Many physicians experience burnout at some stage in their careers, putting themselves, their patients, and even their colleagues at risk. With the amount of responsibility and ever-increasing hours, it’s not hard to see why this is such a common occurrence. However, this inability to find a work-life balance is not sustainable and should not just be accepted as the norm. So, in this episode, Dr. Jimmy Turner, an academic anesthesiologist and a certified coach for physicians, will join the show to share his advice for creating the time and mindset shifts you need to create a life you love.

Listen in as Jimmy explains the benefit of seeking professional help when you’re feeling burnout creep in and what you can do as a doctor to thrive in a broken medical system. You will learn what it looks like when a doctor thrives in medicine, how to take back your autonomy, and the importance of having clarity around what is most important to you.


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In Today’s Episode, You’ll Learn:

  • The benefit of seeking therapy when your life is feeling out of control
  • The difference between burnout and moral injury
  • How to thrive as a doctor in a broken medical system
  • What a self-determined physician is
  • How take back your autonomy

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Katrina Ubell: Well, hello there my friend. Welcome to today's episode. I  haven't had a guest in a while, and I'm really excited to bring  you this one today. 

You might have seen or heard that recently, there was a new  article published in the Mayo Clinic proceedings, which is a  peer reviewed journal that showed some very interesting,  shocking, yet not overly surprising results that 63% of physicians reported at least one symptom of burnout at the end  of 2021, and at the beginning of 2022. 

This was an increase from 44% in 2017, and 46% in 2011. Only  30% felt satisfied with their work-life balance compared with  43% five years earlier. This is a crisis. This is a real big  problem. And so, I heard about this article, and then the New York Times  picked it up. And on September 29th, there is an article written  by Oliver Wong (I'm assuming that's how you pronounce his  name) that goes into deeper information about that. 

And I feel like there's just a lot of talking about it. A lot of people  kind of being like, “Yeah, burnout, like it's so bad.” But I am  reading this going like, you guys, something has to happen. 

And I thought of my friend Jimmy Turner, he is an  anesthesiologist, he's also a coach, and he has gone through  burnout himself and now, coaches, physicians, men and  women, who are experiencing burnout. And he actually just  released a book really, really recently that I wanted you to know  more about. 

And so, I asked him to come on the podcast to talk more about  burnout, to really dig into it. The title of the book is called  Determined; How Burned Out Doctors Can Thrive in a Broken  Medical System. And I think that's the thing, we talk about this  somewhere in the interview, but no one is saying that the  medical system isn't broken. It totally is. 

But if that's the case (which it is), then what? It's like a yes and  kind of situation; what are we going to do in the meantime? And  the better we're able to get ourselves into a good place, the  more of an impact we're able to have in terms of healing and  fixing that broken medical system. 

So, I am just excited to have you listen to my conversation with  Jimmy. He talks about a lot of things that are in the book, but  there's tons more in this book that we didn't even have a  chance to get to. 

So, of course, you're going to want to pick up that book. I was  kind of joking at the end of the interview; people should just like  purchase a few copies and just like place them strategically  within the doctor's lounge at the hospital just like for the people  who need it. 

And so, just a little more information about Jimmy; the description for him on his book says, “Jimmy Turner, MD was  once the poster boy of a burned-out overachieving physician.”  Oh my gosh. “As a husband, father, and academic anesthesiologist, he  maintained excellent clinical outcomes, published RCTs, won  teaching awards, and even launched a successful podcast.”  With so much on his plate, he felt overwhelmed by stress,  which negatively impacted his home life and his health.” 

“After discovering coaching, Dr. Turner customized his principles and created the ACE Program to empower burned  out physicians. He continues to share industry perspectives as  the host of The Physician Philosopher Podcast focusing on all  things physician life, money, and mindset.” So, you'll definitely  want to check that out. 

Jimmy, he’s got a servant's heart. He really wants to help other  doctors to not go through the experience that he did, or at least,  to maybe get help faster to know that help is available,  

particularly male physicians. I mean, everybody but male  physicians as well, who are just not taking up coaching as a  legitimate option when they're feeling burned out as much as  women are. 

So, if you are suffering from burnout or know someone who's  suffering from burnout, this will be a really excellent episode for  you. So, please enjoy my conversation with Jimmy Turner. 

Katrina Ubell: Alright, Jimmy, welcome to the podcast, I'm so glad to have  you. 

 

Jimmy Turner: Yeah, I'm so glad to be here. I think it's going to be a fun  show. 

 

Katrina Ubell: It's really going to be fun. Okay, so before we jump into  this amazing book that you've written that I really, really thoroughly enjoyed — I would love for you to introduce yourself. Why don't you just start with introducing yourself, then we'll get  into your burnout story. Just tell us a little bit about yourself,  what you do. 

 

Jimmy Turner: Yeah, so my name's Jimmy Turner and it's funny when I  talk about this; I'm really big on identity. So, I'm a husband, I'm  a father of three kids. I love empowering other doctors. I happen to practice academic anesthesiology a few days a week  at this point. 

And still love practicing, but really, my big passion is empowering other physicians. And so, yeah, that's kind of what  I'm all about nowadays. 

 

The three things that I really focus on are helping people get that work-life balance. And that has to do with financial freedom and really mindset shifts that are required to practice medicine because you want to, not because you have to. And I want everybody to be able to decide whether you stay in medicine or not; you practice as much or as little as you want. So, that's me in a nutshell. 

 

Katrina Ubell: Amazing. So good, so good. So, you tell the story in your  book, but I would love for you to share your personal experience with burnout because like really on the surface, I  mean, you're that kind of person that like I'm reading all of the  things you've accomplished and I'm like, “Oh my gosh, like I  suck compared to this dude. This is incredible.” Like you're a highly, highly accomplished person. How does someone like that end up burned out? 

 

Jimmy Turner: Yeah, so for listeners that are familiar with the Enneagram, I'm a type three, wing two. So, what that basically means is I'm an achiever. So, I get my self-worth at baseline  predominantly before coaching. But I do fall back into this kind of routine from time to time. 

