Would You Want Your Child to Become a Doctor?

[Music] Many doctors tell me they still love caring for patients, but wouldn't recommend medicine to their children. What do you think has to change so physicians would enthusiastically encourage the next generation to enter medicine? That's what we're talking about today. If you're a doctor, healthcare leader, patient, you belong here. I'm Kim Downey and this is Stand Up for Doctors, conversations at the intersection of connection, courage, and the future of healthcare. This episode is sponsored by a gracious member of our Stand Up for Doctors community. Sponsorship truly sustains this work. Please reach out for more information. And by way of a brief introduction, Dr. Tutor Frank Co is the chief anesthesiologist at Global Anesthesia Service and he's also a podcast host and real estate investor. And Dr. Scott Miller is a board certified plastic surgeon and founder of Miller Cosmetics Surgery and he also has a son in medical school which is important because we need to make medicines sustainable for doctors. What would you most like our audience to know about you as we begin our conversation? Tutor, would you like to go first? Oh, thank you Kim. Thanks for having me and I appreciate being here with Dr. Miller also. What can I say? I'm an immigrant. I came in United States when I was 28. I graduated medical school in Romania. I came here, you know, start everything from scratch back to where I am now. I was very fortunate, but in the same time, I was very determined and resilient to everything that was thrown at me. So this is part of probably a good conversation to have for people that want to go into medicine either from the United States or from overseas. But yeah, that's pretty much in a nutshell what people need to know about me to start with. Okay, well thank you for sharing that and Scott, what would you like our audience to know about you? Thank you for having me. I'm a board certified plastic surgeon in La Jolla for the last 30 years. My passion is just taking care of patients and enjoying the art and craft of medicine and plastic surgery obviously in particular. And I just love it. Take joy in helping patients and face the challenges that the medical system provides us wonderfully and try to kind of adjust to those challenges. And I would like to advocate for changes where appropriate and kind of go forward. My wife and three kids are my world and on a personal level. I just as a former college tennis player, I enjoy playing tennis and that's kind of my meditation mat if you will. Well, thank you for sharing all of that and I appreciate you both so much. I've had five surgeries in the last few years with anesthesiologist and surgeons. So I benefit from the work of both of you, which is a great lead into what we're talking about today is which is like what responsibility to today's physicians have to create a version of medicine that that want their own children to enter. Well, and with a son and plastic surgery, I guess I'll take that one. You know, my son's a medical student at Ohio State and I think he's actually uniquely understanding of the interesting challenges and the interesting opportunities that medicine provides. And at the end of the day, you know, joy and contribution is the most important thing about medicine. Obviously we need a system that we need to advocate for a system that allows and encourages that in a sustainable way. But I also think we need to just take our joy from that and realize the unique opportunity that that is and he seems to get that and that gives me a lot of joy in that. So I think I think our responsibility to get to the heart of your question is to practice medicine at the highest level and then advocate for systems that allow us to do so. I think if we don't practice the highest level, then we lose our ability to advocate and I think if we don't advocate, then we'll interfere with our ability to practice that way. So that that's my thought. To do what would you like to add? Yeah, I think that's a great point that criminal. I totally agree with you. I think the level of passion that you put in this profession would automatically reflect in the way you're seen as a person and as a professional. And it also gives people around you this kind of environment and psychology of growth and well-being and professionalism that would create hopefully the good system around you. Even your office or your hospital or your department or whatever you practice medicine. But I think that the way you portray that to the world is going to come back to you in a way, you know, probably multiplied. So I love the way you said that and spoke to psychology because it makes me think of after Scott and I had our introductory conversation and we were communicating by email and you share with me your interest in the book that as if principal. And you shared you related to the idea that doctors might not be able to control everything in healthcare, but they can control how they show up and what they build. So could you speak more to that? Exactly. I mean, we can do our best to advocate for again, a paradigm, a structure of healthcare that allows us to do what we want to do. But the first thing to do is to start by practicing that way in the first place. And also in that way, we don't lose sight of our why and why we got into it in the first