WCI #355: Burnout in Women with Dr. Darria Long

This is the White Coat Investor podcast where we help those who wear the white coat get a fair shake on Wall Street. We've been helping doctors and other high income professionals stop doing dumb things with their money since 2011.

This is White Coat Investor podcast number 355. Still not sure what to do with your student loans? Overwhelmed with how to tackle that giant debt in an ever changing political climate, the experts@studentloanadvice.com are here to help guide you through the best options to manage your loans. Our experienced staff have consulted on over $250 million in student loan debt and the averagestudentloanadvice.com client has saved over $190,000. You will receive a customized student loan plan using the principles of the White Coat Investor. Get answers to all of your student loan questions, gain clarity about your financial future, and start down the right path toward financial freedom. Book a consult today@studentloanadvice.com you can do this and the White Coat Investor can help. Our quote of the day today comes from Robert G. Allen, who says, how many millionaires do you know who have become wealthy by investing in savings accounts? I rest my case. It's true. You got to put some money at risk, right? You can't just put it all into CDs and savings accounts and money market funds. You got to put some money into stocks and real estate and let your money do some of the heavy lifting for you. Thanks so much. For those of you out there who are practicing medicine, doing dentistry, law, all these high income professions, they're not easy. And if you're listening to this on, you know, while you're working out or walking the dog or on your way to work or coming home after a bad day, just know that we appreciate what you're doing. You know, Katie and I both had, you know, colonoscopies recently and it's interesting to interact with the system as a patient, you know, and to get that view from the patient side. And I just become so much more grateful for what everybody's doing out there every time I or one of my family members has an interaction with, you know, the healthcare system in particular, but just about any high income profession. All right, for those of you who aren't aware, we have a free 12 week email course called Financial Boot Camp. And if you're like most doctors, nobody taught you anything about managing money or investing. Financial Boot Camp is the financial education you need to convert your high income to wealth. It's only 12 emails, one a week for 12 weeks, but could be worth millions of dollars over your lifetime. Sign up for that@whitecoatinvestor.com financialbootcamp all right, we've got a great guest today I learned about not that long ago who who is actually shares a specialty with me, but also shares a love of working part time in that specialty and doing some other cool stuff with their life, a lot of which has an impact not only on your patients, but also on your own burnout. So let's get Dr. Darya Long on the line and we're going to talk about burnout as well as a whole bunch of other interesting topics and what she's doing with her life right now. Our guest today on the White Coat Investor podcast is Dr. Daria Long. She's an emergency physician who's been dabbling in a lot of other things in her life. She actually has had a really fascinating career. But I'll bet there's a fair number of our listeners that don't know you and would like to know you a little bit better. So why don't we start, Daria, with you telling us about your upbringing and education.

All right, so we're going back like we're rewinding a lot there, right. Jim, it's such a pleasure to be here. So thank you and hello to of your listeners. So I grew up in Tennessee and I live in Atlanta. I am a girl from the south, but ended up going up north for college. It was kind of interesting since we're talking about career paths. I was accepted to medical school out of high school. It was a joint program. And I it was at the University of Rochester. And so essentially you had to graduate. You didn't have to take the MCATs. You can major whatever you wanted. You didn't have to do any application, which was wonderful. And so I studied abroad three times and I studied classical piano performance at the Eastman School of Music and did a lot of other things and then went to medical school at the University of Rochester and then got into medical school and was there and kind of a culture shock, having been a poli sci major in classical piano performance. And I saw a lot of physicians very frustrated by the changing dynamics of healthcare, by the changing dynamics of how they were practicing and how they were being told to practice. And I didn't know what I specifically wanted to do, but I felt that I wanted to have some role beyond clinical medicine. So I ended up going to Harvard Business School, got my MBA there and planned to come back and do healthcare finance, do healthcare investing, maybe some Private equity kind of helped, maybe be involved with some operation stuff was always the plan. And after medical school, I was at Yale for emergency medicine residency and was watching TV and Jim, you probably remember it was the swine flu and the bird flu epidemics. And you'd watch the local news and they would say, you know, stay tuned for the 10pm for the death pill for the swine flu. And everybody was terrified. My Yale ER waiting room length of stay was 8 hours to see a doctor. This was before we did like that early triage at Pran Journey that. But still it was packed. And by the time I saw somebody, it was. The typical response was, yes, you have this, but you are 32 and you are totally healthy. And I'm sorry you were scared and you probably caught it in our waiting room if you didn't already have it. And you're fine, you're going to be fine. And that was the first time that I thought, how we talk about healthcare in television, how we talk about health care in the news, to the layperson is broken. So I started outreaching to some local news outlets to asap, working with asap, which is the American College of Emergency Physicians, for any of your listeners who aren't familiar with asap, and ended up becoming a spokesperson to that with them and ended up becoming a national spokesperson with them. As I started doing more and more television and TV was never my plan, I never thought I would build a career doing television like that was never. I mean, maybe I was in a couple of plays and musicals and shows, but beyond that, no, I had no preparation for journalism or television. Remember, I went back to John MacArthur and I'll stop here and let you kind of go from there. He was one of the deans of Harvard Business School and he became a dear friend and a mentor. And I remember saying, you know, I have these TV shows reach out to me. They want me to do stuff. I was like, I have no TV training, I am not skilled in this. Why would I be able to do it? And he said, daria, you know, why not you? Why not? And I was like, oh, okay, you're right. And hence started really building my career doing television and really communicating mainly to the layperson. Important things they need to know when it comes to their health.

