Nisha Mehta on Negotiation, Burnout, and Career Sustainability

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Nisha, thanks for joining us today.

Thanks for having me. I'm excited to be here.

It is my pleasure. So how about you get us started by telling us a little bit about yourself and what you do?

Yeah, sure. So my name is Nisha Mehta. I'm a radiologist by training, still practice medicine, but a lot of what I do these days is actually related to physician empowerment and building physician communities. So I host the largest online physician platform in the country. We have about 173,000 verified physician members. We've got about 20,000 people waiting to join. And it's just been a really fun way to, number one, community amongst physicians, but number two, be able to have some of these conversations that we've never had the chance to have as a community. Because we tend to talk about clinical stuff, we tend to talk about things directly related to our jobs very specifically, but life and medicine in general, we don't hit on a lot of the topics that we should have probably learned in medical school but didn't. One of those ones is negotiations. I am so excited to be here, but we do a lot of teaching of all the stuff that we didn't learn in med school, basically.

This is great. And before we jump into it, can you let the listeners know about the negotiation salary database that you have too?

We have a really comprehensive database that our physician members have actually contributed to in order to allow the physicians to be able to get apples to apples data when they're negotiating their contracts, things like that, just to kind of understand nobody's price fixing or colluding or anything like that. It's literally just thousands of physicians who have said, hey, this is my market and this is what my job is like. These are the things that I've been able to negotiate for so that people can kind of look and say, hmm, maybe this is something that I could ask for. Or a lot of times people don't even think about the different things that they can negotiate into their contract. So it's been really nice for people to be able to go in and say, like, oh, that's interesting. I did realize there was a cap on my salary that was sort of set. But here are all these other things that I can maybe bring up with my employer and talk to them about the potential to make this package what I want. And what we found is that a lot of our members have really been able to create those jobs that they want by thinking a little bit more outside of the box from just, hey, here's your contract, and take it or leave it. And I think that's been really great for our members to just also realize that there's so much more to a compensation package than just salaries. There's a lot of salary databases out there for physicians, but they don't get into the nitty gritty of what does it mean to make $250,000 here versus there? What are the differences in vacation? What's the differences in call schedule? What's the differences in benefits or bonus structures? Those are the kinds of things that they really need to realize. A number in isolation doesn't mean much. And so a lot of times I think doctors are like, oh, well, we make this much. And it's kind of like, yeah, but making this much, taking Q3 call and getting two weeks of vacation a year versus making this much. And you could have a very low salary, but if you have a lifestyle that you love and reflects exactly what you want, then maybe that is what should be negotiating for. So it's been nice to kind of open up the conversation about physician salaries a little bit more comprehensively.

I love this for a number of reasons. First of all, selfishly, my wife is a physician as well, so let's negotiate those salaries. So I like that. Second of all, I think it's really important because it ties right to your core value of physician empowerment, because knowledge is power, and a lot of times we cannot negotiate effectively for ourselves simply because we don't have the knowledge to benchmark ourselves, number one, and then the skills, too. So this is really, really important work that you're doing.

Thank you. Yeah, no, it's been really fun to just watch everyone empower each other and give each other feedback on things. And it's so Important for people to have these conversations because money is always amongst physicians is always a pretty taboo topic. And as we see physician burnout just rising and people being like, this isn't worth it, a lot more of these discussions about how do we make it sustainable, right? And not think about our jobs as such. Cookie cutter Algorith, what can we change? What are the pieces we can move? And especially with budgetary constraints in hospitals and things like that, there's a lot more, hey, this is just what the salary is. And so I think it's really paramount for physicians to kind of go out there and say, okay, fine, we're working with these numbers, but this is what we're going to do for these numbers. Not just, okay, this is the salary, and you can tell us everything that we need to do. And we're not going to protect ourselves contractually. So, like, a really common example is contracts and physician employment contracts with hospitals where the physician will take call as much as everyone else. And it's just kind of this blanket statement of, okay, everybody takes equal call. Well, that's fine. When you join the group, if you have six people and you're like, yeah, of course everything should be split between six people. But what happens in today's healthcare environment where sometimes we do have mass exoduses and things change and all of a sudden there's only two people in the call pool, and now all of a sudden you have the same compensation, but you're on call every other night. That changes the dynamic a little bit. So really trying to make sure that physicians protect themselves and their contracts against some of these forces and dynamics that are happening in the healthcare environment. Contract negotiations have become such a big thing for physicians where they really need to be able to say, like, let's spell out everything in terms of minimums, maximums, whatever, so that we're not ultimately being asked to step up and do a lot more than what we signed up for, but don't have any contractual recourse to say no.

