Physician burnout and quitting medicine - Chris Borth

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Thanks so much for joining us today, Chris.

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If you could give our audience a bit of an intro as to who you are, your childhood, and

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your paths to where you are today.

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Sure.

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Thank you very much for inviting me.

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It's been something I've been looking forward to.

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Yeah, I was thinking about, you might ask me to introduce myself, and I realized that

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the cliche is that people like talking about themselves, but I actually don't really love

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talking about myself, but I'll do my best.

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So childhood, I was born and raised in Kitchener Waterloo, which I sort of recognize is in

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this global era is not all that exciting a background.

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I'm back in Kitchener Waterloo after some years away, but yeah, I think back on childhood,

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it was a very good time in my life.

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One aspect of my childhood that people ask me that I think stands out for me is my mother's

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family were refugees from Eastern Europe.

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They were ethnic Germans who had to flee Romania.

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They lived in a multi-ethnic community with Germans, Hungarians, Romanians, and Serbs,

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but people knew that the Russians were not fond of ethnic Germans, and so they fled.

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And they spent some years traveling through Europe.

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I believe they lived in Austria and then France, and that went on for years.

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But family legend has it that my grandfather, my mother's father, was very anxious to get

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citizenship, which to be fair is a pretty legitimate concern as we know today with people

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fleeing various regimes.

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And he believed that that would happen or could happen faster in Canada, so they ended

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up in Canada.

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And they came to Kitchener Waterloo because at the time, this would have been in the early

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1950s, it was thought that there were a lot of German-speaking people in Kitchener, which

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there were, although I think they thought it would be kind of like back home where you'd

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go into the store and you could speak German or whatever else, but that wasn't the case.

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In the 1950s, it might have been the case in the early 20th century.

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But anyway, what I'm going with this is that growing up, so first generation Canadian, and

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I actually, my parents both worked, so I lived at my grandparents because there was a duplex.

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I'm actually in that house right now because we bought it from my grandmother as a state

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when she died.

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And at the time it was duplexed, and my parents lived upstairs, my grandparents were downstairs,

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and so when my parents went to work, I spent the entire day with my grandparents, as a

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preschooler.

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And I am told that my first language was German, which I guess this is a very long drawn out

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way of getting to the idea that I grew up feeling a little bit like an outsider.

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There was a fair bit of anti-German sentiment in Canada at the time.

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It was pretty soon after I grew up in the 70s and 80s basically, and there was still a fair

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bit of anti-German sentiment.

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So even though, obviously in the real world, I pass as an Anglophone Canadian, but when

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I brought people home to my house and there's people speaking German, and it was awkward

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at times.

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And I think what that gave me was a little bit of empathy into several things.

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One of them being what it feels like to be a bit of an outsider.

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So that colored my childhood for sure.

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I've enjoyed, like, you know, it's easy now, speaking and understanding German as an asset

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in 2024, but at the time it was a bit awkward.

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That said, I had a good childhood.

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My parents are very thoughtful people.

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They're still very high functioning.

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They're both working actually still.

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And yeah, where do I go from there?

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I went to Queens University, did a biochemistry undergraduate degree.

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I worked a little bit in industry during that.

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Toward the end of that I had a summer job at a chemistry lab, and my supervisor was Swiss,

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and he asked me what I wanted to do when I graduated.

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I said, well, ideally I'd love to go to Europe and work in my field in a German-speaking

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country.

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And a couple months later he basically came to me and said, I have lined up a job for

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you in Switzerland with a friend of mine.

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So I went to Switzerland for a year, worked for Hoffman La Roche again in a lab.

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And then that was a contract.

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So I was done, I came back, and I had a PhD in biochemistry lined up, but then applied

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to medical school and did that instead.

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And so all told, except for the year in Switzerland, I was in Kingston through my undergraduate

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degree in medical school, and then I did a five-year urology residency, and then spent

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an extra year doing a locum year there before eventually coming back to Kitchener Waterloo.

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My parents, again, were here.

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At the time we moved back, my grandmother was still alive, and there's a fair bit of

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extended family around here.

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And yeah, I worked as a urologist for, well, from 2005 until I closed my practice last

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year, 2023, so for that long.

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Yeah, I don't know what else you want to know.

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I guess I should mention that around, I don't know if we're going to talk about medical

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burnout, but around 2016 I started to realize I was experiencing burnout, boredom.

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You realize after a while most medical specialties are highly repetitive and there isn't a whole

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lot new.

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You know, again, if we're going to talk about burnout, I'm happy to dive into that.

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But I started looking for directions I could go that would be more positive than I would

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enjoy more, and I eventually decided that I was interested in business enough to actually

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do a business degree, and I did an MBA.

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I was fortunate enough that here in Kitchener Waterloo there's a part-time MBA program through

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Laurier Lazaridis, School of Economics and Business, and so I did that while still practicing,

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and that actually worked very well.

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It was a wonderful experience.

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People ask, you know, as a physician, did you enjoy doing the MBA?

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What was it like?

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I loved it.

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I loved the subject matter.

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I think it's made me a better person, I hope.

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Maybe my wife, hopefully she agrees, but I really enjoyed it.

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And then since then, I've been trying to forge a, trying to build a second career at the intersection

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between medicine and business.

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And again, fortunate enough that we have this vibrant tech ecosystem that includes a fair

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bit of med tech and health tech here in Kitchener Waterloo.

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So I've worked with a number of startups and an advisory and sort of guidance role.

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Just recently, I'm working with a local AI startup called Primal.

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They're trying to build some healthcare products, and that's been lovely.

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They're wonderful people.

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I've enjoyed that work very much.

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And I should mention before I, I'll stop rambling soon, but I got pulled back into clinical

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medicine.

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I've been doing some locom work north of here, which I've actually enjoyed very much.

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So after over a year of not practicing urology at all, I've been doing that, you know, at

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least, I guess five or six days a month.

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And I've actually surprised me how much I've been enjoying it.

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The working conditions are very different from what led to my burnout in my primary practice.

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But so to be fair, there is that, but, but it's been kind of nice to get a little bit

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of exposure to clinical medicine again.

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Let's go deeper into physician burnout.

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There seems to be a lack of meaning and purpose in work for us.

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It's something I've been feeling a lot of my colleagues have commented on it.

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I'm one of my favorite books as man search for meaning by Victor Frankel.

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He's a psychiatrist in the concentration camp.

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And then for those listening who don't know about it, essentially, he talks about the

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people who give up in concentration camps during the Holocaust and then people who don't.

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And the difference is they have meaning and purpose usually driven by someone they love.

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So the question I have for you is how do we get meaning and purpose back into medicine?

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And why do you think medicine has lost its purpose and meaning for physicians?

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Right.

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Yeah, that's a great question.

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A lot to unpack.

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Yeah, I guess, I mean, I would back up a little bit and say, I think my experience of burnout

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and I think when you go through it, you do spend a lot of time thinking about it and

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analyzing it and wondering, like, you know, where could I've gone differently and might

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have made a difference.

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And I often quote a friend of mine who said, who says that medical burnout is not caused

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by a single variable.

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She calls it death by a thousand cuts.

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And I think a lot of those factors are systemic.

