112 - Burnout Isn’t Just About Workload - It’s the Shame No One Taught Younger Physicians to Handle - REPLAY

Have you ever wondered why so many physicians silently struggle with burnout, shame, and the pressure to be perfect—even when their careers look successful on the outside?

In this powerful replay episode from season 1, Coach JPMD speaks with Dr. Richard Shaw about a topic that’s both deeply personal and professionally urgent: physician shame. With September marking National Suicide Prevention Month, this episode sheds light on why the internal weight of “never being enough” is leading to devastating consequences—and what doctors can do to finally heal.

• Learn a 3-step framework for overcoming shame with practical, grace-centered strategies
• Understand the dangerous link between perfectionism and physician burnout
• Discover how vulnerability and safe relationships can become the antidote to hidden pain

If you're a physician or healthcare professional seeking freedom from internal pressure and silent suffering, press play now and learn how to break free from shame—one healing truth at a time.

If you need emotional help or even contemplating suicide please reach out to the following resources.  We are here to help you.

Pamela Wible, MD
https://Idealmedicalcare.org/contact

National Suicide Prevention Line
1-800-273-8255 (TALK)

Dr. Richard Shaw
http://www.shamenomore.com

Link to book - Shame No More
https://a.co/d/1gOBOOk

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

Coach JPMD (00:00.034)
Have you ever wondered why so many of us struggle silently with burnout, shame, and the pressure to be perfect, even when our careers look successful on the outside? Welcome back to another episode where I help younger physicians decrease stress and increase income by transitioning from corporate to independent practices, even without any business experience. 

In this replay episode, you'll discover three things. Number one, a three-step framework to overcoming shame with practical grace centered strategies. Number two, the dangerous link between perfectionism and physician burnout. And number three, how vulnerability and safe relationships can be the antidote to hidden pain. So tell us about yourself. Tell us how you came to write this book and kind of what your journey was.

Dr. Richard Shaw (02:11.722)
So, I'm from small town, Nebraska. I mean, small town, a population of 160 people. And I was a preacher's kid and a farmer's kid. And those things didn't always fit so well for me. And so, education made a lot of sense to me. So, I kind of went to school and just kept going to school. And I enjoyed that a lot along the way. I did some psychology work, some sociology work, professional counseling work.

theology, some marriage and family therapy and by the time I was done, I think they're ready to kick me out because I've been there a long time and ended up with a couple of masters and a doctorate in the field. And this topic of shame has always been really important to me. It was a personal thing before it became a professional thing. I came from a good family but not a great perfect family. There isn't any perfect families out there.

And so, as I worked through some of my own stuff and tried to make sense of this thing that now people talk about as shame, the language made so much sense to me and I found myself just spending a lot of time reading, making sense of it the best I could for myself and then making application to other people around me, professionals and anybody who would listen. So that has landed me in a professor position now for over 25 years training.

Dr. Richard Shaw (02:11.722)
master's level professional counselors and marriage and family therapists full-time, and with my own practice as well.

So this is all in Nebraska or did you move from Nebraska?

So started in small town Nebraska, ended up going to Asbury Seminary in Kentucky. And then from there, went to Fuller Seminary in Pasadena, California. That was a little bit of a challenge from Kentucky to California. And then George Fox University actually brought me up as a professor 27 years ago. And I've pretty much done all my professional work now in the Northwest, in the Portland metro area.

You think?

Coach JPMD (02:49.166)
So you gave me a story or you told me a story about it from thesis to book and you said something about it took you 25 years to actually write this book, but it came out in 2020. you're saying, you know, I actually ordered the book and it's on its way from Amazon, but I think I saw 231 pages. And so I calculated you wrote nine pages a year or something like that.

That's funny. I love it. So, the story really is that when I got to grad school in the late 80s, I took a course on professional counseling and I got introduced really for the first time to the language of shame and grace. And it was the first time that the language made sense for some of my experiences, some of my challenges and hurts. And so, that started me on a journey. And so, while I was in grad school,

I just used every opportunity I could to read and to research and write about the topics. And then in the 90s, I wrote my doctoral dissertation on the concepts of shame and grace. It turned into a course that I was gonna travel with a little bit and speak and then that I use at my current university. So it turned into a two-day course and I thought I would offer it a few times and it would go away.