Wow, what an unusual career path. And lots of emergency physicians, other shift based specialties too, anesthesia, et cetera, can kind of have their career take a serious left turn and do something like this. But it seems pretty common in emergency medicine. Did you feel like your training in emergency medicine really prepared you to do new things that maybe you didn't have any training in doing.

You know, I think that's a great question. I think any specialty you can see in your own specialty opportunities. I think emergency medicine specifically for television was very handy. You know, the CNN network, NBC, any of them knew that they could call me with pretty much anything that was happening. And as an ER doctor, I was like, yeah, yeah, I can talk about that. I saw that last week, that's fine. And so it became very useful as I built my career and doing a lot of, you know, which is really mainly how I built it was doing national news. So yes, ER there, being able to think on your toes, talk to a whole bunch of different people and translate really complex medical things into very understandable and manageable terms is, yeah, I think something that we're taught very. And do all the time in ER.

Now you talk like you're not doing anything clinically anymore, like you're spending all your time on tv, but you're still practicing, aren't you?

Yes, I will practice as long as they let me. Until they pry my stethoscope for my cold, dead hands. I love it. Yes, I practice far fewer shifts a month. I'm no longer my. We got out of residency. What was it, 15 was our full time shift a month. I can't remember. I practice far fewer shifts per month now, but I still do. One is. I love it. I work at University of Tennessee Erlanger. I live in Atlanta, but. But commute up. We have a. I grew up there. We have a farm up there. And so it's very easy to go up. We have residents there. So it's really fun. It's a level one trauma. And you presidency, you're constantly teaching. And so I truly enjoy it. And I think I learn a lot from my patients there, which I then end up putting into an Instagram reel or something else. Because you really are the boots on the ground. Like, oh, this is what people are seeing and talking about. This is where they need to have answers.

So I mean, as a business, when I think of people inviting me on television like you have, you've been on CNN and Fox News and CNBC and these sorts of stations. I don't think of those as paid opportunities. Is that a business for you or is this kind of a passion project and outreach for you?

That's a great question. And if you are not careful, I talked to a couple of friends of mine who do television. Television could just become a really expensive hobby for you. So you have to be very deliberate. When people say we want to be a doctor on tv, I have to say why? Let's, let's look at the end goal. So yes, at first when I was doing local television and you know, some national, you're just trying to get your name out there. Once it became more of a medical contributor and in working as that, then that becomes more of a paid role. But also for me and for everybody, kind of it depends. When somebody says I want to do television, like what is your end goal for say I have a girlfriend who's a plastic surgeon. Her goal is to drive people to come to her business where she does plastic surgery. My goal on the other hand, is not to drive people to come see me in the emergency department. I do not need to stimulate any ER demand, but as a result from kind of a business model for lack of better. If you think of how, how I structure, yes, sometimes it is being paid by a television show, a TV programming. I'm working on a number of different pilots now on a variety of different TV shows, you get paid for those. But also it is once you build a name and a brand which comes from doing television, doing it regularly, producers know you can do that. Then you figure out who's going to be the person paying you. Is it the consumers? Are you doing courses or things like that? Are you having brands pay you for ads or for. What I tend to do in my biggest revenue drivers are a lot of collaborations and spokesperson roles with different brands. So large corporations and hired to speak also by large corporations. So for me, deal with Mucinex or BAYER Or Tylenol, McNeil, Pfizer, the CDC. All of these are groups that I work with and they hire me to function as a spokesperson. So I'll go do a lot of TV shows, TV appearances and things on their behalf.

Very cool. Now this, I've done a lot of things with asep. We're actually going to have a big part in the scientific assembly this year. We're doing a day long financial workshop the day before the assembly starts this year.

Amazing.

But are you the spokesperson for asap? Are you one of multiple spokespersons? How does that work?

No, I'm one of many and some really great brilliant minds. So there's the ASAP communications committee and often that works on, you know, what are the messages that we're getting out. And then within that there are people who are kind of become spokespeople for asap. So but that one that's not paid, that is just because it's an important mission. And I think it's really important that we tell the story of the emergency physician from our perspective and, you know, wear that white hat as emergency physicians and have people see us as that.

Yeah, there's certainly a lot of volunteering going on at asap. That happens a lot with asap. You look at the dues, you pay, and you're like, surely there must be more money than this. But, yeah, there's a lot of people who have done a lot for their professional societies, basically pro bono. All right, well, some of the work you've done has been super interesting to me, is you participated. Not participated. I mean, helped run a burnout study on women. Not women doctors, but women. Can we talk about the key findings of that study?