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We have entities like the Ministry of Health, the college, whose interests are very siloed,

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even though they intersect in the life of a physician.

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And so, you know, oftentimes you'll see situations where the college will essentially implicitly

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say, well, we're agnostic about that.

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That's between you and the Ministry or that's between you and the OMA.

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And likewise, those other siloed entities will do the same thing.

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And I think that that, like, to the point about, you know, meaning in clinical medicine,

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I think that does become very disillusioning, right?

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You think, well, I've approached this in good faith and I put a lot into it and I try to

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be my best every day and give meaning to this job.

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But these other interests are behaving in ways that take away that meaning.

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And I mean, I don't know if I've directly answered your question, but I think the answer

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is it's really hard, like, because those are monolithic forces that we don't really have

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a lot of power over, right?

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I think I'm sure you're familiar with Jillian Horton, who speaks very articulately about

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burnout.

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She's, I believe, a family physician and she lectures on medical burnout.

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And I think she's, and there's other people too, but she does a very good job of framing,

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you know, so the cliche, of course, is that institutions, like, say, a hospital that has

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been a major factor driving your burnout will pay lip service to burnout mitigation and

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say, well, you know, you should do yoga, you should meditate, be more resilient, Rashaan,

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right?

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And that doesn't help at all.

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And so Jillian Horton talks about the fact that until those systemic work environment

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factors are mitigated, we will never see the end of burnout.

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And I believe that very strongly.

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Because, you know, you could look at it too as like intrinsic versus extrinsic motivation

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or factors like that.

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And the reality is you can't intrinsically, you know, meaning your way out of those systemic

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problems.

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Again, I don't know if I've really answered your question, but.

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Yeah.

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Let's go back to when you were a biochemistry major.

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I majored in epidemiology and I kind of struggled with this question of whether I should pursue

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that as a master's in PhD and going to public health.

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As opposed to medicine, as opposed to if I'm being frank with you engineering, which was

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what I wanted to do.

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But we can get into that later.

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We'll prompt the decision to go to med school as opposed to pursuing a more, for lack of

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a better word, scientific or more true science.

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Yeah.

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And that's something I've thought a lot about because like you, I had an affinity for engineering

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as well.

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I never really, you know, pursued it seriously, but my father's an engineer.

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And it's just, you know, there is the appeal of that hybrid, you know, space between theory

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and practice that engineers, they solve problems with a whole lot of information.

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My path to biochemistry, I don't know if it's interesting to anyone else.

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I find it interesting.

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So I was, I had been interested to some extent in a medical career, even in high school.

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And I was never, you know, I knew people who were just so driven from an early age to be

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a physician.

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I actually knew a guy, we were in the same class of medical school who had known he wanted

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to be a pediatric emergency room physician since he was like 12 years old.

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And that's in fact what he actually did, which to me is ridiculous.

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Like I was like, well, do I want to do that?

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Or do I want to pursue a scientific career?

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And so where I was going with this is in high school, I told a guidance counselor that I

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might be interested in, in a medical career.

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He said, well, and you got it, you got to apply to life sciences.

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So I did that.

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And I was in the Queens life science program for exactly one year and I hated it because

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almost everyone else in the program wanted to go to medical school.

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And I wasn't actually 100% sure that I wanted to do that.

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And so you're in these classes with these people that are incredibly competitive and

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driven, but they're not, they're not actually all that interested in the underlying subject

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matter that they're studying at the time.

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It's all about a pathway.

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And I found that to be a significant turnoff.

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So large classes, people are only there as a, you know, a stepping stone.

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So I ended up looking around at adjacent programs and discovered that the biochemistry

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program at Queens was very good and also very small.

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And so I switched into that.

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And by, by third year, my classes were down to like a lot of them were just with the other

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biochemistry students in my year, which was literally like 15 people.

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And it was awesome.

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I loved those classes.

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The professors were speaking to a small lecture hall full of people that were actually interested

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in biochemistry, right?

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A couple of us ended up going to medical school in the end, but at the time it wasn't about

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a pathway.

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It was about, you know, in the moment, I want to know about biochemistry.

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But then, yeah, I, you know, I spent enough time in labs and around disillusioned, pure

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scientists and, and I, and I guess I thought as well that, you know, we should talk about

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this too.

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I don't think a lot of people who are interested in a medical career actually know what the

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reality looks like before they end up practicing, right?

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So I didn't, I assumed that medicine existed at this sort of sweet spot between science

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and art, which, okay, it kind of does, but in, in clinical practice, it doesn't feel

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like that most days, right?

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And I definitely come from a fairly humanistic background and upbringing.

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So that, that resonated with me in ways that pure science or say engineering didn't.

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And that's, that was sort of how I ended up applying and eventually doing it.

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Talk to me about the decision to go back to clinical medicine.

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Just in the last few months, you mean?

228
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Yeah.

229
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So, I will admit that there was an extremely practical mundane reason and it was that in

230
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the spring when my CPSO license turned over, I was very conflicted about, you know, what

231
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I would do about that.

232
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Because as you know, it's very costly to, to renew it.

233
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I wasn't practicing at all and I hadn't been practicing for a year, but it, you know, it

234
00:17:01,080 --> 00:17:04,560
struck me that it would be foolish to give it up entirely and then potentially want it

235
00:17:04,560 --> 00:17:08,720
back, which is not that easy to get back.

236
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So I contacted them and basically discovered that not only do I have to pay the CPSO renewal

237
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fee, but also you have to have CMP coverage, which I didn't.

238
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I had stopped it because I wasn't practicing, which in my opinion is completely irrational.

239
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But anyway, it's a rule.

240
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So, so then I thought, well, if I'm going to spend this money on renewing my license

241
00:17:31,640 --> 00:17:37,320
and paying for malpractice insurance in a context where I have literally zero clinical revenue,

242
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that's a little bit hard to justify.

243
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So I reached out to a friend.

244
00:17:41,640 --> 00:17:45,760
I had been doing some local work.

245
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It's an O1 sound where I've been helping out again and I had been doing that in the late

246
00:17:50,760 --> 00:17:56,400
2000s, but I stopped during the pandemic because my kids were young and I couldn't really travel

247
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up there.

248
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And so I reached out to my friend and colleague there and said, I suspect that the ship has

249
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sailed on that and you probably don't need me, but this is my situation.

250
00:18:05,320 --> 00:18:06,920
Is there any way I could help out?

251
00:18:06,920 --> 00:18:15,280
Because I'm looking for ways to justify the cost of starting up my, you know, whatever

252
00:18:15,280 --> 00:18:16,680
my license and my CMPA.

253
00:18:16,680 --> 00:18:21,640
And he said, in fact, we would be thrilled if he came up because I'm super behind on

254
00:18:21,640 --> 00:18:22,640
follow-ups.

255
00:18:22,640 --> 00:18:24,320
I have nowhere to put people.

256
00:18:24,320 --> 00:18:27,760
My secretary would be thrilled if you come, you know, even just once in a while.

257
00:18:27,760 --> 00:18:29,720
And so that's how it started.

258
00:18:29,720 --> 00:18:32,560
And I was a bit apprehensive, as you can imagine.

259
00:18:32,560 --> 00:18:35,920
I had envisioned potentially never practicing again.