Those contracts with the hospitals, that's so important to evaluate because you're right, you sign the deal and then people leave. Your workload changes, but your pay stays the same. And that's not fair. And now tell me if I'm off on this, because I want to get the physician's perspective here. It seems from the outside looking in that, let's say you grew up wanting to be a doctor so you could help people. Or my family's from the Caribbean. If you're an immigrant, you'll be a doctor. Because that's what your parents tell you to do.

Same thing in South Asian culture. So, yes, I understand that very well.

At some point you want to help somebody, right? So you get go through undergrad, you go through med school, and you have this helping mentality. And then it's almost like these institutions can almost weaponize that against you, because it can feel almost icky to be advocating for more money when you're supposed to be there helping people.

And this is something, if you follow me a lot, I talk a lot about how the altruism of physicians is used against them and the altruism of healthcare workers in general. Honestly, not just physicians, where I think everyone understands that at the end of the day, we took an oath and we're never going to look at a patient and not do what's best for them. And sometimes, unfortunately, increasingly that is being used against health care workers to kind of say like, well, patient care comes first and it does, right? So in the moment, that's not the time for people to pick that battle, Right? But globally speaking, what we try to remind the physicians on our group is you need to be able to do this for the next 10, 20, 30 years, and you can do that altruistic thing five times in a month and do it because that's what you need to be doing, and that's what's the best interest of your patient. But can you do it for three decades? And more and more what we're seeing is that people are saying, I can't do this anymore. And then it becomes this very binary thing where it's like, I've done it too much. I can't do this anymore. I quit. Right? And so we're seeing this mass exodus of physicians and other health care workers out of the health care system because they just reach that breaking point where they quit. So a large emphasis of my work is how do we create career longevity amongst healthcare professionals, Right? And part of that is being able to have terms that actually are sustainable over the long term. And so I keep trying to tell people it's not selfish to put boundaries on, because these are the things that are going to allow you to do this for the next 10, 20, 30 years and not reach that breaking point where you're just like, I gave everything I had. I missed all the holidays, I missed all of my kids events. I did all this stuff, I gave everything, and now I just don't have more to give. Well, you haven't done anybody any favors because right now what we're seeing is about 10% of the physician workforce leaving the workforce every year. And that is not a health care system that is sustainable. Right? So if you really want to do what's best for your patients, you need to be around and patients need to have access to care in 20 years. And the way that we have our health care system built right now and the way that people's contracts are right now, we are seeing a situation where very rapidly that may not even be the case in four or five years. Right. In some markets around the country, right now, you're looking at six, eight months to see a specialist because there's just so much of a doctor shortage. Right? And that's only getting worse and worse and worse. So my big thing is like, yes, we are altruistic. Yes, we have taken an oath. We're always going to do what's best for the patient in that moment, but also make sure that we put systems into place and then systems being into place so that those things are not everyday occurrences that ultimately lead to burnout.

This is so good because I think a lot of people can relate to that fear of looking greedy or selfish by advocating for yourself. Because like you said in healthcare, it's your altruistic nature that's being used against you, either intentionally or unintentionally, that keeps you from advocating for yourself. Because you're thinking, hey, I need to take care of the patients. That's my primary focus. But the question is, who's taking care of you? And that responsibility is yours. And that's really tough to do. And I love this mentality of focusing on career longevity. Then it helps people to recognize, hey, by advocating for myself, I am advocating for my patients because I'm going to be there longer and I'll be able to perform at a higher level. And I think a lot of times people just need that permission to advocate for themselves. And that's really the thing that holds them back.