Yes, absolutely. That was the burnout study in women. So one of the things I was doing was creating a platform which we called truv.com and the goal is to be kind of my mission when I speak to the lay public and to general and social media and different things, is making it easy for women to keep themselves and their family safe and prevent accidents, prevent illness, and to know what to do. Kind of that first step to do if something does happen and give them peace of mind around all of that. Because especially as women, as moms trying to take care of everybody's health, you're overwhelmed by all the health information you're seeing. You're feeling stressed, you're feeling burnout. So as a part of that, I had wanted to do an article on burnout for TRUV and was trying to look through the data and really try to cull through things. And I realized that there wasn't a lot of data when it came to all. All the different hats that we as women wear. And there's a lot of thoughts on here's workplace burnout, which is how the WHO defines burnout. But what about all the other stuff we do? And why can I take two women who might look very similar, but one is losing her mind with stress, and one is, okay, what's going on there? So super curious about that. So another part of the business model, what I do, is the creation of True Lab, which is where we partner, where we find and match, make really exceptional researchers with media outlets, with corporate funding to fund all of this? So the burnout study of women was the very first one that we did, found some brilliant institutional researchers at the University of Tennessee who have done a ton on burnout. So the three of us were CO PIs brought good housekeeping on board as our media outlet to be featuring us in their big conference and in all their. And in magazines and digital and print and a number of things for that. And then as a result was able to bring on a couple of corporations. Clif Bar, Luna Bar, another foundation were able to come on and they were able to sponsor this research to really create this new thing where we can get research done. Essentially from ideation to our very first publication was a year. And I was like, you can't do that with the nih. But when you have really great institutions and you can partner with corporate funds and still with them. We had an irb, we kept Chinese wall. They, you know, Cliff Bar. None of them had no impact on the data. We were very clear for that. You can really get great things done. So kind of created that model which wasn't even part of my initial plan, but really was an exciting evolution. So we created the burnout study in women and it ended up being the largest academic full scale IRB study on burnout. Post Covid had over 4800 women complete a 30 to 45 minute survey and got really fabulous findings from that. We actually are in the process of. We published our first paper. We have a poster up on it, a conference presentation and we're in the process. I was just reading our second paper manuscript before this call. So that's the background of it. You had a specific question, Jim though. Did you ask me about one of the findings or did I answer it?

Yeah, yeah. I mean, I mean it's fascinating to do research but you know, I'm a community emergency physician. I'm very interested in the bottom line. What'd you find when you did this study on women?

So a lot of different things and a lot of these things will go for women, for men as well. We had men, we did not exclude men from the study. Y' all were allowed. We just focused on women. So a couple things and then I'll go into a couple different frameworks because we've also done ended up. This has created some follow on research. We've done some qualitative research in executive women as well to really find out and speaking with some physicians as well. So you know, when we think about burnout and what's happening, a couple of the top things that came up course is we found that 87% of people felt that they needed to be able to do everything and do it all. And in terms of like all the expectations that they had for themselves, 87% of that. I Felt like I need to be able to, quote, unquote, do it all. 7% felt that they actually had the resources to be able to do all of the demands for which they thought they needed to be able to do it. So we said, okay, but 87% of them think they need it and only 7 think they do. So there is this discrepancy. And when you look at models and psychology and burnout, it is a balance between your demands, the things you need to do, and your resources, which are your abilities to handle all of them. That's the case whether it's burnout at work or anything else. And so we found that my demands, my resources might differ from another woman's or another man's, but it is that discrepancy between your demands and your resources. That discrepancy is going to directly predict your burnout. Okay, so we call that the do it all discrepancy. Now we have this framework that is universal across people. We can say, well, you're demands might be different, but we know if we can lower your demands or raise your resources, okay, now we have a way directly to handle burnout. So that was kind of a framework that we created. Another thing, was that an interest? A couple interesting findings. We wanted to say take this beyond workplace burnout because that's how, again, how the who defines it. We said, what about parenting? What about personal life? What about caregiving? Can all of those, can all of those contribute to burnout? And we found that yes, in fact, I mean as we would expect to the degree they are, they all contribute to burnout. They all kind of have their individual places of burnout and there's spillover. So the more employee based work burnout you have, the more likely you are to have parental and personal burnout and vice versa. There's inter roll spillover there.

Interesting.

And these are all kind of background, it's like, okay, now even more reason, let's target these things because yes, as you know, when you're feeling burned out at work, you're going to bring it home. But sometimes you need data to be able to find actionable solutions for it. One other thing, for all the working moms who are your listeners, we had a hypothesis that being a working mom would be more burnout. Jim, would you believe that what we found that working mothers had less parental burnout than non working mothers.

Interesting, right?

So this is going to be a place that we are going to have to dive in more. But the, you know, we were just hypothesizing at this point, we were so surprised that the people who had the least burnout were part time working mothers and the least parental and personal burnout. Then full time working mothers and then the non working mothers had the most personal and parental burnout.

Wow, that's fascinating.

Yeah.

Isn't that, you know, this framework you use about, you know, having resources and increasing resources. Tell us what you mean by resources. I mean, time's a resource, money's a resource. What else are you thinking about when you use that framework?