260
00:18:35,920 --> 00:18:42,200
I wouldn't say I decided firmly that I never would, but at least on a moving forward basis,

261
00:18:42,200 --> 00:18:45,800
I had no specific intention of going back to clinical medicine.

262
00:18:45,800 --> 00:18:48,360
So I didn't know what to expect, like what I like it, what I hated.

263
00:18:48,360 --> 00:18:55,200
I was certainly not enjoying clinical urology in its previous iteration, but I've actually

264
00:18:55,200 --> 00:18:56,520
quite enjoyed it.

265
00:18:56,520 --> 00:19:05,480
And part of that is that the cultural context there is much more positive and team-oriented.

266
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And I've recognized that I really value that.

267
00:19:08,640 --> 00:19:13,720
I don't enjoy being a lone wolf, which is what most hospital-based specialists are.

268
00:19:13,720 --> 00:19:16,240
You know, you did some hospitalist works, you know what it's like.

269
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You're on your own, more or less.

270
00:19:19,040 --> 00:19:24,960
You might get some support from, say, a consultant that you involve in a patient's care, but

271
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for the most part.

272
00:19:25,960 --> 00:19:31,560
And what I tell a lot of people, too, is that you're not only, it's not strictly true that

273
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you're on your own.

274
00:19:33,040 --> 00:19:39,280
In many cases, the systemic, the many systemic factors line up in a way that they're actively

275
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opposing you.

276
00:19:40,280 --> 00:19:44,000
And in fact, in some cases, they're trying their hardest to throw you under the bus at

277
00:19:44,000 --> 00:19:46,000
all times, right?

278
00:19:46,000 --> 00:19:48,800
So that becomes very, very exhausting.

279
00:19:48,800 --> 00:19:54,800
And where I'm going with this is that the work environment in own sound is very different

280
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from that in my experience.

281
00:19:56,360 --> 00:20:03,400
It's very, there is much more of a collective dynamic, you know, we're kind of in this together.

282
00:20:03,400 --> 00:20:04,400
People are nicer.

283
00:20:04,400 --> 00:20:08,800
So, yeah, I've been pleasantly surprised how much I've been enjoying it.

284
00:20:08,800 --> 00:20:20,080
Yeah, I've seen a shift in increase in accountability almost for patient outcomes thrown on to physicians,

285
00:20:20,080 --> 00:20:23,840
but that goes along with a decrease in control.

286
00:20:23,840 --> 00:20:32,000
And I think that the sense of a lack of autonomy is likely contributing to a burnout as well.

287
00:20:32,000 --> 00:20:33,000
Absolutely.

288
00:20:33,000 --> 00:20:38,760
But yeah, I mean, as a surgeon, again, I would say that so, you know, take one individual

289
00:20:38,760 --> 00:20:43,200
example, you have a patient who urgently needs an operation.

290
00:20:43,200 --> 00:20:47,120
A lot of the time getting that done for them, you know, you would think that, I mean, there's

291
00:20:47,120 --> 00:20:51,840
an operating room that's there and it's for elective cases, but it's also for emergency

292
00:20:51,840 --> 00:20:52,840
cases.

293
00:20:52,840 --> 00:20:55,200
So the system should be set up to do this stuff.

294
00:20:55,200 --> 00:21:00,280
But in reality, at every turn, people are trying to stop you, you know, we have no beds,

295
00:21:00,280 --> 00:21:03,520
you can't you can't bring that patient from the other hospital.

296
00:21:03,520 --> 00:21:06,960
But that patient, you know, needs an urgent operation or they'll die.

297
00:21:06,960 --> 00:21:11,400
Well, we have no beds and you didn't fill out this form properly.

298
00:21:11,400 --> 00:21:13,560
So you'll have to fill it out again.

299
00:21:13,560 --> 00:21:14,560
You can't do it from home.

300
00:21:14,560 --> 00:21:18,520
You'll have to come in in person, you know, all these things that, you know, are put

301
00:21:18,520 --> 00:21:22,680
in their roadblocks to getting patients looked after.

302
00:21:22,680 --> 00:21:23,680
That becomes exhausting.

303
00:21:23,680 --> 00:21:32,360
I think this is a wider trend in Canada in which all the golf leaves and people usually

304
00:21:32,360 --> 00:21:38,120
say these are banks and are telecommunication companies, but I would sort of put hospitals

305
00:21:38,120 --> 00:21:44,840
in that in that category as they really aren't accountable for their decisions to anyone.

306
00:21:44,840 --> 00:21:46,320
Right.

307
00:21:46,320 --> 00:21:51,760
Apart from maybe the Ministry of Health, but that doesn't even seem to matter as much.

308
00:21:51,760 --> 00:21:57,520
There are a lot of physicians listening who would have loved to be in your shoes six months

309
00:21:57,520 --> 00:22:01,120
ago where you were not practicing clinical medicine at all.

310
00:22:01,120 --> 00:22:04,480
The biggest barrier for them is finances.

311
00:22:04,480 --> 00:22:11,040
Talk to me about your financial path on how you were able to set yourself up so you could

312
00:22:11,040 --> 00:22:12,600
leave medicine.

313
00:22:12,600 --> 00:22:13,600
Yeah.

314
00:22:13,600 --> 00:22:21,080
Well, I always tell people quite upfront that I was not even close to being financially

315
00:22:21,080 --> 00:22:24,040
independent and ready to retire.

316
00:22:24,040 --> 00:22:28,200
So my patients were saying, oh, I heard you're retiring and I'd say, nope, I am not retiring.

317
00:22:28,200 --> 00:22:31,600
I am not financially able to do that.

318
00:22:31,600 --> 00:22:35,480
I'm quitting.

319
00:22:35,480 --> 00:22:42,840
I did have a buffer, although I viewed that buffer as essentially, well, it is retirement

320
00:22:42,840 --> 00:22:43,840
savings.

321
00:22:43,840 --> 00:22:48,960
So for the last year and a half, I've certainly chewed through some of that, but I don't know.

322
00:22:48,960 --> 00:22:54,960
I think you have to take risks in life and you have to accept that.

323
00:22:54,960 --> 00:23:00,040
So my financial plan 10 years ago was what it was and I've had to deviate somewhat from

324
00:23:00,040 --> 00:23:01,040
that.

325
00:23:01,040 --> 00:23:03,240
But I do a lot of this.

326
00:23:03,240 --> 00:23:07,520
I wouldn't say it's a bit absurd to say I do this for my children.

327
00:23:07,520 --> 00:23:15,240
I guess on some level I do, but I definitely have been guided by, I was aware that they

328
00:23:15,240 --> 00:23:22,160
were listening to my wife and I complain incessantly about the realities of working in clinical

329
00:23:22,160 --> 00:23:27,280
medicine and I don't think that's particularly good for them to say, well, he complains about

330
00:23:27,280 --> 00:23:29,880
it all the time, but he's not actually doing anything about it.

331
00:23:29,880 --> 00:23:31,800
So I went back to school.

332
00:23:31,800 --> 00:23:36,520
No, definitely multiple reasons I did that, but on one level it was to set an example

333
00:23:36,520 --> 00:23:41,040
for my kids, say, well, you didn't like it, so he changed it.