In my world, dissertations usually mean, you know, more and more and more about less and less and less. And at the end of that process, they go into a library and they collect dust. Nobody ever really looked at them or reads them. That didn't happen. I offered this as a weekend course and people really responded to the material. And so it became a stable in our program. And now I've taught it for over 25 years.

and knew that from that doctoral dissertation that I completed in the late 90s, at some point, it needed to get into another format. It needed to be a book. The truth is, I'm not a good writer. It's hard for me to do that. I would rather talk to you all day long or stand in front of an audience and talk than sit in my office and try to write. It's just not a gift that I have. And so, after teaching this for over 25 years,

Dr. Richard Shaw (05:06.4)
refining it, working through in many ways in the last year or two, it really came to a point where it was time to put it into this format. And so with some help from other people that were just really, really key, we were able to take the steps forward and get it published and get it out there to the public. And I just am humbled and happy. I couldn't be more content about what we have.

That's wonderful. you know, one of the reasons why you're here also is because shame has come up in several episodes of our podcast. One of the ones I recall is episode seven with Dr. Denry and just, you know, reviewing what physicians go through in their training. you know, we throw this word shame out all the time, but, I had to kind of sit down and take a step back and say, okay, what's the definition of shame? So if you look at Miriam Webster, it's a painful emotion caused by consciousness of guilt, shortcoming,

or impropriety. And I look at it as being such a negative thing, but we use it often. And we sometimes use it to get people to do something that we want them to do and threaten them with shame or, you know, it becomes a tool even sometimes in residency. I remember going through my rotations as medical student, third year, and was starting the surgical rotation.

One of our interns said, hey, you know what? If you're not sicker than the sickest patient in the ICU, then you need to be here at five o'clock in the morning. And I'm looking around, I'm like, whoa, these are some sick patients. So there's no way I will ever be sick. So I'll come to work sick. that's just not, in retrospect, that is just a horrible thing to tell someone. Because then we think that becomes a norm as a third year medical student. Then we go to the fourth year, then we do residency. So how do you deal with that?

How do you help others overcome that?

Dr. Richard Shaw (07:05.938)
So, let's start with your definition there and lots of authors have written lots of definitions on shame and grace and I'll tell you my personal, my definition of shame is never enough. Never enough. It's never enough. You're never a good enough doctor. You're never a good enough husband or wife. You're never a good enough son or daughter. You're never

good enough at whatever it is that you long and strive to do to make a difference in some way. And so, that shame pushes you to try to do more and more and more and more, but it's like a ladder that always has more rungs on it that you never get to the top of. So, shame is about never being enough, never good enough. And grace, by the way,

is enough, it's being enough. I tell my students in class that shame and grace are constructs. Shame is a construct for brokenness and grace is a construct for healing. So, that's how I think about those terms and you said it. Shame works, it works but the consequences that come with it are

devastating. Shame and fear will motivate us to climb that ladder to be better and better and better, show up at 5 a.m. or 4 a.m. or the night before or whatever. But the consequences that come with shame are so devastating. The fear that comes with that, the internal struggles that I can never get to this place that I strive to get to, to be enough. One author calls it

a shame attendant. It's like we have gremlins or a shame attendant that's always there that we can never quite escape that voice inside of us that continually tells us it's never enough. It is so powerful.

Coach JPMD (09:19.99)
Yeah, and I think it goes hand in hand with perfection, perfectionism. does. It Because we are taught to be perfect. We are taught that as physicians we need to know everything. And it took me a while to come to the point where a patient will ask me something and I say, I don't know. Right. And so, but we're not necessarily taught that. So what would you say is the worst outcome of shame in someone's personal life?

So, like you said, that perfectionism drives shame in us that somehow we have to be above reproach, we have to be perfect. I can only imagine what that must be like as a medical doctor or a surgeon to be able to be in that space where there's no room for error, there's no room for less than perfection. And the drive of that just is relentless. The truth is there's all kinds of consequences that come

a life of shame, the worst being that someone decides they can't do it anymore. It's just not worth it. And literally, they take their own life. Before that, it's the things that you probably would expect. It causes anxiety, it causes depression, it causes relationship issues with our significant others, in our parenting with our kids.

in our workplaces, whether we're the boss or working for someone else, this thing just drives us. And I love what you said. I do the same thing. It took me a long time in my classroom to say to students, I don't know, right? After 25 years in the profession, I'm supposed to be an expert in this field with this material.