You asked about resources. Can I start on the demands? If that's okay, I'm going to. But your demands. So you have your internal or external demands. Your external demands, you know, having to go to work, maybe you know that that's obviously a demand. You have children, you have to keep fed and alive. That's looked bad, frowned upon. If you don't do that, you know, you have a roof you have to keep over your head. Those are kind of things that have always been there, but those things have become more complex. And again, if we looked at the burnout study, about 84% of people felt that those demands have become more complex significantly than our parents generation. You know, work is no longer 9 to 5. It is 247 responding to emails and slacks and all the different things at all times. Childcare is no longer just keeping them fed and clothed. It is, you know, is your child in a travel soccer team by the time they are three, have you signed them up for Mandarin by the time they're 18 months? You know, have you, you know, have you. Am I ready for this Valentine's Day party that I'm chairing at my pre for apparently chairing a Valentine's Day party that I'm cheering for, his party next week for my first grader. All of the things that become more complicated in our kind of external demands and then on top of that are kind of internal demands that we've raised that we kind of put on ourselves. And some of these are idealized. You know, do I look as good and does my home look as good as my neighbor does on social media? You know, when I do that Valentine's Day party, am I taking angel food cake that I baked myself using wheat that I threshed in my backyard because it needs to be organic and not part of the dirty dozen? And while I'm doing that, does my hair look ombre beautiful like everybody else does on, on reality TV and again on Instagram? So these are these demands, I mean, these are just increased in, in caliber and Complexity and just sheer volume. Then there's your resources. Your resources, of course, are income. Yes, we know that to a certain extent, having more income is predictive and protective against burnout. Having a supportive partner, that's also a resource that is protective against burnout. Incidentally, age, the older we get, the less burnout we experience, we can do. We can probably discuss that for a while. But it was kind of a negatively protective. So there's those resources. What is your support system, you know, what is your finances? What do you have for that? You know, time. Do you have, what degree of autonomy do you have? What degree of flexibility do you have? And then there's some internal resources that the world can go on around us. But what do you. What do you have that is protective? And one of the things that we found is something called a sense of coherence. And, you know, you've probably. Jim, I'm sure you're aware there, you know, the 2,000 people talk about resilience and they talk about grit and these things being so important. They talk about optimism, happiness. We found that actually something. A factor called sense of coherence, which is something that doesn't get talked about that much, was actually more protective than a lot of the things, than even. Than optimism. In fact, when we weighted coherence versus optimism, having a strong sense of coherence was more protective against burnout than just being optimistic. Sense of coherence was something that was kind of coined by a gentleman, Aaron Antonovsky, in 1979. It's not even new, but he looked at. He was trying to theorize why people become ill under stress and others and stay healthy. And he found kind of three factors that factor into coherence. A sense of appearance. One is comprehensibility. And that is the sense that you're able to make of the world around you, the stories you tell of what's happened in your life. Number two is manageability or agency, you know, degree to which you think you can control things. And the third one is meaningfulness, the meaning that you take from it. You know, if anybody has read Fried Frankl's Man's Search for Meaning, they know about this. He specifically looked at what helped. And he was. He was a Holocaust survivor, if anyone is unfamiliar at it. And he wanted to look at what enabled some people to survive the Holocaust and these concentration camps when some didn't. And he found very much that it was very similar to this. This sense of coherence. He didn't use that exact word, but very much along those lines, that sense of meaning that they found and experienced, the ability to make sense of it or make a storyline out of it and find some roles of agency that actually were more predictive than people who were hopeful about being rescued. So that's why I think sense of coherence is something that's really kind of exciting because it is something that we know is directly tied and protective against burnout. And it is also something that, yes, we're all born with an intrinsic sense of coherence, but it is something that we can grow. Which is why I like it because, okay, now we can get actionable and help grow that sense of coherence in individuals.

Yeah. Now, obviously this is the White Coat Investor podcast. We spend lots of time talking about finances. And so I want to take just a minute to explore something you said earlier, that higher income is actually correlated with reduced burnout. Are you telling me that getting a raise will decrease my burnout?

No, and interestingly, it is more nuanced than that. And a paper upcoming I can't tell all the details on. There are various factors where it's if you look differently across personal burnout, parental burnout, and workplace burnout, higher income is not universally actually the higher income, the better off it is for burnout. So to caveat that when you look at Maslow's hierarchy of needs, yes, you have to have a certain degree of, of finances to be able to feed and meet at least your basic demands. So yes, a certain income is protective up to a certain point. Beyond that, though, however, income can have some various and some variable effects on burnout.

Your study didn't look at what that point is, did you? I mean, I've looked at happiness studies, income and happiness. You know, it starts to level off at 70 or $100,000 a year and pretty much doesn't climb after half a million dollars a year. But certainly more income leads to more happiness. I suspect that that's about where you see it plateauing for burnout too, but I don't know that anybody's ever really looked at that.

Right. We didn't quantify it by point of $, but yes, it gets to like what? At what point are you able to meet those basic demands that you have a shirt on your back, a roof over your head, and you know you're going to be able to feed your family. Below that you have worse burnout concern, lower happiness. But above that, the income, as you said, it does not improve your happiness per se. And depending on how you are pursuing it and the workplace environment in which you are pursuing it, that higher income can worsen your burnout too.

All right, you've alluded to this difficulty with social media that people look at their Instagram feed and of course that's the highlight reel of people's lives and we compare ourselves to that. Can you talk a little bit about why social media is bad for us and, and what we should do about it?