 

Basically, I get myself worth from achieving, from accomplishments, from getting things done. And so, people  always ask like “How do you get all this stuff done?” It's like I don't know what I would do with my life if I didn't constantly produce, constantly achieve. And so, you're right. 

 

Katrina Ubell: It feels like it's not like a choice. It's like I have to, or I  don’t feel fulfilled. 

 

Jimmy Turner: Yeah, it’s an intrinsic motivation. And, and so for me, like  it wasn't about going out and doing these things, it was just like  that's just what I do. Like that's my personality type. 

And so, yeah, I did all of my training at Wake Forest. So, United  Medical School Residency Fellowship all there. Stayed on  faculty, I'm on faculty at Wake now. 

 

And for me, like I was  always involved in leadership; student body president and I ended up being a co-chief resident. 

 

I was publishing a bunch of papers early in my career and  winning teaching awards. And part of that was that I was  starting to go down this journey of burning out that I'll kind of  share with you in a second. 

 

But what those ended up being was like these things, these accomplishments, these accolades, these little mountains that I  would kind of crest, and they would keep me up for a little bit. It  was kind of a hit of dopamine from achieving those things  because that's my personality, that's how I'm wired, is to achieve. 

 

And when I do, I get that little bump and then I'd settle back  down to my set point and would be kind of a little burned out.  And at first, it wasn't that big of a deal, but I'd kind of checked  all the boxes in academics, I'd done the research, I'd published  the RCTs, I had won teaching awards. I'm really good clinically  and I'd still say that I am today and I'm proud of that.

 

And I still had some leadership positions that kind of passed me up. And this isn't like one time, it was like four times, which is fine. The people that they chose are all incredible human beings and do a fantastic job of what they do. But yeah, it was for me, that's where my career direction, the trajectory I was going was leading. And so, I started kind of  feeling undervalued, not really appreciated at my job. 

 

And in the midst of that, I also had this experience where I couldn't be  there for tee-ball games and gymnastics practice and recitals  for my three kids. And being someone who identifies as a husband first, and a dad as a very close second, that was very hard for me. And so, I started feeling unappreciated. I started feeling like I couldn't really control the autonomy in my life, the personal schedule, and even some professional stuff. 

 

I did a fellowship and I couldn't do that a hundred percent of the  time, I wasn't allowed. And so, because of that kind of concoction of things, I started burning out. And it was completely ironic because I started my business as a personal finance blog. And the tagline has always been about wealth and wellness. And so, I used to say fighting burnout with financial  independence. And so, when I started burning out, I turned to  the thing that I taught everyone else to do; use financial  independence, kind of create some financial freedom, maybe  go part-time if you needed. 

 

And I did that, I built a business, it became a multi-six figure  business, and it didn't save me from my burnout. And basically,  after a couple of years of this, the point that I hit rock bottom, I was actually on a golf course, and I'm going to be playing golf  later today. It's something I love to do. I'm not good at golf. That's a very different thing than playing golf. But I'm going to go out today  and play. And I was actually on the second hole of golf course  with my buddy Mike, and the group behind us were standing in  the fairway, they teed off. 

And for those that don't play golf, like teeing off when someone's standing in the fairway is not safe. It's a hundred mile an hour golf ball. Like it can literally kill you. And so, it wheezes by our head and I just immediately for the first time in  my life, like my heart is in my throat, I'm having palpitations like tremor, which I have at a baseline by the way. 

 

I'd ran out of propranolol that controls my central tremor, that  it’d also been masking symptoms that I'd been having. I just didn't recognize. And so, looking back, I was like hot when everybody else wasn’t. I was sweating like it was a sauna in a room.  

 

Kristen and I, my wife, we were getting into more arguments,  which really wasn't a thing for us. 

Like we get into tiffs like any married couple, but like I was  starting to get angrier and angrier and angrier. I wasn't sleeping  at night. And so, I ended up getting diagnosed with Graves’  Disease. 

 

My PCP, she's amazing. She ordered a TSH and it was undetectable. And so, I was the quintessential doctor, the worst  patient. And I was burning out so badly at the time that I was  actually excited that I got diagnosed with Graves’ Disease. I  was like, finally, there's a reason for why I feel so miserable in  medicine. 

 

Despite all of these outward accomplishments and everything  looking great; I've got this great marriage, I've got these great  kids that are healthy. All of these things that I'm achieving, I  was burning out so badly on the inside that when I got diagnosed with Graves’ Disease, I was like good. Like I got a  medical diagnosis and I was excited. 

 

Katrina Ubell: Now, it's an explanation. Yeah. 

 

Jimmy Turner: Yeah, exactly. And so, started methimazole, got euthyroid, found out I was still burned out. So, financial freedom  didn't fix it, fixing my thyroid didn't fix it. 

 

And it really wasn't until I found coaching that I really started to  find some solutions to my burnout that I could personally put into place and kind of fight back against that system that was  burning me out. 

 

Katrina Ubell: So, help me to understand what your thoughts were about  coaching. Are you someone who's kind of like an early adopter  type of person who's like, “Yeah, I don't know what this is, but  know I need something, I'll try it?” 

 

Like we've kind of discussed you and I privately about how men  in general can sometimes be resistant to coaching. I mean, I  feel like men are just finally starting to open up to the idea of  therapy. So, maybe they're just a couple decades behind. 

 

This is of course, a generalization, but we do of course, have  some men who listen, but even more so, we have a lot of  people who listen who are partnered with a male doctor or have  a brother who's a male doctor or a father or a colleague, and  we know that male physicians are struggling too. 

 

So, I'm just curious because I feel like you're sort of like in our  world, sort of the first male doctor to really kind of come up and  not only benefit from coaching, but then to go, you know what, I  want to help other people with this too. 

 

So, I'm just curious, was there any issue with that or what happened with that?

 

Jimmy Turner: So, it's really interesting, because like this isn't a stereotype or a generalization. Like it is a fact that men are less  likely to get coached. It is a fact that men are less likely to get  therapy. 

 

And so, we know that there's something in terms of the wiring  for a lot of men that says “Asking for help is weakness, and this  idea that I'm going to figure this out on my own. Like if I got this  far in my career, then I can figure this out on my own. I don't need help.” Until it gets to the point where like they need so  much help that it's a really big problem for them — personally,  professionally-

 

Katrina Ubell: Or they're at a point of taking their life which is a really big  issue right now. 

