:26  
So we focus many of our episodes on self care. And that was for a reason, if we as healthcare providers on our A game, and how can we effectively care for our patients? It's impossible. One of the things that doctor Dennery, in Episode Seven shares with us, is a way to help prevent burnout. And one of the things that that you can do that could go a long way in helping you stay focused and stay strong for your patients. And that is just to say thank you. So take a listen to this segment in Episode Seven. Yeah. So in hearing the stresses of the physicians and hearing what they've gone through what what they've struggled with, is there a book one book that you would recommend that your physician clients read?

Dr. Gabriella Dennery  8:16  
Yes, there's one book that I simply absolutely love. It's a quick read, and I recommend it. It's called A Simple Act of Gratitude. I have it with me now. So I want to make sure that I read it properly. A simple act of gratitude, how learning to say thank you changed my life. And the author is John Kralik. And this was the story. And as I said, it's a nice little book it's a quick read. And this was a story of a kind of a Down and Out attorney who was his business was in a shambles. His marriage was in a shambles, his breaking up with his girlfriend, you know, his relationship with his children was strained, especially the older children. I mean, nothing was working. He didn't know if he could make payroll, I mean, everything was just kind of falling apart. And at one point, he receives a letter from one of his his ex girlfriend who, who actually thanked him for being in her life that although things didn't work out, but she was still very grateful to have him in her life. And so he was it kind of shocked him and that coupled with a meeting with a good friend who said you know, if you're not grateful for where you are now in what you have now it'll be really difficult to move forward in anything else. And so once he got that note, he he realized that he had never said thank you to any body, not in those terms. Like he knew people would send these letters you know, every time you go to dinner, you know, somebody sends you a thank you card or so thank you for for having us over and that kind of stuff. And it didn't occur to him to do that. So he started doing it writing these little thank you notes to his staff, to his to family members to his older children, etc. Little by little by little by little, and next thing you know, the response was just something that he really did not expect. You know, old clients who finally started paying their bills, people in the office thanking each other, you know, being appreciative about him and sending him notes and then thanking each other for their work and their, their, their hard work, etc, etc. So, I mean, and it started just kind of snowballing that way, in a good way. Why is this important, and gratitude in and of itself is so important, because it shifts the mindset. And number one, it is ridiculously simple. And one of the things with physicians is that they expect things to be complicated to be worthy. And when you try to convince them that something simple can actually make a massive change in your life, it's a tough one. So I love this story, because there's also a body of research around gratitude, which is interesting, I just kind of started reading on it. Talks about the the physiological effects of gratitude increase in serotonin levels, for example, that happy neurotransmitters that in you know, it can potentially be helpful for mild to moderate depression, that even physical physical effects of gratitude, including decreased blood pressure. I mean, somebody, I think there was one suggestion of an improved lipid panel, sorts of wonderfulness. And so on the one hand, it sounds outrageous, it's like, well, how can this it's not a pill. It's not complicated theory. And it's not complicated medicine. But this is a formula that has worked for 1000s of years. And so medicine is finally catching up to that, and the impact of gratitude on the human body, the human soul, the human spirit, in every aspect of life. And so it does create a shift when you find something to be grateful for, even if it's the simplest thing. You know, I keep a gratitude journal. Sometimes I'll send gratitude notes to friends out of the blue saying, I thank you so much for being in my life. And the response that you get from that, it creates a very different kind of positive shift in mindset personally, and that energy radiates outward. And people notice the changes they do. And you notice the changes to the the level of stress and overwhelm just goes down. The circumstance may be the same for now. But your perception of it, how you relate to it changes back to my why.