Absolutely. And as a mom, I have a, I have three kids, My oldest is a nine year old girl. So I think about social media a lot for her life. But this study was actually very eye opening to see that, how much it impacts us as adults as well. So one of the things we looked at a variety of factors for social media's impact on burnout and one of the things was we found the top two emotions that women feel after being on social media are, are envy and worry.

That's terrible. That's terrible.

Yeah, right. I mean, sounds great. And far outpaced any feelings we had of optimism, happiness or pride. So why, what's going on? Well, one is, it's this self comparison. It is me versus this idealized version we saw in the burnout study. Over 64% of women said they compare themselves against a woman who they perceive as doing it all. And they're never enough, they are never going to be. And that is that we talked about those demands, that top half, which is those idealized version because you can always add more demand. The world is happy to take your time, energy and your focus and make you think that you're not doing enough. And so it is that self comparison that was directly tied to burnout that triggered by that envy and worry from social media.

Yeah. I think this is particularly concerning for younger people. I remember an experience we had with our oldest daughter who's now a very well adjusted young adult in junior high. It was time for her to have a phone. We had an older iPhone or something that we weren't using. We're like, we'll just give her this instead of getting a new phone. And after a few months we realized the damage that social media was doing to her. She was realizing every time she was left out of anything, you know, at the school. And so after a few months we took the phone away, got her a dumb phone and you know, she did a little bit of therapy even. And I realized, wow, this is really dangerous. And I think, you know, here in Utah, our government is actually passing laws against social media use by minors and some families are actually suing the government because they feel like they're being censored. But I think there's a pretty good consensus that it's bad for young people, that it's really doing damage. Did you get any sense of that from the burnout study?

Yes. And I'm on the board of a couple different organizations regarding social media. One is the organization for social media safety and they're specifically putting laws in place to help protect young people. I was speaking at a conference a while back and I was talking to one of the original. Probably make number five at one of the social media platforms that will go unnamed. And he said I realized what was going on when we had more behavioral scientists working at our app than we had programmers.

Wow.

I realized where they were going with this very early on before any of the rest of us knew. What we found also is that, you know, it is the mere presence of social media. We found that those negative feelings, that self comparison was even more important of a factor than time spent. So sometimes people will say, well you know your teenagers, let them spend 10 minutes on the phone, five minutes in fact, if you get on the phone and your first question post you see causes you to feel less than. It doesn't matter, the damage is already done. So we, we'd never seen that before. This is such an important factor. It is more important than the amount of time that you actually spend on it. I created a term, the jokingly called it comparatonitis. In. In. In part because it's helpful, more helpful to laugh about it because you're on social media and you see your friend and her children look perfect and her house looks perfect and her hair looks perfect and her career looks perfect, perfect and. Or this can happen with men or women and it can be easier instead of saying, oh, I'm having self comparison, I'm having envy. This is triggering to say like, you know, I'm having a bout of comparatinitis right now. I'm having a flare. It's kind of like the gout and I just need to get off. You know, I. You don't need colchicine. You need to get off of social media when you're having compare a flare of comparisonitis. So, so yes, we know obviously social media has led to in most severe things. We hear of people committing children, especially teens, committing suicide and really drastic awful outcomes. But on a much greater volume of people is this degree of insecurity, depression, feeling left out, feeling isolation that grows with social media and that I think the biggest conclusion is that it's not just children and teens who are susceptible to this. But we as adults, very much so as well.

Do you think the good can outweigh the bad? Or should we all just get off Facebook and Twitter and Instagram?

I think about this a lot because for me as a doctor on television, I have a lot of followers on Instagram and I that is part of my work. So I think about this regularly. I think it can be beneficial. I think there are studies out of, there are studies from some of the happiness researchers at Harvard looking specifically at what actions on social media can be protective. So we know that protective do you know, just passive consumption of social media just sitting there, doom scrolling. Which incidentally is what TikTok is designed to do. It is designed. You finish one video, it just goes to the next. That autoplay feature, doom scrolling passive consumption is directly correlated with depression and burnout. On the flip side, actively getting involved, using Instagram or Facebook to find a friend, message them, engage with them, be in a friend group on whether that's on Facebook. Those groups and those networks that they have enabled, if you think about that, you know, groups with medical conditions, groups with specific types of children and work careers and the groups they can have together and create that community on Facebook, there's a value there. So like many things, it is neither. It is not a yes, no question. It is a we need to be aware of this. Like Paracelsus said, the dose makes the poison. We can use this in a way that is good, but we can also too much of it in the wrong way can be very harmful.

Good advice. All right, well, the majority of our audience is doctors and their trainees. And the data these days are showing 50%, even 60% of doctors are burned out. They have at least some symptoms of burnout, you know, depersonalization, cynicism, emotional exhaustion, et cetera. What advice do you have for doctors in particular about burnout?