 

Jimmy Turner: And we know that burnout’s linked to higher rates of  depression and suicide and that has become a bigger and  bigger problem. And so, because of that, I do think that there's  this stigma out there for men that exists for whatever reason. 

 

And so, men are less likely to ask for help. And that's backed  up by data. I mean, if you look at Shanafelt studies like the  people that participate in those studies, it's like, I don't even  remember; 70% women or something like that. And these are  studies that anybody can sign up for. 

 

So, the women self-select into these coaching studies, and it's still shown to be helpful among the men, but the men are less likely to ask for that help. And so, it has been interesting, but I  personally didn't have that same resistance. 

 

And the reason why is because I'm not just a physician, I'm also  an entrepreneur. And so, in the entrepreneurial space, coaching is very normalized. I mean, there are people that go to  conferences, there are people that have individual coaches. 

 

And this idea of accepting outside help and counsel and getting  a third person objective perspective to help you with your  entrepreneurial problems to find solutions is very normal. And a  lot of people in that space are women. 

And so, I was around a lot of women entrepreneurs, it felt very natural. And you're right, because there weren't a lot of male physician coaches. And honestly, I love being coached by  women. 

 

And so, I ended up having a woman coach and it  really, really benefited me. And so, it's exactly what you said. I was like, well, if this benefits  me, I know that this would be beneficial to other men and  women physicians who are struggling with burnout. So, why not  get the certification? Why not go and help those people and use  my knowledge and personal finance that I already built over  that time.

 

Because at the end of the day, the reason that you stay stuck in  medicine is because you can't financially afford to leave. I mean, that's always going to be a part of it. 

 

And so, the personal finance piece came along with me as I  entered the coaching world. But for me, there wasn't as much  hesitance, I think, as there is for most men because of that  entrepreneurial experience. 

 

Katrina Ubell: Yeah, that makes so much sense completely. Because  like in the corporate world, it's like, yes, every executive has  their executive coach. And even for entrepreneurs, having a  business coach, hiring people who know more than you and  can help you with whatever it is that you need help with is so  normalized. 

 

But for doctors, it's like, no, just like all you need is CME, go to  a conference every now and then, that's it. Yeah, that makes a lot of sense. 

 

And so, not to say that that's a good excuse or anything like  that, it just helps us to understand so maybe we can reach men  who are struggling a little bit better, helping to kind of shift that  perspective a little bit. 

 

So, let's touch on the word burnout. It's interesting, there's  more, I think, kind of like sensitivity around this than I even  really understood, you talk about it in the book. I definitely can  understand how the word burnout and kind of the ways some  people might think about burnout makes it seem like it's blaming the victim. 

 

Like we are the victim of a broken system as physicians. And  so, by asking us to work on ourselves, that's denying that  there's a problem. It's like a very all or nothing way of thinking.  It's like whose fault is it? There can only be one kind of group or  system or person to blame. 

So, if it's the physician, that means that the system gets off  scot-free. There's a lot of resistance to that. Of course, it makes  so much sense. Also, kind of this like, well, if you're struggling 

with burnout, that's like you must be weak or something's  wrong with you or you can't hack it. Or like all the things that  we're so afraid of when we've gone through such a lengthy  period of time to get to this place. 

I was just reading about like an organic chemistry professor  who got fired in in the New York Times. And people were  talking about, like these students were saying like this class is too hard and now, I'm not going to get into medical school and stuff. 

 

And it's like it starts so early, like can I hack it? Am I good  enough? And so, getting to a place where you finally feel like  you've sort of made it and then feeling like now, they're just  blaming me for not having a good experience of it. It's like you  feel like you're in a vortex of like the twilight zone. You're like,  what is actually happening? 

 

So, a lot of people prefer the word moral injury, the term moral  injury, instead. I would love for you to talk about this whole  concept and the difference between burnout and moral injury,  and how it affects physicians. 

 

Jimmy Turner: So, it's an interesting conversation because people really,  really do … I mean it's a giant elephant in the room when you  have this conversation because people really get riled up about  these two terms and which one it is. It's either moral injury or it's  burnout. 

And the subtitle of the book is what it is for a reason; How Burned Out Doctors Can Thrive In a Broken Medical System. It  is recognizing that the medical system is fundamentally and  systemically broken. 

 

And so, in philosophy, my business as the physician philosopher, I was a philosophy major – so, we would call us a  false dichotomy or an either or fallacy — it's referred to by both  names. And it's this idea that like you just explained, that it's  either moral injury or it's burnout. And I think that doesn't really  do justice to what's actually happening.

 

What I think is happening is that the system is fundamentally  broken, the medical system is broken, and that causes the  phenomenon of moral injury. That culture that surrounds  

physicians, that leads to the individual phenomenon of burnout. 

 

So, I think it's a both and, it's not an either or. I think that the  system's broken, we need to work on fixing it or healthcare  administrators and politicians, tort reform need to work on fixing  it. 

But at the same time, we don't have to remain powerless in that  situation while that system is broken. There are things that we  can do on an individual level to kind of fight back. And from a  business standpoint, this makes sense. 

 

Because the bigger picture is to empower enough physicians  that we might have that grassroots effort where we stand up  and say, “No, we're not willing to do this anymore” and fix that  culture that causes moral injury. 

 

But in the meantime, like I refuse to let doctors continue to get  burned out at epidemic rates. Just saying, “Hey, let's just wait  until the system gets fixed” because we all know that if that  happens, it's going to be a long time coming, and I'm not going  to leave doctors sitting there hurting in pain, not enjoying their  career, being burned out in medicine and not help them. 

So, it's a both and, it's not an either or. 

 

Katrina Ubell: Will you define moral injury, because I think that's the  term that maybe a lot of people are not familiar with? 

 

Jimmy Turner: Yeah. So, moral injury is the idea that you have the training, you have the knowledge, you have the expertise to  know how to care for somebody in a situation. And that might  include caring for yourself, but you're not able to do it because  of the systematic and systemic failures that exist in the system. 