334
00:23:41,040 --> 00:23:46,080
But again, there is risk and financial risk is definitely one of those risks.

335
00:23:46,080 --> 00:23:50,240
My fingers are crossed that this is going to eventually pay off and I believe that it

336
00:23:50,240 --> 00:23:56,520
will, but I think you have to definitely prepare yourself for a lean period when you're changing

337
00:23:56,520 --> 00:23:57,520
careers.

338
00:23:57,520 --> 00:24:05,400
Yeah, I think most people I talk to, including myself, my income, if I were to transition

339
00:24:05,400 --> 00:24:15,080
and I have not been brave enough to take that leap yet, would be about a fifth to a half

340
00:24:15,080 --> 00:24:18,600
of my clinical income.

341
00:24:18,600 --> 00:24:22,520
And yeah, I'm nowhere near financial freedom.

342
00:24:22,520 --> 00:24:33,720
How do you, is this, how do you decrease your anxiety on the lack of income in terms of,

343
00:24:33,720 --> 00:24:37,680
are you saying, okay, I'm going to give this a shot for one year, two year, three years,

344
00:24:37,680 --> 00:24:40,960
or is it, no, this is what I'm doing for the rest of my life.

345
00:24:40,960 --> 00:24:46,400
And I'm going to figure out a way to make enough income so I'm comfortable and my kids

346
00:24:46,400 --> 00:24:47,400
are comfortable.

347
00:24:47,400 --> 00:24:50,800
It may not be my clinical income, but it will be enough.

348
00:24:50,800 --> 00:24:52,320
How do you decide what that number should be?

349
00:24:52,320 --> 00:24:55,240
Should it be 75% of your clinical income?

350
00:24:55,240 --> 00:24:58,880
And then, yeah, I didn't really approach it that way.

351
00:24:58,880 --> 00:25:02,760
And maybe I should have, like, I think, for sure, a more prudent way to approach this

352
00:25:02,760 --> 00:25:10,240
would be to, you know, you could continue practicing medicine and just try to, you know,

353
00:25:10,240 --> 00:25:16,880
restrict your hours enough to gradually increase whatever alternate, alternate career you're

354
00:25:16,880 --> 00:25:19,440
trying to build.

355
00:25:19,440 --> 00:25:20,640
And I didn't do that.

356
00:25:20,640 --> 00:25:22,480
I was pretty burnt out.

357
00:25:22,480 --> 00:25:28,280
And I really did not enjoy the work environment in Kitchena Waterloo.

358
00:25:28,280 --> 00:25:32,160
But yeah, I don't know if I would view it as sort of, like, sure, I could tell you what,

359
00:25:32,160 --> 00:25:38,680
ideally, I would like to be earning, and I'm not, but for me, it was basically a necessity.

360
00:25:38,680 --> 00:25:42,960
My former career was not only not working for me, it was harming me.

361
00:25:42,960 --> 00:25:44,880
And I needed to do something different.

362
00:25:44,880 --> 00:25:51,480
And on multiple levels, you know, there was the PTSD, the burnout, also the boredom, the

363
00:25:51,480 --> 00:25:54,200
lack of intellectual stimulation.

364
00:25:54,200 --> 00:25:58,480
And that's, I think, for a lot of physicians, that has to be a huge disappointment to think,

365
00:25:58,480 --> 00:26:03,320
well, you know, the public thinks that this is super interesting and challenging, and

366
00:26:03,320 --> 00:26:06,400
you're making up creative solutions to people's medical problems.

367
00:26:06,400 --> 00:26:10,480
One of the realities, you're not doing that 99% of the time, you're just following guidelines,

368
00:26:10,480 --> 00:26:11,480
right?

369
00:26:11,480 --> 00:26:12,480
It's boring a lot of the time.

370
00:26:12,480 --> 00:26:16,360
And then when you, that's compounded by the fact that a lot of patients aren't actually

371
00:26:16,360 --> 00:26:19,160
all that, well, they're not grateful at all, right?

372
00:26:19,160 --> 00:26:21,360
They take you for granted.

373
00:26:21,360 --> 00:26:24,760
Do you think it's always been boring, Chris, or is that a new phenomena?

374
00:26:24,760 --> 00:26:28,920
And if it's a new phenomena, are people different now?

375
00:26:28,920 --> 00:26:32,200
Because that is, I hear that a lot, and I experience that as well.

376
00:26:32,200 --> 00:26:37,400
But I do wonder why older physicians don't seem to say it's boring, or it's not intellectually

377
00:26:37,400 --> 00:26:38,400
stimulating.

378
00:26:38,400 --> 00:26:42,080
Yeah, I think that's an excellent question, and I thought a lot about that.

379
00:26:42,080 --> 00:26:46,240
But I think that to some extent it has become more boring, because, I mean, guidelines are

380
00:26:46,240 --> 00:26:47,920
a good thing, obviously, right?

381
00:26:47,920 --> 00:26:51,880
Like having somebody make something up, and, you know, while this works for me, so I'm

382
00:26:51,880 --> 00:26:53,480
going to do it to all my patients.

383
00:26:53,480 --> 00:26:55,160
That's nonsense, right?

384
00:26:55,160 --> 00:26:59,800
But for sure, the reality, the flip side of guidelines is that it makes everything a recipe.

385
00:26:59,800 --> 00:27:03,000
And it's the same recipe almost every time, right?

386
00:27:03,000 --> 00:27:05,120
So that's, I think that's somewhat different.

387
00:27:05,120 --> 00:27:09,800
That wasn't, you know, guidelines really only started being part of the fabric, what, like

388
00:27:09,800 --> 00:27:13,320
10 or 20 years ago, maybe a little bit more.

389
00:27:13,320 --> 00:27:16,840
But I think that that piece that I mentioned that I think, you know, if you go back far

390
00:27:16,840 --> 00:27:19,600
enough, maybe you have to go back to the 80s or 90s.

391
00:27:19,600 --> 00:27:25,840
But I think that patients were much more grateful, you know, they put a value on it.

392
00:27:25,840 --> 00:27:31,560
I think for me, a pet peeve of mine is that when healthcare is quote unquote free, the

393
00:27:31,560 --> 00:27:34,320
implicit assumption is that it has no value, right?

394
00:27:34,320 --> 00:27:38,320
So then people, and I guess, you know, it's always been like that in our lifetime.

395
00:27:38,320 --> 00:27:39,920
So why is it different now?

396
00:27:39,920 --> 00:27:44,600
Well, I don't know, I guess there's been enough propaganda around that or something, but people

397
00:27:44,600 --> 00:27:47,080
don't seem particularly grateful for the care.

398
00:27:47,080 --> 00:27:51,200
There are exceptions, as you know, like some people are enormously grateful, and that's

399
00:27:51,200 --> 00:27:52,200
very gratifying.

400
00:27:52,200 --> 00:27:58,120
But yeah, I, and then you were so, when did it change?

401
00:27:58,120 --> 00:28:04,000
I think you asked, is that, so I think it's been changing very gradually, but it definitely

402
00:28:04,000 --> 00:28:05,880
is much more noticeable.