So I think that's a great question, Jim. And one of the things, one of the reasons I did the burnout study is because I thought, you know, there's more to this than self care. We don't need a doctor. Another doctor appreciation day. Bringing me pizza. That's not going to help my burnout or donuts or anything. What are things that can be done? So I think, especially when it comes to physicians, one of the traps that can happen for burnout is to say, well, here's the things that you individually as a physician can do to reduce your burnout, your personality and self care, things you can do. And while that is True coherence. Building things like that, building your network, spending time with your friends and that support network around you and calling them, getting off of social media, eating while sleeping. Well, all of those things, yes, can build your resources and decrease your burnout. Decrease that, do it all discrepancy margin. With physicians especially, we have to look at all the demands that we face specifically from a work standpoint. As we found in our study and other studies have found, flexibility and autonomy are two very important things. And this is especially the case, you know, for positions for top level executives. What is the flexibility that you have in your career? What is the autonomy that you have over it? And your schedule makes a huge difference in your ability to reduce your burnout. So when you're looking at a new job, you know, what flexibility will you have over your schedule and choices to be able to make for that? I think another one is one of the things in our study of executive women is how much women are more likely. And I think this also falls to doctors as well, to do the unpaid corporate housework. So women are doing the housework at home and then they come back and they're doing the unpaid corporate housework in the office. So look at that. We, as you mentioned, ASAP. I think ASAP's a great thing develop. I think ASAP has been a wonderful thing for me to be involved in. So not saying ASAP as an example, but look at all of the volunteer, all the volunteer things or what are, what's your hospital expecting you to do? What is the unpaid stuff? You know, that extends from maybe committees that you're on, mentoring that you're doing. Those things that are important are important. So you either have to decide, do I drop these things or do I go back to my administration and say this needs to be compensated, need to do one or the other. But don't just keep doing all these unpaid corporate housework that we are very good at as physicians. I remember when I was in Harvard on faculty, that we'd all write these medical chapters and textbooks. We never got paid a dime for that. Nobody else in any other industry would ever say, oh, you want me to go write a chapter in a textbook? Sure, let me do that. Take the however many hours it took me to write that chapter and do it totally for free out of the goodness of my heart. No. So be very careful with that. Go to administration with the worth of that. That also comes down to also to how you are paid. A lot of doctors, if you're only RVU paid, then you are Paid effectively for seeing those patients, maybe for charting. What about all the other emails, the other admin, the other leadership things you're expected to do to go to your leadership, you know, to, to make sure that you are either being compensated for those or minimizing the non paid work you're doing. Another thing that we have seen now I've talked to since I speak regularly about burnout, end up seeing some different models that, that work in different places where they work better. I think institutions where they do give the physicians more flexibility, autonomy over their schedule. Institutions where they kind of help pick up the extra stuff sometimes. Some places they provide Bright Horizons child care. You know, I always joke as a working mom, I'm only one stomach bug away from like it all falling apart. So you know, does your employer provide Bright Horizons childcare? Another one in Texas they have free doordash, you got to get dinner at home and you're, you're running late. Things like that they can do. And then also one of the things I speak to institutions about is how do you take out all the little obstacles and things that don't need to be done from a doctor? Can you take that off of their plate? Whether that is, you know, filling out their CME, their ACLs, credentialing, having admins help them with prior authorization and treatment denials, things like that. There are things that institutions can do to make their physicians feel more valued, have more time, have more energy to really do a better job of taking care of their patients. And when institutions do that, they see that they have better talent retention, they have better physician retention. And it is not cheap for an institution to bring on a new physician. So it is beneficial for the institution as well. So find those things and take that to your institutions as well.

Yeah, it's not cheap, that's for sure. I've got a friend that's a physician recruiter and he gets paid 50 grand to bring a doctor to a hospital. I mean, it's not cheap. To turnover for doctors is a serious expense. You know, you alluded to this earlier, that this is particularly bad, I think for women because lots of professional women find they've still got the lion's share of duties at home. Now what advice do you have for them to help them get a better division of labor once they go home from work?

No, man, this is a good question. Yes, for women it is especially hard. And this is what we have had this, the qualitative research. They express a couple of fears. One is, especially in medicine, I did medical school I did residency, I did fellowship. I worked my, you know, one off to get to a point that somebody is respecting me as a physician. Here is what, what so many of them say. And then if they have a child, it becomes this issue of either they're afraid that if they do try to cut back, they get put into maybe it's like some mommy track which they worry they can't recover from, or they say, and there's nothing formal there, there's no. Or there's no way to do so. There's no way to really cut back. It's like either you quit or not. There's no part, no part time formal track. Or they don't want to show it because they're very afraid that if they say, you know, I'm having a hard time or this is difficult, or I have to go for a practice, that they will lose the respect of their colleagues, they will lose promotion abilities, maybe research things. So they kind of fake it. Everything's great, nothing's wrong. Of course I can take on that extra responsibility, that extra leadership role, that extra administrative role, because I'm having no problems managing everything. And then they're secretly and quietly crumbling at home trying to manage all of these things. So one is for institutions and for managers, and it's to really create for women formal tracks. You know, to say you have family, or maybe it's not him, maybe you're caregiving your parent. It is not only for moms, it is, it's for fathers and anybody as well who might have something. Is there a formal track to reduce? A physician is such a valuable resource. If you can keep that physician in the clinical workforce and maybe cut them down to 50%. What are the ways we can do that? We're smart people. We can think creatively about this and get somebody off the 80 hour per week track if they need to be. So that's one of the things. And talking openly about that, I think having female physician groups that you are able to support each other, share best practices and go en masse to leadership to really ask for things is really helpful. Another thing is kind of having, we talk about having disconnected time when you are on vacation or when you go home at the end of the day, are you able to be disconnected and finding that time, it can be difficult because you have to go home and you have to chart. But how can you find that when you go on vacation? Different hospitals sometimes do things like an inbox buddy. I know a lot of physicians, they do an epic inbox body. They're on vacation. So they have another attending check checking their EPIC inbox. So now at least for that week that they're gone, they're not having to check their EPIC inbox. And they're actually able to be present with their family. And then I think also when you are home, yes, I did a whole TED talk on how to delegate and automate and things like that. But I think first is to really look to what resources you have, whether that is your partner and having a discussion with your partner and how you will share resources, whether that is having whatever childcare resources you need to get you the help. Because again, you don't have to do it all. And it is okay to be a physician mom and say I'm not going to be doing the beautiful crafts at my child school, but I'm going to be present for this, for this one event or that event. So again, it comes down to really just being deliberate about your choices and what you're spending time on and outsourcing when you can because as a physician you probably have a little more income flexibility. So outsource, outsource the things you don't like. I remember somebody telling me when I was hiring a nanny, she said make sure you have the nanny do all the things you don't want to do. So that minute you get home or you stop doing work, you use that precious time to now be spending time with your children as opposed to doing laundry or chopping vegetables or something. Have them do that. There's no shame in that. And there's lots of ways to find that without having to hire a governance so you can outsource in a more cost effective way.