 

So, for example, and there's a plethora of examples you can  come up with. But let's say that you're trying to take care of a  patient and you know the right thing to do, but they won't give 

you preauthorization. The insurance company won't let you do  it. 

 

Katrina Ubell: Who has not had this experience? Everybody has had  this experience. 

 

Jimmy Turner: And you got to go to the peer to peer just to prove that your medical training is sufficient to make the decision for  this thing this patient actually needs. Or maybe it's an electronic  medical record system that doesn't let you put the order in for  the thing that you know the patient needs and they're urgently sick. 

 

You're in an ICU setting and like you literally can't put the order  in because Epic or whatever EMR you're using is failing. And  so, those are examples where you know you have the  

knowledge, you have the expertise, and you're seeing people  get harmed because of systematic failures that exist, and these  obstacles and red tape you have to go through in order to help  people. 

 

And the same is also true when you are being harmed and you  know what the potential solution is, but you're not able or  allowed to put it into place. 

 

Katrina Ubell: Right. Oh my gosh. Just even having this discussion, like  I feel so much like kind of tension and anxiety in my chest. Like  it's just bringing back like so many memories like you've been saying, like getting to the tee-ball game and stuff. 

 

Like I remember having the school play and being so clear, you  guys, I have to be walking out the door literally at such and  such a time tonight. And then them still adding people on and  it's not the patient's fault, but you're like trying to rush and then  trying to rush through the traffic and like my poor kid, and what  if I miss it? 

And like, oh man, it was so stressful, and it felt so like it was happening at me. Like I cannot even leave one day when I  need to.

 

Jimmy Turner: Yeah. You're like I just need to make this one thing and it  won't let me and more keeps getting added on. 

 

And like in anesthesia, the equivalent is like you're at the end of  the day, you're about to get relieved and then the patient in your OR starts like dying basically and you're like, “I can't leave. 

Like I need to take care of this patient, and like I was supposed to get out an hour and a half ago, but I had to stay and take care  of this person.” 

 

Which is great, but that altruism that doctors have is often taken  advantage of, and to an extent where it really negatively impacts your personal life. And at some point, you have to say,  look, if I keep putting myself last, I really can't take good care of  people. 

 

And so, there's this mantra in medicine, the patient comes first;  and what medicine has turned that into is like everything comes  first. The insurance companies, the administrators, the  

electronic medical record system, messages, inboxes, all that  stuff, and you know who comes last, is the doctor. And we don't realize that until you take care of yourself, you  really can't take the best care of patients. So, the patient first  and hospital first mentality, actually, leads to worse patient care. 

 

Katrina Ubell: Right. Oh my gosh. Alright, it's like such important stuff  and you actually do such a good job of really describing the  problem in a really skillful way that we don't really have time to  discuss today. 

 

I just want to tell everybody that they should read the book  because we could talk about that. But I don't want to spend the  whole time just like talking about problems. 

 

So, actually, okay, we're going to talk about one more problem  before we move on to some solutions. Learned helplessness,  let's talk about that because that is something that I think a lot  of doctors resist.

 

They're like, “No, I'm not doing that.” Like, no, that's not what  this is, but it is. So, how is that contributing to burnout? 

 

Jimmy Turner: Yeah, and I think this is an important thing to discuss  because it also explains what you can potentially start doing if  you shift your mindset around this. 

And now, we just got our German Shepherd puppy, so we have  two. And this always makes me sad when I tell the story, but it  comes from an experiment where they had three groups of  German shepherds and the short story, the short version of this  is basically, there's two parts of the experiment. 

They all got a harness put on them that would shock them. And  the first group of dogs, they just let them get into the box that  would shock them and then they just let them go. They're the  control group. 

 

The second group, they put them in the box, there's a lever they  could press. And basically, when they got shocked, they learned that if they pressed the lever, it would stop shocking  them. 

And so, this group learned like, okay, I've got this bad thing  going on but when I press this lever, it goes away. I can do  something about this. 

 

The third group, sadly, got put into the box and had a lever, but  when they pressed it, it didn't do anything. So, they just kept getting shocked. 

 

And the interesting part came from the second experiment  where they put these three groups of dogs into a separate box  where there's just a small divider, I don't know, 6, 12 inches tall.  And I can promise you with having two German shepherds,  they can easily jump over that. 

And they basically had to jump to the other half of the box to  stop getting shocked. And so, the first group that didn't get  shocked in the first experiment, they just said, “Hey, this doesn't 

feel good” and they jumped to the other side of the box, they  stopped getting shocked. 

The second group who realized, hey, there's something I can  do about this, did the same thing. And just like the lever worked  last time, let me figure out the solution. They jumped over the  divider, they stopped getting shocked. 

 

The third group who learned in the first part of the experiment  that there's nothing that they could do to stop their terrible  situation, 70% of them literally laid down and just kept getting  shocked. So, they had learned that there's nothing that they can  do. 

 

And so, these group three German shepherds were exhibiting  what became known as learned helplessness. They had learned that there's nothing that they can do in their situation. 

 

And unfortunately, in medicine, that's what's happened to a lot  of doctors. Some doctors have figured out, yeah, there are  some things that I can do. And those group two doctors make  some changes. 

 

But the group three doctors, and there's a large number of them that exist,  they basically, now, think that there is nothing that  they can do in their situation. And these are the people that say  no, it's just moral injury. This is not burnout. 

 

And so, because it's moral injury, it's the system's fault. There's  nothing that I can do. The system needs to be fixed, which is by  the way, 100% true. Those dogs shouldn't be getting shocked  either. But you don't have to lay down and just take it. You don't  have to exhibit learned helplessness as a physician. There are  ways to fight back. 

 

And so, the goal is to transition as many doctors as we can  from group three to group two where they feel like they are now  empowered enough to do something about it. 

 

Katrina Ubell: That's so good. I mean, there's so much learned  helplessness with weight loss as well. It's just like everything 

 

I've done doesn't work, I'm not happy where I'm at, but why  even bother trying? 

 

And I love how you explain — I mean, I don't love that those  dogs are shocked because it is so sad. 

 

Jimmy Turner: Me neither. 