Coach JPMD  12:12  
So running a Medicare Advantage practice is what I've been doing for a while. And I'm still learning how to be better, how to improve my scores, my MRA scores, my HEDIS scores. And it may not be for everyone. And one of the things that I realized is out is that if you understand how to run a Medicare Advantage, practice, and manage your populations, and you can essentially run any medical practice, and really make a good living, seeing even fee for service patients. Like I said, it may not be for everyone, but learning the differences between insurance plans will help determine that. So let's have you listen to a clip in Episode Five that can help you understand those differences. And here we go. You see that HMO doctor that that it was laughed about joining mainly saw patients under Medicare Advantage plan. And those plans that he was contracted with received money from the government. And those monies were distributed to through an IPA or independent physician organization or association. And with that, Medicare Advantage Plans contract with health care providers, PCPs, specialists, hospitals, nursing homes, radiology centers, they contract with all these providers, and are given a pool of money to care for that patient population. So those groups of providers, in particular, the group that I joined, manage the care of a large population of patients. And what's unique about this arrangement is that, as a primary care provider, we receive monies on a monthly basis. And that's called a capitation check. And that check comes in regardless of whether or not we see the patients if we take care of the patients well, and if the patients stay out of the hospital, and they're prescribed generic medications, and they receive or go to in network providers, there may be a bonus that is distributed amongst the IPA as well as the physician office. And these bonuses can be fairly lucrative depending on the contract that you signed with the particular Medicare Advantage plan. So one of the things that instantly jumped out at me was the fact that if you are a physician that cares for your patients, and that is responsive to your patients, then those patients become very loyal to you. And because they're part of a Medicare Advantage plan. It is not common for those patients who are satisfied with their primary care doctor to switch doctors. So it's not like a fee for service plan where that patient can go to any provider, because they're they're not tied down to that Medicare Advantage plan for many of the Medicare Advantage plans, particularly one set and the ones that are managed through capitation arrangement, and which is also called Risk arrangement. Specialists usually have to send authorization requests in order to see patients under a particular PCP's panel. And with that you're instantly involved in the patient's care because the specialist then has to send consultation notes in order to receive that authorization. The next clip is from the most downloaded episode guest episode 2021. And it was an episode on real estate with Dr. Pariksith Singh. Interestingly enough, he might have had some help with some of his friends from India. But no, I'm just kidding. But he gives us some practical tips on how to purchase real estate, and just things that he's gone through over the years that helped him amass the real estate portfolio that he's has that he has and how it's impacted his medical practices. So let's take a listen to a clip from episode eight. And it was a great episode. How or when did you kind of separate out real estate business from the medical practice?

Pariksith Singh, MD  15:54  
It happened very early Jude in 2001. When we we bought the practice from our the employer who wanted to kind of phase out. And so we bought it and then a friend of ours offered to sell us land on 19, which is the road that connects Pasco and Hernando County. And I was very naive. So you know, I, two acres $235,000. He said we are you can have it you can have a location, you can have an office and knowing nothing. And that's the problem with this physicians. Since we are good at one thing, we think we're good at everything. So I asked our attorney attorney said no, that's not a good deal. I still went ahead and bought the property. And I can tell you that area has not grown in the last 20 years. Nothing that area is still as dead and dry as it was 20 years ago. Don't ask me why. If you go down south on from your office on 19, you will find this patch from Hernando to Pasco there's almost a patch of four or five miles, nothing like a desert in terms of commercial activity. And so that was a mistake, although we eventually took advantage of it and made money out of it. But really, that was a poorly executed real estate deal. And I'll tell you why. Also, no, no diligence. So there were wetlands, 1/3 of it is wetlands. Just to put up an office is a disaster, because you have to do a lot of mitigation. And since there is no real population around, there's no point even putting up an office there. Because if you put an office, nobody will come there. And so why buy this land? It was land bought for the is everything that you should not do. Maybe I should write that book, what you should not do in real estate. Because when you learn not what not to do you I think you'll do everything else the right way. So this was everything a classic textbook case of how not to buy a property.

Coach JPMD  17:58  
So it boils down to location, right? Location, location, location, it was badly unrealistic. And so if you I mean, there's not much you can do with that location, unless things change drastically in the community. So how do you find property? What are your what are some of the criteria that you use? Distressed Properties? Income properties? How do you find properties? 

Pariksith Singh, MD  18:20  
So over the years, I've worked with different brokers who kind of have access, they have all these, you know, systems on which all the new properties that come on the market, you have access to them, bring them to you. But then you have to have certain exclusivity. I know of certain brokers who don't what is called MPs system or MLS system... 

Coach JPMD  18:41  
MLS 

Pariksith Singh, MD  18:41  
MLS so everybody, whenever a property comes to market, all the brokers put it on there.

Coach JPMD  18:46  
So do spiritual people live longer than those that are not? Some researchers say yes. And Zach Elliot, our guest in Episode Six, gives us some insight on what he thinks is the reason why people with religious backgrounds or spiritual backgrounds or spiritual practices tend to live longer. Great, great talk on relationships and, and how it impacts longevity. Yeah, and so some people might be wondering, okay, so I'm a physician. And, you know, I need to teach my patients about this. And, you know, I know that I've done some research and found out that there is some there's actually one particular study that showed that women who attended religious services tended to live longer than those who did not. So what are your thoughts on that? And in terms of, you know, we talked about religious services versus spirituality versus just belief of in higher God or higher being? Have you seen that translate in the church as far as the church members that you've seen that are older in your population? Have you? What have you witnessed? 