403
00:28:05,880 --> 00:28:09,680
You know, it was no, it was more noticeable toward the end of my practice in kitchen water

404
00:28:09,680 --> 00:28:11,120
earlier than it was at the beginning.

405
00:28:11,120 --> 00:28:15,080
So I think it is an inexorable change over time.

406
00:28:15,080 --> 00:28:19,600
With the rise of guidelines in algorithmic medicine, do you think we're over trained?

407
00:28:19,600 --> 00:28:25,240
This is another way of asking, do you think NPs and PAs should replace us?

408
00:28:25,240 --> 00:28:30,760
And then in the future, should AI replace us and can it?

409
00:28:30,760 --> 00:28:33,880
My take is, and I don't claim to know the answer to that.

410
00:28:33,880 --> 00:28:38,040
I think it's a very challenging question that we will have to witness how it plays out and

411
00:28:38,040 --> 00:28:43,000
see, but my sense is, maybe it's a bit overly optimistic, but I think that those sorts of

412
00:28:43,000 --> 00:28:48,080
changes are just going to push us to a different place in the value chain of delivering healthcare.

413
00:28:48,080 --> 00:28:53,680
And in an ideal world, it'll put us in a position, the value chain that's more interesting and

414
00:28:53,680 --> 00:28:55,160
less burnout driving.

415
00:28:55,160 --> 00:29:01,440
That may not be the way it plays out, but I think that AI and, you know, alternative

416
00:29:01,440 --> 00:29:07,200
healthcare providers have the potential to make being a physician a much more interesting

417
00:29:07,200 --> 00:29:10,080
and gratifying job.

418
00:29:10,080 --> 00:29:12,520
I think in terms of being over trained, I don't know.

419
00:29:12,520 --> 00:29:20,680
I do believe that, like I can recall specific examples where I made a significant difference

420
00:29:20,680 --> 00:29:24,520
in someone's care because of something I remembered from training.

421
00:29:24,520 --> 00:29:27,640
You know, there wasn't any guideline.

422
00:29:27,640 --> 00:29:32,200
And everyone else involved in the care of the patient was like, oh, we would have done

423
00:29:32,200 --> 00:29:33,880
this and that would have been really bad.

424
00:29:33,880 --> 00:29:39,320
And I only knew that because I was well trained.

425
00:29:39,320 --> 00:29:43,760
So I don't think that that, I think you're right that to some extent that's what happens

426
00:29:43,760 --> 00:29:48,600
with guidelines, but there are scenarios that guidelines don't cover or scenarios where

427
00:29:48,600 --> 00:29:54,080
you have to say, look, the guideline is great for this, but if you apply it to this, then

428
00:29:54,080 --> 00:29:55,640
that's not going to work out very well.

429
00:29:55,640 --> 00:30:00,160
And it takes insight and experience and knowledge to know, you know, which of those scenarios

430
00:30:00,160 --> 00:30:01,160
applies.

431
00:30:01,160 --> 00:30:05,640
Yeah, there's a couple of themes that come to mind there.

432
00:30:05,640 --> 00:30:11,520
One is we're happy to pay for things that we want, but we're not happy to pay for things

433
00:30:11,520 --> 00:30:12,760
that we need.

434
00:30:12,760 --> 00:30:18,240
We think certain things should be nonprofit, whereas we're okay with certain things being

435
00:30:18,240 --> 00:30:19,240
for profit.

436
00:30:19,240 --> 00:30:22,520
And it's never made sense to me why that distinction exists.

437
00:30:22,520 --> 00:30:31,560
But you know, we think if something is a human right, then we should be nonprofit, which

438
00:30:31,560 --> 00:30:35,920
the downstream effect of that is people aren't paid as well, you know, attract the best and

439
00:30:35,920 --> 00:30:37,280
brightest.

440
00:30:37,280 --> 00:30:44,120
And there seems to be somewhat of a contradiction there.

441
00:30:44,120 --> 00:30:45,880
What are your thoughts there?

442
00:30:45,880 --> 00:30:52,480
Yeah, I think, I mean, to me, recent examples of exactly what you're talking about are the

443
00:30:52,480 --> 00:30:59,120
shifts within dentistry in Canada where the Canadian government is saying, well, and you

444
00:30:59,120 --> 00:31:02,200
know, I think your point is well taken, like those are fundamental rights.

445
00:31:02,200 --> 00:31:07,080
Like why should you lose your teeth because you don't have dental care?

446
00:31:07,080 --> 00:31:11,360
It's absurd because of course that's a huge hit to your health, right?

447
00:31:11,360 --> 00:31:16,040
So on one level, I think it's great, but on another level, like I tell my dentist, like

448
00:31:16,040 --> 00:31:17,040
you guys are screwed.

449
00:31:17,040 --> 00:31:20,800
It's going to be just like medicine, they're going to pay you some absurd fee that doesn't

450
00:31:20,800 --> 00:31:23,000
actually cover your overhead for that procedure.

451
00:31:23,000 --> 00:31:25,960
And they'll just be like, well, that's the way it is now.

452
00:31:25,960 --> 00:31:28,520
Or another one is subsidized daycare.

453
00:31:28,520 --> 00:31:30,440
That's a fundamental public good.

454
00:31:30,440 --> 00:31:31,440
It's fantastic.

455
00:31:31,440 --> 00:31:35,360
But you know, you can see where the economics go.

456
00:31:35,360 --> 00:31:39,200
You know, daycares would be like, well, we can't afford to look after children for those

457
00:31:39,200 --> 00:31:40,200
rates.

458
00:31:40,200 --> 00:31:44,520
And then, you know, that's what happens with publicly provided services.

459
00:31:44,520 --> 00:31:48,640
Yeah, I think this is going to sound very privileged.

460
00:31:48,640 --> 00:31:52,480
And I am very privileged in a lot of ways.

461
00:31:52,480 --> 00:32:00,040
But it seems like there is a percent of society we can economically support.

462
00:32:00,040 --> 00:32:07,200
So say if 10% of people spend all their money on iPhones and to take it further drugs and

463
00:32:07,200 --> 00:32:10,080
gambling, then that's okay.

464
00:32:10,080 --> 00:32:15,000
But if 50% of people spend all their money on what their wants are and don't save any

465
00:32:15,000 --> 00:32:19,280
money for their needs, then the economic model starts to crumble.

466
00:32:19,280 --> 00:32:20,280
Yeah.

467
00:32:20,280 --> 00:32:25,680
So I think that's something we kind of, I don't know, we need someone smarter than me

468
00:32:25,680 --> 00:32:27,280
to figure that number out.

469
00:32:27,280 --> 00:32:28,280
Yeah.

470
00:32:28,280 --> 00:32:31,720
I mean, that kind of economic problem is incredibly complex.

471
00:32:31,720 --> 00:32:38,160
And there's a huge risk, I think, of what they call the wicked problem where you do

472
00:32:38,160 --> 00:32:41,600
something that you think is going to help, but in fact, you make it worse.

473
00:32:41,600 --> 00:32:47,040
But yeah, I think, you know, so we say, well, we are economically a collective and we have

474
00:32:47,040 --> 00:32:51,320
to look out for the, you know, people that can't afford, again, dental care.

475
00:32:51,320 --> 00:32:52,480
Well, I agree with that.