 

Katrina Ubell: Because I'm a dog mom too. But still, it's so good for us to see that the system can be bad. You're getting shocked. And also, there are things that can be done. And  that's just so important to recognize that. 

 

Okay, so the title of your book is Determined. You talk in the book so much about self-determination and the self-determined  physician. What is a self-determined physician and how can we  become one? 

 

Jimmy Turner: Yeah. So, I think so much time is spent talking about what  Herbert Freudenberger would describe as burnout; the emotional exhaustion, the depersonalization, that lack of accomplishment. 

 

And not enough is spent describing, okay, well, if that's not  where we want to be, what does it look like when a doctor  thrives in medicine? What does it look like when a doctor loves  what they do, they have work-life balance, they're intrinsically  motivated and engaged at work, they have good clinical outcomes? 

 

And this comes from something called self-determination  theory, which Edward Deci and Richard Ryan started explaining  50 years ago. And this is another example about how medicine  is always behind the times. We just do things the way they've  always been done because it's the way it's always been done. 

 

And so, it's not like we have to reinvent the wheel here to figure  out like what makes people happy in their job. There's three  things. You need to have control, you need to have autonomy  personally and professionally over your schedule and how you  practice medicine. You need to feel like you belong.

 

You need to feel like you're valued and you're attached to a deeper purpose, which is the idea of taking care of patients.  That's probably the one of the five pieces that doctors don't  

normally struggle because most of us feel like we're doing  things for patients. 

And then the fifth component is competence or perceived  competence. You need to feel like you're good at what you do.  And that's what people experience when they have imposter  syndrome, is the 60% of doctors up to 60% that experience  imposter syndrome; it's not that you're not good at what you do,  you just think you're not good at what you do. It's that lack of  confidence. 

 

And so, the autonomy, belonging and perceived competence  are the three pieces you have to have in order to truly love your  job. And those are the three things you have to have in order to  be what I call a self-determined physician. 

 

And so, if you feel like your personal and professional  autonomy are being stripped from you, it is on us to become  group two German shepherds and to fight back for that  autonomy or that lack of value that we feel like we have in  medicine. And that may mean some mindset work. 

It might mean shifting your perspective on where you get your  value. Maybe it's not work. It could mean creating that financial  freedom to steal back some of your personal autonomy. And  that's certainly the direction that I've gone and in my career. 

 

I still practice three days a week, but I've purchased some of  my time off and I will always practice anesthesia to some extent. I love it and I still love it. But that ability to become a  group three physician, a self-determined physician, and take  back your autonomy to take back the sense of belonging that  community that we all need as human beings because we're  tribal creatures whether we like it or not. 

 

And then that sense of perceived competence and that story  that we tell ourselves when we have that medical malpractice  case or we have the bad online patient review, or we get the 

bad outcome or criticism from administrators — we get to  interpret and think about how we view those things and what it  means about who we are as doctors. 

And so, those are the ABCs of self-determination; autonomy,  belonging, and competence. 

 

Katrina Ubell: Yeah, I think it's so good. Because sometimes, yes,  whoever, the powers that be are saying like you can't do this  and these are the rules. But I feel like again, like just to your  point, there's often times where we are just telling ourselves  what we can't do and it's not true. 

I've seen this time and time again where I've had clients say,  “Well, I can never make it to a live call if it's during the day  because I've got patients, I've got this busy practice.” And  literally, just saying to them, like “If you had to go see an  oncologist for yourself, how would you fit that into your day?” 

 

Like totally, they would clear a hole in their day to be able to go  see a doctor. Or maybe it's not even for them, or it's for  someone that they love for their child, or God forbid, or their  parent or whoever. 

 

And so, it is possible. You just aren't valuing yourself enough  and the process of you getting what you need enough. You're  putting, again, patients first over what you need and then telling  yourself you have no choice about it when that just is not the  case. 

 

Jimmy Turner: Yeah, no, I completely agree. And that's one of my  favorite things to teach our clients is something called — it's  affectionately called the “Hell yes!” policy. And so, it's this idea  that you have to figure out what's important to you. 

 

And maybe for the people listening to this podcast, obviously,  that might be weight loss. It might be being more present as a  parent or partner. It might be various number of things. 

But you have to get clear on what matters to you. And when  you do that — and I love this, Greg McKeown described like what the word priority meant, or in the 1400s, it meant the one  thing that's above all other things. 

 

And then sometime in the 17 or 1900s, we pluralized that word  and we pretended that all of a sudden, we could have multiple  priorities that were above all other things. And that's just not the  way that it works. 

 

And so, when you get a lot of clarity around what matters most  to you that makes you like really want to say hell yes, you can  start saying no to other things. And I think that a lot of doctors  don't realize like the most powerful word in the English  

language is no. 

 

Katrina Ubell: And you're allowed to say it. 

 

Jimmy Turner: And that you're allowed to say it. And so, like when  people ask you to join the committee or to write the book chapter or to see more patients, like at some level, you can say,  “No, I'm not doing that. Like my clinic ends at four or five (whatever time of the day that is), I'm not seeing patients. If you  book patients past five, I will not be seeing them. They will be  sitting in the holding room.” 

 

And then your administrator gets to decide what they want to do  with that. And I'm not saying you're going to keep your job, but I  bet there's a good chance that you will, and I bet there's a good chance that you'll have the opportunity to negotiate, which is  something else I love coaching people on. 

 

Because if you start pointing people out to the administrators or  the bosses that you have, the problems that exist and you just  keep pointing out the problems, human beings want to solve  problems for other people. 

 

And so, you can probably get to a situation where you're not  seeing patients after five o'clock if you learn how to negotiate  and you learn how to say no. But most doctors feel like no,  there's nothing I can do. This is what they're doing to me. And it  takes a lot of clarity on what do you want to say hell yes to, so  that you can say no to everything else.

 

And that's one of my favorite things to kind of walk people  through how to create that “hell yes” policy. 

 

Katrina Ubell: Yeah. I was just remembering the other day I was out  walking my dog … just like random memories pop up, I don't  know why I was thinking about this. 

 

But I was remembering how when I was looking for a job at the  end of residency, I was offered a different job than the one that  I took first. And I turned it down. I totally forgotten that this  happened. 