Zach Elliot  19:58  
Yeah, I think in general, just categorically, when you're in a spiritual community or faith community, there's a literally a dimension to that community that exists and creates space. And what I mean by that is, there's a sense of transcendence rather than just the imminent frame. Charles Taylor, a great Canadian philosopher talks about that. And I think that that's really important. Because if you live only in the kind of the material world in what happens to us as we become more and more the center of that story, and what happens eventually is that we end up carrying the weight of the world, and there's nowhere to transfer that right. We can transfer it, maybe to our family, maybe to our team at work, maybe to culture in some way, have the right organization is leading politically. But little by little, we end up carrying more and more that way to the world. I think in the spiritual community, there's a recognition that we're really not the center, and that we're in relationship with a God who is kind of holding us. And so I think, just first and foremost, that shifting of that weight of the world, and I talk about this in terms of vertical relationship, when you're in relationship with God, who is other, he is greater than you. And nothing that's not greater than you should be a god. But if, when if you have that perspective, you can transfer that burden somewhere else, I think that makes a difference. The other thing is on the on the horizontal plane. Now I'm in community with people who feel they see a dignity in me, they see something about my personhood, that that allows them to embrace me and I to embrace them. And I think in the kind of triangulation of that vertical and horizontal relationship, you get human flourishing. And I think I've seen it over and over again, that you have people who maybe are a widow, or they've lost family members, and yet they're immersed in a community that again, gives them relationship, up and out. And that's really the heartbeat for me is flourishing is relational, not circumstantial. And in a spiritual community, the apostle Paul writes this, whether I have all things or I have nothing, I've learned to be content. And I think it's that deeper truth that allows people to experience something in spiritual community that they maybe can't articulate, but it translates to health. And I think it does translate to longevity.

Coach JPMD  22:36  
That's interesting, you say that, because as you're saying that I'm thinking about my patients who, you know, are over 90 years old. And I would say the ones that are flourishing like you with the word that you're using, are the ones that come in with their, their children, their daughters, or their sons, and they have notes. And they're describing what's going on with mom. And Mom is kind of agreeing or disagreeing. And it's a caring, it's a relationship that they have as, as mother and son or daughter that I feel has helped them. And then you contrast that with patients who come in that are at 85 90. And I ask them, how's your son doing? Or how's your, your daughter doing? I don't talk to them anymore. I have no relationship with them. And you can see that they're obese, their blood pressure is high, and they're not happy, they're depressed. So I certainly see that in the practice. And I wonder if I mean, I wonder, I'm sure that it has something to do with the connection and the flourishing of that relationship?

Zach Elliot  23:33  
Oh, absolutely. In the Christian tradition, reconciliation, is the story, right, the putting back of relationship. And so the invitation is, and the you don't always get that perfectly. But the heartbeat is mother to daughter, daughter to sister, brother to brother, neighbour to neighbour, if my heart is orienting towards that idea of reconciliation and wholeness, not just for me, but for my neighbour, I mean, we could peel layers back of what that is doing to us. And I mean, that's on the relational side. I think the other thing that you get in the spiritual community, especially in the Christian tradition, is the right ordering of creation. There's an acknowledgement that there are, there's, there's evening and morning, there is, you know, there's limits to us. And so, this translates all the way down to stewardship. How do I care for this body? What is my view of the body? And I think the scriptures give us a tonne of language. The body is a temple. There's meaning and there's dignity to your human existence. It's not a platonic view, despite what some people have kind of read into the scriptures. There's not a dualism that says spirit good body bad. You know, Jesus takes on flesh, and the resurrection even is an indication that there is a beauty to creation that was originally good. And so it gives us language to say Hey, don't do these things, you know, the BlueZone diet, we mentioned things like this. There are habits and practices that are rightly ordered, they seem to be good for the body. And there's a why to it. That's just, it's deeper than vanity. It's more about stewardship.

Coach JPMD  25:14  
In Episode 11, I had the privilege of interviewing Dr. Richard Shaw, and we discuss how physicians can not just physicians, but anyone can overcome the shame that often binds us in our professions, let's join in on the conversation and find out how you are enough. That's, that's really, really good. And does that make sense? It does make sense to me. And it speaks to the Pareto Principle, doing that one thing that you can do to help trigger that brain connection, and also is to do it repetitively, over time to build a habit. And that's really great. And so you, you mentioned grace in the title. So how does Grace come into play with that, and what is grace?