place and what we take joy of. So otherwise you create you end up with, you know, with a structure without anything to fill it with. I think if we behave and design and our practices around an ideal situation and then do our best to act that way and create that situation. And again, not polyanna. We need to get involved and make those things happen. They don't grow on themselves. But, but I think you start with what you want you act that way you want to act and be seen as he referred to. So, aptly. And then you can create that reality. Yeah, this is a great point for the new new graduates of medical school or even the new graduates of high school, I would say, to choose to go into this field because I feel, you know, lately in the past few years, I thought that everyone I talked to. Had such a, I don't know, such a sad demeanor when I brought up medicine for future profession and everybody is like, oh my god, no, there's no way, you know, the way medicine is going now, it's just, it's not my field. I don't have any joy, it's all, you know, controlled by insurance companies and all the stuff. And I mean, that's true. But in the same time, I feel like all of us have to contribute of pushing this new generation to change something because that's what I remember when I was in high school and getting into medical school, I had some teachers in my school that had the same attitude. And they said, listen, things are never going to be perfect and things are always going to be hard to solve in medicine. But we can let go, we can just like get out of the way. We need to push the new generation, we need to encourage the new generation to get something more done than we did. And that's what progress is, right. I mean, we all can retract in our own comfort zones and, you know, get our own office or practice and stop practicing at some point, but we need to get this, you know, to the new generation somehow, this feeling of continuation of progress. Efficiency, the concept of just being efficient, in other words, if you're, if your structure only allows you X time with patients and therefore you can't practice the same way you want to practice in that time. So therefore you adapt to that and practice within that time and give up the essence of what you want to be. That's not inspiring. That's not exciting. People who go into medicine are very bright and capable people and they've got other options. And so that's not it. You have to, the inspiration is to care for people to be involved in people's lives and to distribute. And again, we live in the real concrete world. And so you need to, you need to be able to do that and survive and distribute, take care of your family and yourself and your health and wellness and stability. But you have to have an inspiring vision of what you're. trying to do and of yourself. I think if you see your career as a bit of a heroic journey, then those things that look like obstacles suddenly become part of the story because you see it as a heroic journey and you see the finish line or at least the joy of the journey rather than seeing each one of those things as a heartbreaking obstacle that finishes your whole path. So I'd like you each to share a little bit of how you've actually managed to do this for yourselves because until recently when I had cancer three times and all this stuff happened, I didn't really consider myself a patient. I was an average person walking around, not really involved in these spaces. I did know in our local healthcare system a lot of the different practices that used to be independent over time got absorbed into the big healthcare system and the idea, even though I haven't discussed it with my own specific physicians, was that when they used to be able to maintain their own practices that they'll overhead and all the, you know, that they had a deal with the insurance companies that they had a higher like whole staffs or maybe at first they'd dealt, they could do it with like one secretary or something and then they added administrative assistant and then they needed an office manager and it got to the point where I believe that financially it wasn't sustainable. So it appeared to be lucrative to join in or just to make it sustainable, but then they feel like right, they lost the autonomy, they lost the control and speaking to, you know, what's got what you were saying, how they feel. So if you could each speak to like how have you actually done this for yourselves? I mean, your story is inspiring and that's a perfect example of how you, you know, turn things, take lemons and make lemonade, so to speak. So I mean, interesting, you made me think of, I just got back from a meeting in Japan and, you know, my son was lamenting that we don't have more restaurants like the ones you find in Japan on the street and I was letting him know that like you couldn't have those because they wouldn't pass regulations here and then to run a restaurant here, you need twice the space, it would cost you twice the money and yet you see these sushi chefs doing such a immaculate job. I mean, I just sat there at the counter and watched their pride and performance as they work in this little rectangle of a space on a street with, you know, 20 other places just like theirs and I think that's how we as physicians kind of need to be and then you turn around and you put it into our