You use a phrase frequently that I really like being unflappable or unoverwhelmable. What lessons about balance and burnout has practicing emergency medicine taught you?

Oh well. So to use unflappable. I love unflappable. It sounds like you're about 80 years old when you use it. But I think it's perfect because it says how can you go and you have some situation no matter how stressful. And yes, being an emergency medicine, maybe I self selected to emergency medicine because I had some of this. But I think being an emergency medicine also helps you no matter what craziness comes in the door. How do you keep your cool? And that's useful if it's a multi trauma coming in. It's also useful if it's, you know, your children and they suddenly have 14 different things coming up next week that you need to be able to attend or need to be ready for. So a couple different things. One is what you do in the moment or what you will have done is, you know, we talk about triage. We talk about triage in the emergency department. And the reason triage matters, there's research from Robert Sapolsky that shows that it's the ability to isolate and to be able to differentiate what is threat versus non threat is crucial for our stress levels. So our brains are not intrinsically capable of doing that. Because you might have 14 different things on your to do list. And then you get another email that comes in and this is about a request to do. And they all seem equally noisy. They all seem like urgent and emergent that you have to be able to handle all of them. And now you have 16 things you have to do, but you have to pause and say, okay, what's my most important thing? What's my red in the er? Who's my level five that I need to go take care of immediately? What's my most important thing now that I need to handle? So when you have 80 different things coming at you, you triage. And I do this constantly during my day. Like even today I had some things come up and it's okay. What's my most, one most important thing that I have to get done? Because if you've gotten that one or two or three most important things done, then when things get really stressful, you're okay because the important priorities are covered. Number two is automating as much as possible. What are all the decisions that you make every single day? Whether that, you know, Steve Jobs were the same thing every day. You don't have to do that. I think that's a little bit boring. But how can you automate different tasks, things in your schedule, carpool, meals, any number of things, workplace meetings, things. How can you automate as much as possible? And then you also have to delete. So, Jim, you're. We in the ER are able to say, like, what are the things that we're not going to take care of? What are the things that are not emergent that I'm going to tell you to follow up with your primary care doctor for? And we have to be able to look at our to do list and you know, in your, in your life, out of the er, translating back, say, okay, here's my most important things I'm triaging, but then here's the things I'm going to take off my list. And that comes down to the do it all. We do not have to do it all. By whatever definition of do it all that we're looking at. From my idealized definition, if there are things on your to do list that you can take off, so you're triaging, you're automating and you're deleting the things that maybe are there because you felt like, well, every, all the moms do this. This is a good thing. This is what makes a good parent. Take that off. If it's not something that's a high priority for you and it's just taking you away from your most important things, then you delete. So triage, automate, delete.

Love it. Great framework to think about that. All right, our time is now getting short, but I wanted to give you a chance. By the time all is said and done, something like 30,000 people are going to listen to this podcast. Mostly high income professionals. What have we not talked about that you think this audience ought to know?