476
00:32:52,480 --> 00:32:54,520
But I think your point is correct.

477
00:32:54,520 --> 00:32:59,840
Like, you know, there comes a certain percentage of the population, if they're not able to

478
00:32:59,840 --> 00:33:03,400
contribute in that way, then eventually it isn't affordable.

479
00:33:03,400 --> 00:33:06,160
And I guess, yeah, you guys see where you're going with this, that our publicly funded

480
00:33:06,160 --> 00:33:09,280
healthcare is headed toward that outcome potentially.

481
00:33:09,280 --> 00:33:11,080
We just won't be able to afford it.

482
00:33:11,080 --> 00:33:14,760
Yeah, let's talk about AI a bit more.

483
00:33:14,760 --> 00:33:22,960
We seem to be very comfortable when AI makes mistakes we would make rarely.

484
00:33:22,960 --> 00:33:26,640
But we're not comfortable in the AI makes mistakes we wouldn't make.

485
00:33:26,640 --> 00:33:32,280
So when you think about regulating AI, say AI misses a PE, a very obvious PE, someone

486
00:33:32,280 --> 00:33:36,040
who has cancer, comes in and attack a car here, shortness of breath, and AI is like

487
00:33:36,040 --> 00:33:38,800
whatever this is, is a UTI.

488
00:33:38,800 --> 00:33:42,480
Anything just complete nonsense to us, right?

489
00:33:42,480 --> 00:33:49,520
But it catches more PE's in people who come in with, because my right pinky is tingling,

490
00:33:49,520 --> 00:33:52,000
something that doesn't make sense to us.

491
00:33:52,000 --> 00:33:53,920
How should we regulate that AI?

492
00:33:53,920 --> 00:33:59,800
Should we just look at it as a whole and say, okay, if you're doing a net positive, then

493
00:33:59,800 --> 00:34:01,360
you're good to go.

494
00:34:01,360 --> 00:34:04,200
Or is that you cannot make these mistakes?

495
00:34:04,200 --> 00:34:09,040
Because one of the problems with AI is it drifts, which is from what I understand, I'm

496
00:34:09,040 --> 00:34:13,920
not an engineer, but what people have explained to me is it goes wonky.

497
00:34:13,920 --> 00:34:18,640
It's like it goes drunk, or it's on drugs for like a second and it just completely loses

498
00:34:18,640 --> 00:34:20,720
its mind.

499
00:34:20,720 --> 00:34:23,400
And there's no way to control for it.

500
00:34:23,400 --> 00:34:25,960
There is a way to control for hallucinations, which is different.

501
00:34:25,960 --> 00:34:29,720
You can put parameters, but this drift phenomena you can't control for.

502
00:34:29,720 --> 00:34:33,440
So how do you think about regulating AI and its mistakes?

503
00:34:33,440 --> 00:34:37,160
Yeah, I mean, that's again, that's a very challenging question.

504
00:34:37,160 --> 00:34:38,920
Good for you for asking it.

505
00:34:38,920 --> 00:34:44,400
I guess the first thing I thought of when trying to think of how I would answer that

506
00:34:44,400 --> 00:34:52,240
is that, so I'm a big believer that I think the terms that are used are AI co-pilots versus

507
00:34:52,240 --> 00:34:54,200
AI agents.

508
00:34:54,200 --> 00:35:01,560
And I think to some extent, what I would respond to the scenario you posed is that I don't think

509
00:35:01,560 --> 00:35:05,000
we're anywhere near relying on AI agents.

510
00:35:05,000 --> 00:35:10,280
So completely putting control over processes into AI.

511
00:35:10,280 --> 00:35:13,280
I think that having an AI co-pilot makes a whole lot of sense.

512
00:35:13,280 --> 00:35:17,720
So in theory, the specific example you mentioned, there would be a human radiologist who would

513
00:35:17,720 --> 00:35:21,040
also be looking at this and saying, well, that doesn't make sense.

514
00:35:21,040 --> 00:35:24,520
There's clearly a PE here or vice versa.

515
00:35:24,520 --> 00:35:30,320
So I think that to me, that's the reality is, and I get a lot of the fears around AI are

516
00:35:30,320 --> 00:35:36,080
really fears about AI agents rather than AI co-pilots.

517
00:35:36,080 --> 00:35:41,320
Three years ago, I was working in urgent care and I felt uneasy.

518
00:35:41,320 --> 00:35:47,600
I went to check my heart rate and I was 126.

519
00:35:47,600 --> 00:35:51,360
That was how I recognized I was burnt out.

520
00:35:51,360 --> 00:35:53,880
And I was working full time in clinical medicine.

521
00:35:53,880 --> 00:35:56,960
I had a startup, I had a young baby at home.

522
00:35:56,960 --> 00:35:57,960
I went home.

523
00:35:57,960 --> 00:35:58,960
I rested.

524
00:35:58,960 --> 00:36:02,800
I did not go to the doctor when I should have.

525
00:36:02,800 --> 00:36:06,800
But that was the beginning of my burnout journey.

526
00:36:06,800 --> 00:36:11,000
Talk to me about how you've recognized you were burnt out.

527
00:36:11,000 --> 00:36:16,160
How long did that journey take and what made the decision to say, okay, I've had enough.

528
00:36:16,160 --> 00:36:18,040
I need to leave this setting.

529
00:36:18,040 --> 00:36:19,040
Yeah.

530
00:36:19,040 --> 00:36:28,400
I mean, I think that I'm also inclined to answer that with reference to anecdotes because

531
00:36:28,400 --> 00:36:30,120
the reality is it is a continuum.

532
00:36:30,120 --> 00:36:37,040
I will say I've thought a fair bit about the fact that I used to use the term PTSD quite

533
00:36:37,040 --> 00:36:42,560
liberally when I think a lot of the time what I was really talking about was burnout.

534
00:36:42,560 --> 00:36:49,080
But that said, I mean, I do recall instances that are pretty classic like PTSD.

535
00:36:49,080 --> 00:36:56,560
And it's funny too because I think for surgeons, there's legit PTSD around body horror and

536
00:36:56,560 --> 00:36:57,560
stuff.

537
00:36:57,560 --> 00:37:02,000
And I remember in my intensive care rotation as a surgery resident, there was a guy who

538
00:37:02,000 --> 00:37:06,480
had necrotizing pancreatitis and they used to bring the general surgery team would wheel

539
00:37:06,480 --> 00:37:07,480
him out of the O.R.

540
00:37:07,480 --> 00:37:09,680
every day or wheel him out of the ICU to the O.R.

541
00:37:09,680 --> 00:37:14,160
every day, wash out his retroperitoneum and then bring him back.

542
00:37:14,160 --> 00:37:19,840
And eventually they installed somebody actually literally went to Canadian Tire and bought

543
00:37:19,840 --> 00:37:23,240
a zipper, which they then so they wouldn't have to open and close it.

544
00:37:23,240 --> 00:37:25,200
They just used a zipper on his abdomen.

545
00:37:25,200 --> 00:37:26,200
And that's horrifying.

546
00:37:26,200 --> 00:37:31,200
You know, this poor guy was there for probably the entire entirety of my ICU rotation.

547
00:37:31,200 --> 00:37:35,080
It's like, how can this possibly happen to somebody?