system and you say, okay, there's all these regulations, but does that mean there's no good restaurants here? Does that mean there's no good sushi restaurants? So to speak, you know, just to stick with the metaphor, you know, I think that there are a lot of ways to skin a cat and you have to adapt and adjust to the environment. I recently had a colleague who's a bariatric surgeon and he was just telling me that things he's doing, you know, he starts with this picture of, you know, his life the way he wants it and his practice wasn't providing that and instead of throwing his hands up in the air, he's making little fine tuning adjustments to his practice to be able to kind of write that path and, you know, as my co-presenter said, he's like, you know, you look at every other field, talk to your colleagues, talk to your friends who are lawyers, talk to your friends who are in construction and real estate, you know, you'll find the happy ones and the sad ones. It exists in every field and the question is, how do you make yourself one of those people who make the circumstances work as best they can for you in your life? Yeah, I think there has to be a distinction here in terms of the financial success of a small practice versus the joy and the professional satisfaction you're having a small practice. Unfortunately, I know a few cases where, like you said, the small practices, the small offices went away because they couldn't resist financially to this kind of reimbursement from insurance companies and they just gave up and throw their hands in the air and said, okay, I'm going to sell everything. I'm just going to be hired by one of those big health corporations and don't worry about anything financial or business-wise. But the joy was still there. Their joy to practice was still there. So, I need to make this distinction between having financial stress in your practice and still have joy of practicing and seeing patients every day. And I'm sure you find a way to do that continuously. After, let's say, you gave up your business in medicine and still be able to inspire someone that comes behind you. And I'm sure that Dr. Miller probably remembered too. There had every single physician that I know had one teacher or one professor or one mentor in their medical school that still is in their mind right now. By the way, he behaved, he practiced medicine, the ethics, the professionalism that he had. And that's what we need. We need to inspire, like you said, people behind us. The financial aspect of medicine is something that we never learned. And it's one of the things that we probably have to change at some point in healthcare to prepare people to have their own offices. We don't know how to do that. We don't learn this. We get out of the medical school and have no idea what the balance sheet means or a P&L or something like that. And it's normal that insurance companies will take over that and say, "Okay, well, we'll give you what you think you deserve." And you're never going to make it. But, you know, that's where we need to educate people more in the business of medicine, I would say. Do you find those doctors then that switch? It follow up with them. What proportion are then happy with where they've shifted or do they find themselves just, they traded one pain for another? Yeah, it's interesting you've said that because the cases that I know were a primary care physician who gave up his office and start practicing emergency medicine in a big hospital on a contractor basis. And, you know, just don't go and shift there and that's it. He doesn't have to worry about anything else. And he still loves seeing patients and practicing. But, in the same time, their business past comes back to him right now and he wants to do something on his own again. He wants to open up maybe a different type of practice or a different type of office. The other case I know was, you know, someone who just said, "Look, I am not made for this. I am not made to have my own office. I have no idea what the heck I'm doing. I'm probably failing in this and I don't know. So, let me just get out hired by, you know, a group in a hospital and he's part of a system and he's happy." And obviously, I mean, you know better probably that having your own office in your own special needs. It's a big enterprise, right? You need to hire people. You need to know what you're doing. Get the financials at the end of the month and make sure you make it what you don't. But, they're not too many people like you. They're successful. I mean, they do it successfully. And that's what we need to train people in. Right. I think I'll do this because that's a bigger topic to discuss of ways of implementing this in the medical school. So, people have this kind of knowledge, at least the basic financial knowledge, to go into an enterprise like that. And maybe the satisfaction will be better or be higher when you start practicing like that. Yeah, well, when you talk to, when I talk to residents, you know, I always ask them to like, as you alluded to, ask yourself, be honest with yourself about your strengths and weaknesses and feelings and foibles and what you want out of things. You know, the reality though is that in any studies of happiness, autonomy is a huge chunk. Now, you don't have autonomy if you're not in, if you're in the red and, you know, the creditors are