Two things. One, we touched on in the beginning. For me, you know, television, again was something that I didn't expect and was something off of which I now made a career. I think anybody who's looking at doing television or being kind of a thought leader, it's important to always look at what is the yield for it. So if anybody is interested in watching, listening to this and watching this, then, you know, again, for me it was doing national tv and that is the business model. But for other people, maybe it's growing your practice, in which case you don't need to do national tv, you don't need to be on CNN to grow your local practice. If you're an ENT doctor, it's doing local news to being involved in the local media circuit and local newspapers and things. So people see you as a local thought leader to drive your practice. So I would say use media not just, hey, I want to get on the Today show, but by figuring out what is your goal, your end goal, and then you can leverage media, however fits that. And it's much easier if it's you say, I just want to, I need to drive my local practice. Great. Okay, now you know what you're doing. Just use media strategically because yes, you don't want it to become an expensive hobby. I have seen that happen to people, so know where you want to take it. And then I have one more burnout tip that I like to share when I am speaking called batch. The small stuff when we talk about the small things. So when I, when I talk about triage, in my talk again, the reds are your most important Things your. These are your, like, your level five patients. The yellows are your level three patients. The greens are your level one patients. You still have to get them seen. But how can you get your level one patient seen in a way that doesn't keep you from taking care of the level five septic shock that's in room nine? Similarly, in our lives, we have greens. Greens are things that we have to get done, but are really not our mission critical things. Maybe they are. You know, hey, send $8 for Mr. Jones coach's gift. Or send. Make sure you're, you know, you sign up for this Girl Scout cookie link or make sure you sign up to bring in donuts for Janet's retirement party. These little tiny things. And research shows that these little tiny things really can be interruptive to your day. And so I think of them, they're kind of like the compsognathus in Jurassic park. The little tiny. You remember those, those little tiny dinosaurs, like, as a single one, they're like, oh, cute little dinosaur. What's up? As a herd of compsognathus, they will devour you. And that's what these little tiny tasks are like. Just one. Sure, I'll send that $8 over. I'll buy that one thing on Amazon. Just one. They seem fine, but constantly, throughout the course of your day, constantly interrupting you, trying to do patient care, trying to do the important things, it's distracting you. So I call these. These are your BTSS batch, the small stuff. If it's a more adult audience. I don't always say stuff. I use another word that's but doesn't matter. You get my drip. Create a folder called BTSS in your inbox. And every time one of these requests comes in, do not stop and do it. Just drag it, drag it to that folder. And then periodically, once a week, once every couple weeks, or when you are doing something like, you know, carpool, which is, I think, you know, where my soul goes to die is sitting in the carpool line, or you're on hold with the pharmacy, with a pharmacy or insurance or something, pull out your little, your phone, pull out your BTSS folder and go to town and you will get 10, 15 tasks done in 40 minutes. You get your green things that you gotta get done without taking over your whole day and without derailing the things that are really important and that move the needle.

Awesome. Great tip. For those who want to learn more about Dr. Daria, you can actually go to one of her websites. Drdaria.com is one. And then of course, as she mentioned, this business truva is how you pronounce it. T R U e v e tru.

Truv.Com troove it's a combination of true like source of truth and the French word trouvet, which means to find.

Ah, very nice. True, very cool. So you can get more information about her there. Thank you so much for coming on the White Coat Investor podcast and sharing some of the results from your study as well as these other helpful tips for burnout.

Thank you so much, Jim. And I would also say if anybody's interested, they're welcome to connect with me on Instagram. Rdaria When I'm on Instagram, usually my content is again keeping women making easy to for women to keep their families healthy and safe and accident free and to know what to do if something does happen with that peace of mind to follow me there and always love hearing from physicians, hearing stories. If there are stories that people, physicians think that need to be shared with the general public, share them with me and we can help educate public together.

Awesome. Thank you so much for what you're doing.

Thanks, Jim.

All right. She's got a lot of energy. It's pretty amazing, right, how much she can accomplish in her life and in her career. But you know what? Just like everybody else, we only have 24 hours in a day. You've got to delete out of your life those things that aren't moving the needle for you. I love her tips about automating, about triaging, and about just deleting stuff out of our lives. I think that is probably the most powerful thing. It's interesting anytime Katie or I try to take something else on in our lives, we we got to look at what else we're doing and decide, well, what's coming out if we really want to do this, what's going to come out of our lives? Are we going to travel less? Are we going to spend less time with our kids? And if not, then it's got to come off of something else. Our volunteer work or I paid work or those sorts of things. Because it just doesn't make any sense to squeeze out the most important things in order to do more things that aren't necessarily all that important. Still not sure what to do with your student loans? Overwhelmed with how to tackle that giant debt? In an ever changing political climate, the experts@studentloanadvice.com are here to help guide you through the best options to manage your loans. Our experienced staff have consulted on over $250 million in student loan debt and the average studentloanadvice.com client has saved over $190,000. You will receive a customized student loan plan using the principles of the White Coat Investor. Get answers to all of your student loan questions, gain clarity about your financial future, and start down the right path toward financial freedom. Book a consult today@studentloanadvice.com you can do this and the White Coat Investor can help. Don't forget, as I mentioned at the beginning of the hour Financial Boot Camp. Sign up for that whitecoatinvestor.com financialbootcamp free 12 week email course could save you or make you millions of dollars over your lifetime. Become financially educated. Become financially literate. Become financially disciplined. These emails will help thanks for those of you who've been telling others about the podcast and giving us five star reviews. One just last month came in from Doe123 said great podcast. WCI should be required reading and listening in medical school and residency. I started listening around 2016. I've listened to every episode since and I've learned so much. I'm now retired from medicine and still enjoy listening, reading and learning from both the WCI podcast and blog. Thanks for the great work in helping us docs get our finances on track. 5 stars. Thanks so much. Great review. That does help us to spread the word. All right, for the rest of you, we've come to the end of the episode. Keep your head up, shoulders back. You've got this. We're here to help. We'll see you next time on the White Coat Investor Podcast.

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