Dr. Richard Shaw, DMFT, LMFT, LHMC  25:59  
So again, for me, when I define shame, as never good enough, or never enough, then grace is at least enough, if not more than enough graces, this idea, this construct of healing of breakthrough of knowing that, I mean, it doesn't mean I'm perfect, it doesn't mean I'm not in process. It doesn't mean I'm not on a journey. But I mean, in the relationship enough in the moment and enough in relationship to God and others that he is a part of that journey in that process in that healing place. And so it's helping people speak the truth about their enough pneus. Even when they struggle, even when they're working on it, the recovery idea is kind of a day to day process, right one day at a time. And the grace idea is not unlike that, where we are working on who we are, and the changes we're making on a day to day basis, knowing that I've got a chance and a chance and a chance and a chance to be able to make changes in my key relationships. And I'm an ordained minister as well. I believe that this starts in my relationship to something bigger and greater than who I am. 

Coach JPMD  27:23  
Absolutely. Marketing comes in many forms, and an episode 19 I believe that the only explanation for me meeting another Jude Pierre in the same county was through divine intervention. Same name, same town, same hospital system, and descendants from Haiti is just nuts. So listen to this conversation, because it was, it was a fun conversation. 

Jude Farley Pierre, MD  27:49  
Because after even you were like, Yeah, this was twilight zone. 

Coach JPMD  27:52  
Yeah. And I actually think I asked you for your licence. I said, let me see your licence. 

Jude Farley Pierre, MD  27:57  
Right. Yeah. 

Coach JPMD  27:58  
And then you said your dad's first name is my middle name. 

Jude Farley Pierre, MD  28:02  
That's absolutely correct. Antoine Pierre. 

Coach JPMD  28:04  
So you could have easily been a Jude Antoine Pierre. 

Jude Farley Pierre, MD  28:07  
Oh absolutely. 

Coach JPMD  28:08  
So in my infinite wisdom. You know, I said, You know what, you need to join us at access. Because I was like, I have to say it was selfish. On my part. I was like, We can do the marketing blitz on this and Jude Pierre and Jude Pierre, podiatrists, and internist on the same block. So you ended up moving your office or joining us on the same street, actually, right next door, two doors down from where my office was.

Jude Farley Pierre, MD  28:35  
We were actually pretty much next door. I think you were 5362. And I was 5374. 

Coach JPMD  28:41  
Yeah, it was great marketing. I mean, it was just gonna cause mass confusion and, and cross promotion. Yeah.

Jude Farley Pierre, MD  28:49  
The hospital was the worst because I think there are times when you were on call, and you had patients sitting in the hospital for at least three or four days before we even found out because they would admit them under my name.

Coach JPMD  29:01  
I don't know if we should admit that right now. 

Jude Farley Pierre, MD  29:03  
Probably not. Though, it worked out well. 

Coach JPMD  29:07  
So actually, recently, it's still happening. So recently, I was I was being Judah and Creole Judah is like nosy and I listened to everything my staff is saying on the phones and try to try to interject if I need to the way they speak to patients. But last week, we had like a plethora of phone calls. And they kept saying no, this is this is not a podiatrist office, this is the internist office. I'm like why they keep saying that why? So I do a Google search. And I do a Google search on your name. And my phone number pops up on your Google on your Google page. So I had to actually contact and it's interesting cuz I tell in our course on the llama course I have a course on marketing that actually tells providers that they need to go on Google make sure that stuff is updated, because who knows what they're doing online. So that caused a mass confusion. So there you have it, my year end, cliff note review of the what I thought were the best episodes or clips from the best episodes of 2021. It's my first year end review, first year of podcasting, we've got over 20 episodes recorded and it's just, it's just been amazing that I was able to do this while practicing and, and it's just, it's just a testament to my focus and dedication to not just helping my patients but also helping physicians and helping the population. Now, there's certainly more that I could have added to this episode. But I wanted to keep it relatively short. It's been an amazing year. And I want to thank all of your listeners, for supporting me and sharing the podcast with your friends. And I want to reiterate that I'm here for you. I want to be that resource to help you understand the business of medicine and, and really how to live long, powerful and fulfilling lives as health care providers. And I want to wish you a happy new year for the bottom of my heart.