 

And it was a great practice, like super well-respected. I'd  actually spent a little time there as a resident, like super great,  but they had this reputation for working really late until the night  like 7, 8:00 PM. 

 

And I don't know if I was actually pregnant yet. I knew we were trying, like definitely wanting to start a family and stuff. I knew that was a priority for me; priority, the priority, whatever,  one of the priorities for me. 

 

And so, I came back to them and said, “Hey I'm really interested, but I really want to be able to eat dinner with my  family every night.” And they were like, “No, we can't do that.”  And so, we parted ways. And that was in 2005. It was a long time ago. 

 

But even so, it was just so like the culture of that practice was  we work, I don't know what the indication was of when they felt  that they were done, and they could leave for the day. And  even then, I knew like this is not okay. 

 

So, even though the place I did join did also have somewhat of  a policy like that, it wasn't to the same extent. And so, it felt  more acceptable. 

 

Jimmy Turner: Yeah. And I think that that's one of the things people don't  realize is like you don't have to stay at that practice. And in fact,  you don't have to make income from just practicing medicine.

 

And far too many physicians are like, “Yeah, but like I feel  stuck” and it's like I could never transition to something else,  whether that's a new job or a side gig or whatever happens to  be for you. 

 

And I think that doctors get lulled into this idea that you  don't have value. And it's like the amount of critical thinking that  you've learned, leadership that you've learned, and medicine  that you've learned, and like all these other abilities to work with  people on a team, like those are all translatable skills. 

 

Whether it's at a new job or it's at the same job, negotiating for  change, or it's starting a side hustle to give you some financial  freedom – like it can look a variety of other ways, but you do  absolutely and fundamentally have a choice. 

 

And the second you start telling yourself that you don't, you  become a group three doctor, it becomes this impossible  situation where there's just nothing that I can do about it. 

And I'm sure you talk on the show like a lot of coaches do about  well, we got to do the thought work and really kind of figure out  where we're at and I'm all about making the diagnosis. Like why  do you feel so burned out before you change your circumstance.

 

But I do think it's a bit naive to say that some circumstances  don't produce better thoughts than others. You do have the  ability to negotiate for change. You do have the ability to say no  and change jobs. You have the ability to create income outside  of medicine or to go to a non-clinical job. There's a variety of  things you can do. 

 

And helping people figure out like what that change and circumstance might be after they do the thought work to figure  out what the problem is first is just so important to people's success in terms of escaping a lot of their burnout. 

 

Katrina Ubell: And not to skip over the fact that I know you speak about  it in the book, and I've had this experience too with clients  where they came in so done with medicine, wanting out so 

badly, and then through coaching, they fall in love with their  exact same job and nothing has changed there. 

 

They actually like, not even just like find it acceptable, they love  it. And so, that is available, like you don't necessarily have to  make any outside changes. You don't have to like move around  or uproot your family or anything like that. It's possible that what  you have might actually be the dream job already. 

 

It also might not be, but it's possible that it is. And it's cool to be  able to get to a place where you can at least be open to the  idea of that being the case. Instead of being so shut down that  it's all horrible. 

 

Jimmy Turner: A hundred percent. And that's why Epictetus is right — where all of coaching pretty much comes from. It's like a  mixture of stoicism and a few other belief processes. 

But that's why Epictetus said the chief task in life is figuring out basically the things that you can control internally and the  things that are external you can't control, and to do the work on  the things that you actually can control, which is your internal  narrative, your perspective. 

That was something that he said like 2000 years ago. 

 

Like this is not new, it's just modernized. And we recognize that that is  so true. And we've had so many examples in our program.  Exactly like what you said, they fell back in love with their job,  and they came in saying, “No, I got to change jobs, I'm going to  quit medicine.” 

 

And did the shift in perspective, like that mindset shift they  needed and now, they love what they do. 

 

Katrina Ubell: Right. I feel like back in my day, I would've been even more overwhelmed. It's like, well, yeah, you can improve your  thoughts, but then you might have to move jobs and then you  might have to move your whole family. 

 

And then sure, you can start a side gig. But like at that time for  sure, I would've been super overwhelmed by the concept of that. Like oh great, so to be happy, I got to work even more  now. You know, whatever it was, like that's available. And also,  there's other options as well. 

 

Jimmy Turner: A hundred percent. 

 

Katrina Ubell: There’s one other thing that you actually — a story you  told about a client in the book that I wanted to touch on because the whole like FIRE movement. What does FIRE stand  for again? Financial Independence Retire Early. That's what it  stands for, right? 

 

Jimmy Turner: You nailed it. 

 

Katrina Ubell: And this kind of idea how some people, because I hear  this too, like people are like “I know I need your help, but right  now, we're on this like super rocket fueled debt reduction plan.  And so, it's not in the budget.” 

 

And I just think to myself, “Okay, wait, so you're just completely  putting off anything that would help you to thrive in your life  so you can see that number go down?” Like there's got to be a  balance. 

 

Like sometimes either the kind of insanely supercharged drive  to get the debt down or to get the net wealth up in order to get  to that arrival fallacy place – the there that doesn't exist that like  then I'll finally get to feel how I feel. 

 

I mean, obviously, we can't say what's best financially for  people, but there is definitely somebody who is like everyone  was miserable. He hated his job, his family was miserable, but  he's like, “But if I work here, I make so much money that I'll be  financially independent in five years. If I go back to where we  actually like to be, then it'll take longer.” 

 

And he kind of living like this very austere life to try to just collect all his nickels for some time in the future when he  believes he has enough money that he can be happy, except  we know that's not how it works.

 

Jimmy Turner: Yeah. So, obviously, all the client names in the book are  changed, but I think of the book, I call this person Rhett. And  yeah, it was really interesting. Because Rhett was practicing in critical care in a rural part of the country to make more money. 

 

His partner was not able to finish their post-doctoral work. They  were actually training in psychiatry, which I found really interesting having a psychiatrist's husband as a client in the  system. They actually both became believers in coaching. 