548
00:37:35,080 --> 00:37:41,440
So there's I think there's legit PTSD and not just a surgery, but in medicine more generally.

549
00:37:41,440 --> 00:37:47,120
And I remember where I was going with this is I remember doing a circumcision in the

550
00:37:47,120 --> 00:37:49,760
operating room and the tissue was garbage.

551
00:37:49,760 --> 00:37:56,680
Like this guy had like awful chronic fibrosis and chronic inflammation.

552
00:37:56,680 --> 00:38:01,080
And I was thinking like, you know, this is one of the most trivial operations in urology.

553
00:38:01,080 --> 00:38:05,000
I, you know, sorry to interrupt Chris, just for our audience, when you said the tissue

554
00:38:05,000 --> 00:38:07,200
is garbage, what does that mean?

555
00:38:07,200 --> 00:38:09,720
And what does that mean in terms of, you know, operation?

556
00:38:09,720 --> 00:38:13,080
That sounds derogatory to a layperson because it isn't meant to be.

557
00:38:13,080 --> 00:38:21,000
But basically, you know, if you can imagine normal skin is supple and healthy and pink

558
00:38:21,000 --> 00:38:25,760
or, you know, beige or whatever.

559
00:38:25,760 --> 00:38:31,560
In some instances, human skin, when it's diseased is not that it becomes, you know, it has the

560
00:38:31,560 --> 00:38:38,840
consistency of styrofoam, I guess, hard to come up with with examples.

561
00:38:38,840 --> 00:38:44,640
But there are scenarios where, you know, the routine performance of an operation is almost

562
00:38:44,640 --> 00:38:48,960
completely impossible because the tissue quality is so poor that it just doesn't do what tissue

563
00:38:48,960 --> 00:38:49,960
is supposed to do.

564
00:38:49,960 --> 00:38:52,200
You can't, you know, put it back together again.

565
00:38:52,200 --> 00:38:53,560
And that's what I was faced with.

566
00:38:53,560 --> 00:38:57,680
You know, on one level, I would say a circumcision is a pretty mundane operation.

567
00:38:57,680 --> 00:39:00,600
But on another level, I literally had a panic attack in the oar.

568
00:39:00,600 --> 00:39:02,840
I doubt anyone else perceived it.

569
00:39:02,840 --> 00:39:05,600
But I bet you my heart rate was 120 and I felt faint.

570
00:39:05,600 --> 00:39:09,400
And I'm like, you know, the other thing with a lot of this stuff is you're on your own,

571
00:39:09,400 --> 00:39:10,400
right?

572
00:39:10,400 --> 00:39:14,560
If I was at a teaching program, I would have a resident and then you're just talking about

573
00:39:14,560 --> 00:39:17,000
it and saying, wow, this is going to be really hard.

574
00:39:17,000 --> 00:39:18,920
But there's nobody there that appreciates it.

575
00:39:18,920 --> 00:39:21,560
They're just like, they're looking at the clock thinking, when is he going to get done

576
00:39:21,560 --> 00:39:22,560
this operation?

577
00:39:22,560 --> 00:39:30,320
Anyway, so an instance of not the only instance of like a legit, you know, PTSD response.

578
00:39:30,320 --> 00:39:34,960
But I think the, I can't remember what your original question was, but the, how did I,

579
00:39:34,960 --> 00:39:39,000
what did my burnout pathway look like?

580
00:39:39,000 --> 00:39:44,800
I just got, you know, I was historically a very empathetic physician, I think, like

581
00:39:44,800 --> 00:39:45,800
unusually so.

582
00:39:45,800 --> 00:39:48,840
And I would, you know, we could talk a lot about maybe being more empathetic puts you

583
00:39:48,840 --> 00:39:52,320
at a higher risk of burnout because I think that's actually true.

584
00:39:52,320 --> 00:39:56,440
But I found myself thinking, wow, I wasn't really all that nice to that guy.

585
00:39:56,440 --> 00:40:01,200
And to be fair, that guy wasn't nice at all to me, but I lost my patience, you know, and

586
00:40:01,200 --> 00:40:02,480
I was sharp with them.

587
00:40:02,480 --> 00:40:04,240
I said, you know, whatever.

588
00:40:04,240 --> 00:40:08,800
So I started noticing instances like that more frequently.

589
00:40:08,800 --> 00:40:13,880
And just, you know, again, the boredom, like coming home and thinking, why, why am I doing

590
00:40:13,880 --> 00:40:14,880
this?

591
00:40:14,880 --> 00:40:15,880
I hated, you know, that sort of thing.

592
00:40:15,880 --> 00:40:23,880
It just became, I guess, putting it another way, the positive experiences diminished

593
00:40:23,880 --> 00:40:30,480
in frequency and intensity and the negative experiences increased, you know, in the opposite

594
00:40:30,480 --> 00:40:31,720
way.

595
00:40:31,720 --> 00:40:34,840
And then at a certain point, I'm like, I really can't do this anymore.

596
00:40:34,840 --> 00:40:39,160
And I struggled through because, you know, the MBA I did took three years and I was still

597
00:40:39,160 --> 00:40:41,320
working through it and beyond it.

598
00:40:41,320 --> 00:40:45,360
And sometimes you just do what you got to do, right?

599
00:40:45,360 --> 00:40:49,400
There's lots of people out there who are working through burnout because they at least financially

600
00:40:49,400 --> 00:40:51,240
have to, right?

601
00:40:51,240 --> 00:40:52,240
So I did that.

602
00:40:52,240 --> 00:40:56,840
But yeah, that's, that's, I don't know, you talk all day about burnout, but that's sort

603
00:40:56,840 --> 00:41:00,720
of one way of framing what my experience was.

604
00:41:00,720 --> 00:41:08,880
If you could talk to 20 year old Chris, biochemistry major, hasn't written the MCAT yet, has not

605
00:41:08,880 --> 00:41:11,200
applied for med school.

606
00:41:11,200 --> 00:41:13,840
What would you tell him in general life advice?

607
00:41:13,840 --> 00:41:17,800
And would you advise him to not pursue medicine?

608
00:41:17,800 --> 00:41:19,840
Yeah, that's tough.

609
00:41:19,840 --> 00:41:26,200
I mean, my kids would probably say, yeah, never a million years based on what they,

610
00:41:26,200 --> 00:41:30,200
you know, what they witness us saying at home and also what we actually say directly to

611
00:41:30,200 --> 00:41:31,800
them, like, don't do this.

612
00:41:31,800 --> 00:41:36,520
But I don't know.

613
00:41:36,520 --> 00:41:40,720
There have been enough upsides to my career choices that I don't think I would tell 20

614
00:41:40,720 --> 00:41:43,240
year old me not to go to medical school.

615
00:41:43,240 --> 00:41:48,120
But I think I might have, like one thing that I really look back, this wouldn't be 20 year

616
00:41:48,120 --> 00:41:52,120
old me be more like, you know, almost 30 year old me.

617
00:41:52,120 --> 00:41:58,320
But I think, again, I think I mentioned earlier about enjoying the team dynamic.

618
00:41:58,320 --> 00:42:01,760
And the other the other piece that I would say is missing and was missing through most

619
00:42:01,760 --> 00:42:03,400
of my career was the teaching part.