And I think it's been ingrained into us throughout our training that we go above and beyond for everything, right? So the minute that you check off that box that you're pre med in college, all of a sudden you're doing all the unpaid research, all the unpaid fellowships, all the unpaid everything to get to your spot in medical school. And then when you get to medical school, your attending physician says to you, hey, show up for rounds at 7 o' clock. And you show up at 5:30 at a pre round. Because that is the nature of what we do, is we're. And the system breeds the system where it's kind of, hey, you have to go above and beyond. Because that's what doctors do. And I think that that's part of the wonderful part about our profession is that people are so giving and that I see stories every day on our communities of things that people have done where I'm kind of like, I want you to be my doctor because you are awesome. Right? We want that in our physicians. But then we also see the same stories from those same people saying, like, I'm at my wit's end, I can't do this anymore. I've spent four hours every night charting. I haven't read a book for fun in a year or five years or 10 years. Right? @ some point, what we need to be able to give ourselves permission to do is say, like, we actually do have to start saying no. And that is something that comes so uncomfortably. It's not natural for a doctor to say no. Right. We do everything we can. And that's always been how it's been ingrained into us. So people are just very uncomfortable with the word no. And sometimes people will draft their responses to how they're going to respond to a request from the administration. And it's like this long paragraph of like, I'm so sorry, I can't do this because of this, this, this, this. And I'm like, stop apologizing. No is a one word sentence. I did not sign up for that. I'm sorry. No. If you want me to do this, we can talk about how we can make that sustainable. But it's not a no holds bar. Yeah, sure. I'll do whatever you want to do because that's not sustainable, right? So just getting comfortable with that idea of setting boundaries and saying no is something that I think every physician and every healthcare worker really needs to learn.

Hello, my friends. Before we get back to today's episode.

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Yeah. And I think one thing I've learned both in medicine and in business is just this idea that you can think that you love what you do so much, right? Like, for me, what I do professionally as a physician and what I do in the business world, I just, like, I love it, right? Like, I would do it for free if I could because I love it, right? For a lot of doctors, where is this very different thing where this is my, like, passion and this is my calling, not this is just a job, right? So we'll see other people say to us, like, oh, we're not going to do this. It's not worth it because it's not worth $5 an hour, it's not worth $10 an hour or whatever. For people that are working and seeing their profession as a job as opposed to their calling and their passion, right? And I think physicians are in a very fortunate position where what they do does feel like their passion and a calling. And so for me, it's like, I would do radiology every day of my life till I was 80 because I love it, right? And at some point it's kind of like, well, if I make this much or if I make this much, does it really matter? Like, I love what I'm doing, but what I need to remind myself is then what happens is whenever there is a conflict, if I'm like, well, actually I'm not being paid my worth over here, then I'm only doing that on days where I don't have something better to do, but I'm not actually driven to do it on days where I have something else that I want to do that becomes problematic, right? So if I haven't negotiated terms for myself, it might be okay in my life because maybe I'm saying, I don't need the money, I'm going to take these extra. I'm going to take the summer off and be with my children or whatever it is. Right. I can say that in that moment. But when you start thinking about the workforce as a whole, that's really problematic. If everybody's like, I only do this job because I'm incentivized to do, or I'm only doing it because I love it, it actually from a monetary perspective doesn't make sense. Well, especially when you start looking at changing demographics in the physician workforce where you have more dual income families and you have more female physicians. 50% of the pipeline into medicine right now is female. And statistically speaking, 70 to 80% of female physicians are married to other high income professionals. So the financial dynamics in their household are such that they don't necessarily need to work. They're only going if they really want to work. Right. So if you don't make the finances worth it, what you see is more and more women saying, hey, I'm going to step back. I love what I'm doing. Financially, it's not worth it. I'm just doing it because I love it, but I'm going to do it part time or I'm going to do it three days a month or I'm going to do, you know, whatever. And again, what happens to the workforce in that situation? Right. So really trying to behoove employers to realize like you can feel like you're getting a great deal, but then when you ask somebody to step up and show up, there's going to be nobody to be there because people are going to say, well, I'll do it on a day that I don't have anything else to do, but if I could go on vacation instead, or if my kid has something else going on instead, like you just don't pay me enough to make that sacrifice. Right. And that's what a lot of employers are running into right now. On a macro level is a lot of people saying, you don't pay me enough to want me for me to do this seven days a week or you don't pay me enough for me to take 24 hour calls or do X, Y and Z. And then it's like, well, who's going to do that? Right. Medicine is 24 7. You need a workforce that's willing to do all of that 24 7. So when you look at these numbers about female physicians, 40% of female physicians will actually cut back clinically or quit medicine entirely within the first six years of finishing training. And that is like terrifying when you think about 50% of the pipeline being female. So what are These jobs doing wrong in terms of not giving flexibility, not giving options, and paying well enough that people are wanting to say, hey, actually, I see myself as the primary breadwinner, or I see myself as being able to go do this and be able to make enough money that it feels like it's worth what I'm giving up to be there.