in your door. That's not autonomy either. I agree. So, I think people need to be honest about what their, what their capacity is and capabilities, what their interests and are they willing to do what it takes to learn that you're absolutely right. If that's what you want to do, you need to invest in it when I went into practice. There was no books on how to run a medical practice, no less a plastic surgery practice. And I mean, I was, I was honestly, it's funny. I have, I was reading dental books, okay, because they are much more ahead of the curve than we are. And I was basically writing in the margins. I was basically reapplying things they were saying about dental practices and kind of like, you know, making the book applicable for myself, you know. And that. was how I kind of started that journey. I think you have to have a thirst for knowledge and information, but there's so much information and education out there. I mean, you can get the equivalent of a Stanford degree without going to Stanford nowadays, right? It's all online. It's all available. Books are the way we talk with genius mentors. I was fortunate, as you said, to have some great mentors, and they each contributed something different. I have one mentor that was more where I got kind of the art of things and the aesthetic of another mentor who was a huge ethics exemplar, but it was great because in my day, if you went through general surgery, they didn't want to train plastic surgeons, but you had to go through general surgery, getting a plastic surgery. And so I asked this mentor who was like, you know, he went to Africa two months a year and did surgery. And he was just like, he was like the Pope of plastic surgery, if you will, amazing person and ethically like at a higher level, right? And I asked him, Dr. David Furnace, and I asked Dr. Furnace, Dr. Furnace, I was a medical student. I said, how are you supposed to get into plastic surgery if the general surgeons don't want to train you, and yet you're supposed to prepare for to be able to go into plastic surgery after general surgery? And he turns to me, and again, this is kind of imagine the Pope turning to you in his white coat, right? And he turns to me and he says, you keep your mouth shut. So, you know, that to me was like, shows me there's a balance between idealism and practicality and I think running a practice is a lot of that. I will say at this point in my career, I thought I wanted to just practice medicine and plastic surgery and the business part would be kind of a necessary hassle. And I've come to really enjoy that added challenge, that added aspect, the personalities, I mean, I'm fortunate to have a great staff and have maintained them for a long time so that certainly makes it a lot easier. But I love that aspect and that's one of the things that's kept it stimulating and interesting to me, along with advances in our field that allow you to keep growing. So. Yeah, no, definitely. Another point that I want to make is the fact that, you know, if I think about my journey in medicine and I'm sure you probably had the same kind of path, we didn't have much to learn from in my time. We were, you know, happy if we had a textbook, a printed textbook and pretty much it. Nowadays, people have a lot of resources, like from internet to AI to, you know, all this social media channels and all this stuff. I mean, they, you can learn a lot if you want to and you need to get out of your comfort zone to do that. And if you have enough passion and joy of practicing medicine, you can do it because you have all the resources out there, do it. It's just a matter of that what's coming from inside you. So it's, it's all about mindset here. It's not like, oh, I don't know how to do that. Nobody can say, I don't know how to do that. Exactly. And I'm not talking about practice in medicine. I'm talking about learning how to make your office more productive, how to set up what LLC, how to, you know, learn what the balance sheet or a PNL is, like all this type of information is out there free for you if you want to do it. So the question is, what does a medical student needs to get into that kind of mindset? Because once you unlock that, everything is possible. 100% agree. Yeah, I love all of that. And my physician coach, Dr. Michael Hersh is, I've done some of these things and sometimes I'll say kind of like to your point that, well, I don't know how to do that. I've never done this before. And he's like, well, you've never done any of this before, right? And that's what I want. One of you spoke earlier about like your ideal life or for somebody and what their life is like now in just figuring out what's the next right step. But I think if you're overwhelmed or feel like a cog in a wheel like you need to take a pause and have some white space. And like you said, either read a book or go to chat GPT or Claudette, like just something to figure out, okay, or to work backwards, right? Or where's my ideal? Where am I now? What is one thing I could do? And on that note, just to add that, you know, there's a great book called The Gap in the Gain. And on that note, you can, you can, it's very easy to pay attention to the gap. And that can be depressing because you get 10% better. And there's still a 90% gap between those two endpoints. You have to pay attention to the gain. You have to enjoy the