620
00:42:03,400 --> 00:42:04,600
I really enjoyed teaching.

621
00:42:04,600 --> 00:42:05,600
I was good at it.

622
00:42:05,600 --> 00:42:09,480
I actually won a clinical teaching award when I was there in Kingston.

623
00:42:09,480 --> 00:42:17,360
So I would say to myself, you should seriously consider a career path that allows you to

624
00:42:17,360 --> 00:42:22,520
be part of a team and to teach because you you're good at that and you enjoy it.

625
00:42:22,520 --> 00:42:23,520
So that would be one thing.

626
00:42:23,520 --> 00:42:25,020
But yeah, it's tough.

627
00:42:25,020 --> 00:42:29,440
I mean, you know, I made a good living for a few years as a physician.

628
00:42:29,440 --> 00:42:34,440
I definitely found as my burnout got worse, my ability to, you know, actually generate

629
00:42:34,440 --> 00:42:38,720
enough revenue to to exceed my overhead got harder and harder to do.

630
00:42:38,720 --> 00:42:43,440
But but it's pretty, you know, people think what physicians make is obviously much more

631
00:42:43,440 --> 00:42:44,600
than what they actually make.

632
00:42:44,600 --> 00:42:46,760
But the reality is it is a pretty well paying job.

633
00:42:46,760 --> 00:42:52,120
And so it's kind of hard to say, oh, yeah, I would probably still do it.

634
00:42:52,120 --> 00:42:56,480
But I think I would have, I know stuff now that would have altered my pathway in important

635
00:42:56,480 --> 00:43:02,840
ways might have mitigated my or slowed down my burnout.

636
00:43:02,840 --> 00:43:09,800
What advice do you have for physicians looking to break into the startup ecosystem as advisors?

637
00:43:09,800 --> 00:43:12,680
Right.

638
00:43:12,680 --> 00:43:18,720
I guess depending on the context, like for geographic reasons, I've mostly been focused

639
00:43:18,720 --> 00:43:22,320
on the Kitchener Waterloo tech ecosystem.

640
00:43:22,320 --> 00:43:29,120
And the reality is that it is normal not to have to pay for advisory services.

641
00:43:29,120 --> 00:43:34,320
So so prepare yourself to not make any money for a while.

642
00:43:34,320 --> 00:43:39,480
I actually had a really lovely conversation with a physician earlier today who asked me

643
00:43:39,480 --> 00:43:41,120
exactly exactly that question.

644
00:43:41,120 --> 00:43:47,360
I said, well, what I would probably do now and that I frankly didn't really do over the

645
00:43:47,360 --> 00:43:54,800
last year is say to any startup that wants to talk to me, I will I will offer you, I

646
00:43:54,800 --> 00:43:58,720
will I will be your chief medical officer and I'll do it for free.

647
00:43:58,720 --> 00:44:02,840
And if I think if you did that enough times, you eventually generate a certain level of

648
00:44:02,840 --> 00:44:06,720
credibility and people would be then coming to you and then eventually it would become

649
00:44:06,720 --> 00:44:08,880
remunerative.

650
00:44:08,880 --> 00:44:11,400
So that would be one thing.

651
00:44:11,400 --> 00:44:22,480
I think the other thing is learning about some of the business type frame framing to

652
00:44:22,480 --> 00:44:26,280
these situations because it's one thing for a startup to come to you and say, well, so

653
00:44:26,280 --> 00:44:27,280
you're a radiologist.

654
00:44:27,280 --> 00:44:29,240
I've got this radiology startup idea.

655
00:44:29,240 --> 00:44:30,520
What do you think?

656
00:44:30,520 --> 00:44:33,680
And in general, the answer is, yeah, that sounds interesting.

657
00:44:33,680 --> 00:44:35,360
You should pursue that.

658
00:44:35,360 --> 00:44:40,680
But I think it helps a lot to say to be able to say, well, okay, but you're going to face

659
00:44:40,680 --> 00:44:46,400
this problem and this problem and the pathway you've chosen is probably not going to work.

660
00:44:46,400 --> 00:44:49,800
So or or if you're going to do that, you're going to have to do this, this, this and this

661
00:44:49,800 --> 00:44:51,800
and you're going to have to be financed for that.

662
00:44:51,800 --> 00:44:53,360
And a lot of you know what I mean?

663
00:44:53,360 --> 00:44:57,880
So that sort of advice is takes a level of knowledge that I think a lot of physician

664
00:44:57,880 --> 00:45:02,280
advisors need to acquire and don't have from the get go.

665
00:45:02,280 --> 00:45:07,320
So how would they acquire that knowledge?

666
00:45:07,320 --> 00:45:12,600
I think the MBA is the easy answer there, but if they can't afford or don't have time

667
00:45:12,600 --> 00:45:15,120
for an MBA.

668
00:45:15,120 --> 00:45:23,000
I think, you know, so one of the most surprisingly good courses that I took at Laurier was their

669
00:45:23,000 --> 00:45:24,640
entrepreneurship class.

670
00:45:24,640 --> 00:45:27,960
I thought it was going to be fluff, but it was actually excellent.

671
00:45:27,960 --> 00:45:32,200
And every week, the professor would bring in a guest lecturer for even for like half

672
00:45:32,200 --> 00:45:36,800
an hour, an actual entrepreneur and like anything, some of them were better than others.

673
00:45:36,800 --> 00:45:40,320
But there was one guy, well, a number of them were excellent, but the one guy in particular

674
00:45:40,320 --> 00:45:45,440
that I recall in this context is he was asked, you know, a similar question.

675
00:45:45,440 --> 00:45:50,880
This wasn't physicians, but you know, what, what, what's your best advice for someone,

676
00:45:50,880 --> 00:45:52,280
you know, who wants to be an entrepreneur?

677
00:45:52,280 --> 00:45:55,280
And he said, read, read everything you can.

678
00:45:55,280 --> 00:46:01,120
And I think nowadays with the transparency of information on almost any topic, you can

679
00:46:01,120 --> 00:46:03,760
train yourself very, very effectively.

680
00:46:03,760 --> 00:46:07,120
It's not going to be the same as doing an MBA, obviously, but you know, you can come

681
00:46:07,120 --> 00:46:09,880
pretty close and depending on how committed you are.

682
00:46:09,880 --> 00:46:15,000
So reading voraciously, falling into rabbit holes and, you know, thinking, man, I just

683
00:46:15,000 --> 00:46:18,560
spent two hours reading about this obscure topic.

684
00:46:18,560 --> 00:46:22,280
That's I think a reasonable way to approach it as well.

685
00:46:22,280 --> 00:46:28,120
Well, we didn't cover, I think, about 70% of the questions I have here.

686
00:46:28,120 --> 00:46:30,120
Well, I'm sorry.

687
00:46:30,120 --> 00:46:33,080
No, this is amazing.

688
00:46:33,080 --> 00:46:34,080
Let's do a part two soon.

689
00:46:34,080 --> 00:46:35,080
Oh, sure.

690
00:46:35,080 --> 00:46:36,080
I'd love to.

691
00:46:36,080 --> 00:47:05,080
It's a pleasure.