They expect me to know the answers. I expect me to know the answers. And so, when they ask me something and I invite them to ask questions and I say, when I say to you, what a great question that is, I don't know. Let's explore, let's sort this out, let's figure it out together. You are literally helping me work on my own shame.

Coach JPMD (11:35.886)
Interesting. So, it kind of leads into the next question is what does it look like for someone that has no shame? Or I don't know if I can say has no shame or quote unquote no shame.

Yeah. So, interesting question because there's, I'm answer that in two ways. In a not healthy way, a person with no shame, we might call a narcissist or we might call a sociopath. In other words, they don't allow other people's opinions to impact them at all. Now, that's a negative no shame, right? I don't allow anything to impact who I am. I don't care.

what you say or what you think, you have no influence on me. By the way, side note, the opposite of that, sometimes we call it codependent. That's a person who cares too much what everybody else thinks about them. They want to make the world happy and they're willing to go to extreme levels in order to try to do that. So both ends of that spectrum, kind of the no shame and all shame

often is tied into a place of how we relate to other people. But no shame in a healthy way, healthy relationships and not letting shame or that shame attendant or those gremlins be there always pushing at our door looks like good boundaries, looks like being able to say no, looks like

being able to deal with consequences that come with the actions that we take. Having a healthy understanding of shame and grace allows us to make choices and live with consequences.

Coach JPMD (13:30.894)
Yeah, that's really powerful. So your book is titled, Shame No More, a framework for healing through grace. So what is that framework? Do you have like a stepwise process and the book that did come out last week, think, or? Last Friday. you give us a kind of a snippet and like a quick overview as to what that framework looks like?

the

Dr. Richard Shaw (13:56.302)
So, the idea of shame in a person, I say this in the classroom, shame would be bad enough if it just stayed in the person, just inside of me and I had to wrestle with my own personal shame. But the jump in shame that even makes it more powerful is that there's a systemic piece to it. It shows up again with my wife, with my kids, at work.

in the marketplace, in the world, in church, in business, in hospitals. And so shame is inside of me, but then it gets touched and triggered and impacted by all my key relationships. So we call that a systemic piece of shame. So it's more than just my own individual shame. And so really, the process of trying to work through that in healthy ways looks a little bit like this. Number one, I try to help people speak the truth.

out loud. Speak the truth out loud. When I'm getting tripped or triggered, when I'm struggling with my shame, I try to help people grab those moments when that's happening, slow it down and speak truths about themselves, about the circumstance, about others, about the relationship in that moment. And I hesitate to say too much on this because I know

Honestly, you will know way more about this than I, but as I understand it, literally what's happening in that process is we are helping people move moments that light up in our brains from the reptilian area to the prefrontal cortex where they have choices of what to do and what to say and how to move forward. When moments are trapped in our reptilian brain,

We basically have fight or flight as our moves. And so number one, we're capturing moments. We're slowing it down. We're moving in our brains where this moment lights up. And part of that process is helping people speak truth out loud. And then just really quick, second, it's small changes, small changes over and over and over and over. We know

Dr. Richard Shaw (16:20.546)
how change happens. That's how change happens. It happens a little bit at a time, over and over and over and over. And then third, we just try to help people practice that in the real world.

That's really, really good. And 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 it's really great. And so you mentioned grace in the title. So how does grace come into play with that? And what is grace?

except

Dr. Richard Shaw (17:03.96)
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. Grace is this idea, this construct of healing, of breakthrough, of knowing that I'm enough. 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'm enough in the relationship, enough in the moment and enough in relationship to God and others that he is a part of that journey and that process and that healing place. And so, it's helping people speak the truth about their enoughness 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.

episode.

For me, that's God, that's Jesus Christ, and I find my grace in relationship to Jesus. And then I'm challenged to live that out in my key relationships with my brothers and sisters in the world.

Coach JPMD (18:45.614)
And from a practical standpoint, I I can see exactly the things that you're talking about in that framework and in the decisions I've made financially. You know, I went through some short sales and stained my credit, had to list that on every application that I was applying for mortgages and credit. Some physicians have gone through lawsuits and then they have to report that. So what you're describing is that antidote and that way of understanding that, yeah, we are enough and

these things will pass and you're right, they have passed through better decisions moving forward through getting the steps in place for me to get out of debt, to be able to be in a powerful position financially. But the same is true for other decisions as well. That's really, really powerful stuff.