journey. It sounds trite, but it's, I heard one person say once, you know, clichés are clichés for a reason. So there's some truth in them. Yes, I have that book. He recommended it. What would you like to add to her? Yeah, no, that's, that's true. I was just thinking about in my experience, you know, I'm, I come from a place where I think bigger than I can do anything. And at some point, even if, you know, I don't reach whether I want to be, I'm still higher than I was before, just because of the mindset. You know, I, I immigrated from a country in another country with not knowing the language, not knowing anybody here, not having any money. And I think everything is possible. If you have the vision, if you have the mindset, if you think bigger than yourself, you can accomplish anything. And I, I don't want to, I don't want to minimize anything that everybody else is doing, but I'm just saying that the advantage of having a medical school graduate finished in United States is immensely different than one that comes from overseas. And it's, I want to take this as an example for medical school graduates here to tell them that the start they have, it's unbelievably great. And they can do anything they want. They just need to have the right mindset. That's all. Yeah. Well, thank you. Sadly, we have to wind down. I feel like I could ask you so many more questions, but I'll just ask if you each have any take home action messages for our audience, whether it's med students, residents, attendings, what would your, Scott, what would your take home action message be for our audience today? Well, I would just say that I think that for physicians, remembering your why and why you got into this and, and then optimizing your situation as we alluded to to meet the needs of your patients, your family and yourself is really key in order to do that. Sometimes you have to step back and look at the thing from a whole and pretend like you're your best friend and you're giving yourself advice and I find that's very useful. And for patients, I think in this current system, I'd be the first to say you have to be, you have to advocate for yourself, you have to be clear. But also remember that your physician is a human being with strengths and foibles and feelings and just be kind to them and patient with them in your advocacy, which I would never diminish the importance of. Absolutely. Tudor. Yeah, I think I'm just going to reiterate what I said before the fact that anything is possible in life and anything can be learned. It's not a matter of skills practicing medicine. It's a matter of how far can you think about yourself and how far can you think you can go in this profession and the joy of practice medicine. If the joy is there, you can achieve great results. No matter what specialty you're going to choose, you know, you can learn anything in that specialty. It's just your own limitation is your own mind. So go for it. I love that. That's the perfect way to add and thank you again for being my guest today. I've been inspired by both of you, which is why I wanted to have you want to introduce you to each other. I yours again, your story inspires me seeing, you know, what you dealt with and, you know, making making the most of it the best of it and turning it into a net positive is inspiring. Thank you, Kim. I really appreciate this format and I hope everybody is going to, you know, learn something from your experience and from your episodes because, you know, this is one thing that people have this day. They have the option of listening to experiences like us, like you, and learn from them very easily and they need to take advantage of this. Thank you. If I could just add, I know we're on time, but Dr. Tudor made the point that we have being a graduate from medical school in the United States. You have incredible opportunities. You're five steps ahead and there's a lot of talk in the world now about privilege and I would say it's absolutely true, but with, to quote, from Spider-Man with great privilege comes great responsibility. And, you know, taking that privilege, you know, all you could do, you can't throw away privilege. That's not how you honor it. You make the most of it. - Absolutely. - Yeah, I love that. Thank you. And one of the places I did share my story was on Tutor's Stellar Success, leveling up for medical pros. episode. So thank you for hosting me as well. I was happy to reciprocate. - Absolutely. - Okay. And thank you for being part of our stand up for Doctor's Global Neighborhood. A place where physicians and those who care about them can connect and power recharge and celebrate. You'll find more stories like this in our White Coats book series. And if you're a doctor, we'd love to welcome you to our inaugural Physician Retreat this October, where these conversations can continue in person. We would be honored to have you join us. And if you'd like to help sustain this podcast, please consider sponsoring an episode or connecting us with a mission-aligned sponsor. Links are in the show notes, including how to reach out to our guests and in closing to move the needle in health care. We all need to raise our voices and we all need to care about each other. We already know that doctors need to care about patients. Patients need to care about doctors too. So stand up doctors and let's stand up for doctors. [Music]