 

And one of the most powerful coaching sessions we had, Rhett's partner came on and we talked to both of them and I basically  coached both of them for the entire hour. And that's the only  thing we did. And everybody in the group was like, “Wow, that  was just incredible.” 

 

And where we got to is exactly what you're describing, which is  the balance between YOLO (You Only Live Once) and this idea  like you're basically pinching pennies and living a life that you  don't necessarily want so that someday in the future, whether  that's five years, seven years away, you can actually start to  live the life that you want. 

 

There's some balance in between those things, and I'm really  glad that you mentioned the arrival fallacy which was a huge  part. So, when I referred to all these accomplishments and  achievements, accolades that I was having a hit of dopamine,  that idea that when I arrived I'd be happy. And it's a fallacy for a  reason, it's not true. 

 

But Rhett had this arrival fallacy that when he got financial  independence, he'd finally be happy. And it turned out that that  wasn't true. And that I pointed out to Rhtet, “Hey, look, would you  rather work in the place where you currently do and be able to retire in five years (which was the math he had done) and hate it for five years?” 

 

“Or move back closer to the city where you're closer to family,  your partner can finish their post-doctoral training. You actually like your job, you're working in a hospital that you've worked at in training and you know that you would like the job, they need your services and you'd be happy, but it would take you 10  years to retire instead of five.” 

 

And Rhtet's like, “Well, when you put it that way, I guess, I'd  rather delay my retirement by five years.” And we're talking  about like this person was planning on retiring at like 48 or 50.  And it's like, so we're talking about delaying it to 53, like that's  technically still retiring early. 

 

And so, he's still going to achieve FIRE. And when I put it that  way, he is like, “Yeah that, that actually makes a lot of sense.”  And so, like the very last call that I had with Rhett, sitting in like  this new BMW 3 series that he'd been wanting to buy for like 10  years, but was something else that he didn't spend money on  because he was trying to get financial independence. 

 

He had changed jobs. He was going to be starting in like six or  eight weeks and the job was going to actually pay him more and he had more academic time. So, this story that he had  been telling himself that if he moved closer to the city, he'd  make less money and delay his financial independence — interestingly, we got through the thought work and said, “Is that  really true?” 

He found a job closer to the city, closer to family, his partner could  finish training, made more money, had more time off, and could  get to financial independence sooner.  

 

Katrina Ubell: I love that story because it's just such a good example of  like what you think is true may not be true. And that's why it's  worthwhile to just spend the time really evaluating what are you  doing? Like what is the point of this? 

 

What do you think's going to happen when you have that magic  dollar amount? Either you're closing out the loans or you are at  a place where you feel like you have whatever that magical  number is. 

 

Jimmy Turner: And for Rhett, and these are I think just amazing stories to  get to your point about investing in yourself. Ret paid $5,000 to  be in the program and then worked at a job that made six figures more than what he was making than he worked at his  previous job. 

 

Katrina Ubell: Talk about return on investment. 

 

Jimmy Turner: Yeah, return on investment. And actually, I got an email  like in the last couple of weeks, someone emailed back said,  “Hey you really taught me a ton about negotiation. You taught  me how to really work through the situation and my job. And I  actually just made $293,000 more this year than I did the year  before because I negotiated for changes and how I got paid,  and now, I'm negotiating for the other eight doctors in my  group.” 

 

And so, like this idea that you don't get an ROI on coaching, I  just find so funny cause I see it all the time. But until you like  take that leap of faith, then you don't really see it. But once you  do, you're like, “Oh wow, this is life-changing and has the  potential like in a very measurable way to give you and provide  you a very real return on your investment.” And so, I just love  those stories. 

 

Katrina Ubell: Oh God, it's so good. Okay, so as we're wrapping up  here, you have a number of great solutions for people in the  book. So, definitely pick up Determined: How Burned Out  Doctors Can Thrive in a Broken Medical System. 

 

But just for the person who's listening today who's like, “Yeah,  yeah, yeah, I'm going to pick that up or I'm going to buy the  audiobook” like what is one thing, one solution that's really  actionable that people can apply starting now, starting today,  the day they're listening to this, where they can get some sense  of like, “Oh, there is hope for me. This can actually be a little bit  better?” 

 

Jimmy Turner: So, I think that probably one of the most concrete things  in terms of actionable advice, and I think this would apply to  your listeners too, and I'm almost certain that you go through  this work too.

 

But the idea of really processing emotions and the reason that  this matters in the burnout space is because of that inability to  make those changes. And so, we really go through the process  of figuring out what are the three most common feelings  you feel most weeks? 

 

And for my group of people, they're naturally going to say the  three most common things that I feel in a week are anxiety,  overwhelm, and burnout. Like almost always all three of those  things are negative. And if not all three, like 100% of people, at  least two of them, are negative. 

And then we ask people, okay, and you can even pause this  podcast right now and think about, like what are the three  things that I experience. 

 

And then the next question is, what are the three feelings that  you want to experience on a daily or weekly basis? And they'll  be universally positive. It'll be like, “I want contentment, I want  happiness, and I want fulfillment in my career.” 

 

And it's like, okay, so isn't this an interesting phenomenon that  what you actually experience is two-thirds at least, but  probably, a hundred percent negative. And what you want to  experience is a hundred percent positive. 

 

And they've kind of wrapped themselves around this idea that  they don't want to experience negative feelings. And when you  stop and think about that, that's not really true. 

 

And I learned this lesson from entrepreneurship, but I think it's  something that's immediately applicable to physicians too, that  actually, in my world, in entrepreneurship, you have to be  willing to experience failure, you have to be willing to  experience discomfort — sometimes anxiety or nervousness  about the decisions you make; you might actually fail. 

 

And if you're willing to work through those negative feelings, like  what you want in life is often on the opposite side of it. And so, I  always encourage people to write down where they are 

emotionally right now and what they want to experience, and  what they're willing to experience in terms of negative stuff. 

Because when you stop and think about it, like the day that you  proposed to your partner or you had a kid and like you sat over  their crib, like just praying to God that they'd keep breathing — like some of those moments in your life that produce the most  stress and anxiety and discomfort, on the other side of them are  some of the most rewarding moments in your life. 