Thank you. The power of shame is in its silence. When I feel like I can't share this with another, I can't be authentic and honest and vulnerable with others, they'll never understand me, they'll never accept me, they're gonna affirm that I'm not enough. That's kind of that element of greatest fear is if I come face to face with my own personal shame.

and I decide to let somebody else into part of that world, they're going to affirm everything that I'm so afraid of inside of myself. And the truth is over and over and over, when I've stepped into that space of vulnerability with others and authenticity, you know what happens. People meet you there and they tell you their story and all of sudden,

We're like comparing stories of how we struggle in that place of hiddenness and sight and we break through in a way that allows me to share that, connect with another and affirm each other and we walk away closer than if we had to state on our own individual and keeping that stuff on the inside. Shame thrives in hiddenness, it thrives in darkness, it thrives in silence. We have to break through that and make it more okay.

Dr. Richard Shaw (20:59.618)
for people to sit around the table together and have real hard authentic conversations about ourselves and what we're gonna find often is most of the people at that table not only relate to it, they may have had very similar experience.

You're absolutely right. And that's happened to me multiple, multiple times. So, you know, I like to ask this question in most of my podcasts, but I think you've answered it already. And if it's not one thing, it's multiple things. What's the one thing you could tell a physician that they could do such that by doing it would help them overcome their shame? And I think you described that one thing, but what's a one first thing?

Part of that is to speak the truth out loud with another. If every one of us could find someone that we felt safe with, that we trust, that we're willing to kind of go to the wall with and bear our souls, including the stuff we don't tell most people and have that person that we're able to say, I'm going to speak some of these truths and some of these hurts out loud.

and receive some of the care and feedback and connection that happens with you. And then you tell me your story, which is probably what's gonna happen there. I mean, first, we bring those shame places out of the hiddenness and we put them in the light and they just don't survive there. And then the second part of that is now we're connecting in real ways with another surgeon, another human being.

who is also not perfect and trying to make sense of their own life in the world. And that connection that happens when we choose to step into that space, I'm not over dramatizing this. It will change your life.

Coach JPMD (22:58.606)
I'm so, so, so happy that I had you on the podcast today. Where can we find you? I know that you have the book coming out. It's on Amazon and I'll link that in the show notes. Is it a website or is there somewhere we can find you online?

So shame no more dot com is the best place to find me. Shame no more dot com. is not a fancy website. It's very simple, but that's the best place to find me. I'm in the Pacific Northwest in the Portland, Oregon area practice here. I'm a full time professor at George Fox University here and that's the best place to find me and to get more information about this along with that.

Finding shame no more on amazon.com. You know, it's funny when I first set up, I set up shame no more. my gosh, again, it's more than 25 years ago. I was sitting in my house in a bonus room on a simple computer trying to do this and I wanted no more shame. That was what was in my mind, but the website was gone. I couldn't get it. I couldn't trademark it. And so I'm sitting there and I decided to turn it on the chair and come up with shame.

no more. Learning to live with shame no more. Nobody had the website. I could trademark it. I grabbed it. And now, like I said, almost 30 years later, unbelievable to be able to work and walk in that freedom, the best I can and helping others to do the very same thing out of that shame.

Congratulations. Congratulations on your book. I know that this will be successful because I know that there's a lot of physicians that would want to hear the framework and how they can overcome their shame. It is possible. I know through my own personal story and you've described that in your personal stories as well. Thank you again and may God continue to bless you.

Dr. Richard Shaw (24:50.715)
My pleasure, thank you.

I am so excited for the opportunity to have interviewed Dr. Richard Shaw and discuss his book, Shame No More, a framework for healing through grace. And it's my hope that physicians and other healthcare providers will find peace in knowing that there is someone that cares for them out there. Know that my personal healing came only from sharing my feelings and my experiences and things that I went through over the past several years, not only as a physician, but as a human being.

especially sharing those things with the people that I trusted. So take a look at the show notes for links to Dr. Shaw's book and know that you are loved out there. What an eye-opening conversation with Dr. Richard Shaw that I had in season one on a topic that we don't talk enough about. Shame in medicine. As physicians, we are trained to be perfect, but perfection can come at the cost of our mental and emotional wellbeing. We are reminded that healing starts

when we speak the truth out loud and stop suffering in silence. Remember, you are enough. And there is grace and healing on the other side of vulnerability. Share this episode with someone you think needs to hear it and know that you're not alone on this journey. Thank you so much for listening to the podcast. If you'd like to hear more, subscribe, follow, your favorite podcast app so you'll never miss an episode.