And so, the ability to tell yourself, I'm not willing to put in the  work or to try something, or to potentially make a change in my  life because it might fail, which doctors hate; flipping that script  on failure and allowing yourself to process those negative  feelings without it holding you back and actually working  

through it … 

 

In stoicism, they'd say like the obstacle isn't in the way, it is the  way to success. And so, when you can really pivot on that,  you'll be better able to enjoy the journey, you'll be better able to  get to your goals, and you'll be better able to take the risk and  make a change that you know you need to make. 

 

Katrina Ubell: Yes. Like yep, what he said. Yeah, it's so important. The  number of doctors who are so deathly afraid of failure, it's really  fascinating. Like I just did something on Saturday that totally  was a bomb. 

 

Like I mean, it's like all the time. Like I think maybe  

entrepreneurship just also numbs you to that. You're like, “I’ll try  that, it didn't work. Okay, next thing.” Maybe that helps, but I  think it's like when you have linked your assessment of yourself,  your opinion of yourself, your thoughts about yourself to your  ability to achieve, it's like, oh, you only get to feel good about  yourself when you're winning. 

 

And therefore, if you're failing, that means that you have to feel  terrible about yourself and beat yourself up. So, there's the disappointment of failure. There's the feeling that feels bad,  but what's so much worse than what I think so many people want to avoid is the treatment of themselves that they think is  required if they've failed. 

 

Like sometimes I try to just call it like a mistake because people  are so adverse to that word, and I'm like, it's a word. 

 

Jimmy Turner: Well, and I think that's interesting work. Like in terms of  like even categorizing it as a mistake. Like in the  entrepreneurial world, we say either get what you want or  get the lesson that you need. 

 

Neither of those are negative, like whether you view it as a  mistake or failure. And I think that having that self-compassion,  like there's a huge piece of burnout that is having self 

compassion for yourself. And so, when you're processing  something, you're not having the best day, you make a  “mistake,” you're failing forward, how do you treat yourself? 

 

And I think that a really applicable question is like, how would  you treat a friend or a family member who's in the same exact  situation that you are right now? And my guess is that when  they're going through that moment, they're having a hard time,  you're not going to be like, “You are a total failure.” But we use  the same language when we talk to ourselves. 

And so, learning how to talk to yourself with self-compassion by  asking yourself, like “What would I say to someone else that I  love in the same situation that I'm going through right now” can  be a really helpful exercise to allow you to get through some of  this until you learn that skill of tolerating and working through  negative emotions in order to get to what you want. 

 

Katrina Ubell: Yeah, totally. So good. Alright, so you've got this book,  Determined: How Burned Out Doctors Can Thrive in a Broken  Medical System. Where can listeners find this book because  they definitely need to pick it up? 

 

Jimmy Turner: Yeah, so since they're podcast listeners, the easiest place  is probably the audio book, which is on Apple and on Audible  and a variety of other places. And then if they like Kindle or  Paperback reading, it's obviously available on Amazon as well.

 

Katrina Ubell: Awesome. I was thinking, I was like if someone reads this  book and feels really connected to it, they could just buy a few  copies and just scatter it in like the doctor's lounge, just like  leave it there. 

 

Jimmy Turner: I obviously wouldn't hate that. And that's why I wrote the  book, and we talked about this when you came on my show;  that you don't write books to make money, you write books to  help other people. 

 

Katrina Ubell: And I think there's so much help in this book. This is  packed with good information, and I mean it's totally worth the  read. And then tell us about your podcast. Obviously, we're  podcast listeners over here. 

 

Jimmy Turner: Yeah. So, The Physician Philosopher Podcast is where I  hang out and thephysicianphilosopher.com is where you can  find the other stuff that I'm doing and hanging around with. 

 

Katrina Ubell: Awesome. Yeah, great. And you offer group coaching and  help people through this as well, so there's obviously way more  help and individual and personal help than just what's in the  book. 

 

But I think what's so great about the book is it's just such a good like taste. Like I really learned a lot, and sometimes,  you're like, “Okay, what's going to be new in here?” I was like,  “Oh my God, yes, wow. Wow, I didn't know that.” You know, it  was really good stuff. 

 

Jimmy Turner: Yeah, I appreciate it. 

 

Katrina Ubell: So, thank you for writing it. I mean, I it's desperately  needed. I think a lot of people have been thinking a lot of this  stuff and then they just don't know what to do next. 

And there's always been kind of a culture of sort of complaining  within medicine, but I feel like it's gotten a lot worse and  people just don't know what to do about it. And this is such a  great place to start looking for what is that ramp off of the  superhigh of complaining.

 

Jimmy Turner: I really appreciate it and I hope it's helpful for a bunch of  doctors out there and hopefully, they'll get some reprieve from  their current situation if they personally feel burned out or if they  know somebody who might benefit from it. 

 

Katrina Ubell: Yeah. Even if they're not burned out themselves,  guaranteed they know some … if two-thirds of doctors are  burned out, then for sure, every non-burned out doctor knows a  burnout out doctor. 

 

So, even if it's not for you, make sure that you're sharing this  with people who need it. Because a lot of people really do feel  kind of helpless. Like from a peer colleague perspective, they  don't know what to do to help, and this is going to be really very  interesting. 

Even just toss it like, “Hey, I listen to this episode …” like  we have to be nuanced in how we suggest things. 

 

Jimmy Turner: And that's the funny thing about any of this stuff. And I  know you experience it in your niche, but unless people want  the help, nothing will change. 

 

Katrina Ubell: Yeah, you got to get to that place where you've had  enough, you're willing to try something new that's less scary  than staying where you are. 

 

Jimmy Turner: A hundred percent. 

 

Katrina Ubell: Absolutely. Well, Jimmy, thank you so much for being  here. 

 

Jimmy Turner: Yeah, thanks Katrina. Thanks for having me on the show. 

Jimmy Turner:     A hundred percent.

Katrina Ubell:      Absolutely. Well, Jimmy, thank you so much for being here.

Jimmy Turner:     Yeah, thanks Katrina. Thanks for having on the show.

Katrina Ubell:      Ready to start making progress on your weight loss goals? For lots of free help, go to katrinaubellmd.com, and click on free resources.