This is incredible. I appreciate the statistics. And I also, as you were saying something, it made me realize something really interesting because like I said, I'm married to a doctor and I see how stressed out she is and I see how burnt out she's been. And I tell her every week, I said, my goal is to just buy back more of your time. So I took her Mondays, great, now you. And I'm like, I'm just taking these days off the plate with. It's so funny because first of all, I'm realizing I'm part of the problem. Nisha.

Well, but you're not. I mean, I'm doing the same thing to my husband. It's just happening to women, right? I'm also saying to my husband, like, you don't need to take that much call. We don't need the money if that means we can't go away for whatever time. Or, hey, if this procedure is stressful to you, it's not worth the money. Or why don't you just end your days earlier so that you can get home earlier and be with the kids. Everybody is making these decisions in medicine right now. It's not just females. Females have a lot more. As a general 30,000 foot view, obviously every case by case is different. But on the macro level, females in medicine have more of an ability to step back because they do have a little bit more on average financial support at home. That's coming in from other places. But the trends are the same regardless of whether you're a male or a female. Everybody's stressed out by all the things that are happening within the healthcare environment. And everybody's saying, hey, we want to cut back. And they're saying, actually financially we probably could cut back. And the marginal cost or the marginal benefit to making X amount more and then paying taxes on it and then also having to maybe hire a nanny to cover those hours or whatever. All of a sudden everybody's doing math because the numbers have gotten so much smaller in terms of the incentives. My dad is a cardiologist and when he was practicing medicine, he just recently, during the pandemic, stopped working clinically. He spent 40 something years practicing medicine. And I remember when we were younger. The bonus structures and everything was there such that it wasn't a big deal to go in on call or this or that. You were reimbursed so well for what you did, for each additional thing. That at least from the financial perspective, he wasn't like, is this worth it? I mean, he may have chosen to cut back for other reasons, for other things, because of family priorities or whatever, but there was never this, it's not worth it. Like, this financial incentive is not worth it. Whereas now, with a lot of these cuts and prior authorizations and denials and all the things that are happening in the healthcare environment, people are like, it's not worth it for me to chase this extra dollar. Right? So you see more and more people on various different levels, whatever works for their lifestyle, saying, I'm going to leave that aside. No, thank you. I don't want to take call anymore. No, thank you. I don't want to be in a job that makes me do X, Y and Z. So what you're seeing on a macro level in the negotiations world in hospital systems is I think that you're going to have a lot of pain if you're an administrator because you're trying to kind of run things the way that they always were. And you're making all these market assumptions and pro formas based on the fact that you think you're going to have a physician who's going to say yes to the. And all of a sudden you're like, I can't find that doctor to say yes to this stuff. We've talked to so many healthcare systems. One of the things that we're working on is trying to be able to have like a more friendly job match for doctors. And what we're saying to a lot of these healthcare systems is like, you got to have a little bit more flexibility. Like, nobody's going to take this job. We see the jobs that people are looking for and what they're taking, and this job is ridiculous. You're not paying them enough to do all these things and you're going to sit within this opening for years, potentially. And we've had people say that. We talked to one oncology group at a hospital system who were like, we've had an opening for three years and we cannot fill it. And then I was like, well, tell me about what the job looks like. And as soon as they told me, I was like, it's gonna be another three years if you don't change what you're asking for. So just having realistic expectations about Making sure that doctors feel like it's worth it is a new battle for these hospital systems. Because they were always kind of like, oh, of course everybody's gonna want this job. And the fact is, the supply and demand curves have shifted so much that, no, not necessarily. I think that should scare everybody from both, yes, at a very tangible level from the employer perspective, but also just from a macro level, from a public health perspective. The fact that more and more people are just like, this is not worth it is really scary.

Agreed. And it's challenging because we can see the challenge occurring right now and we can see it potentially getting worse. And what you're doing is physician empowerment, empowering the individual. And so it's going to be great to have this new wave of doctors advocating for themselves, getting paid what they deserve. And then on the other side, the things that are outside our control are the macro forces within administrations and policies and things like that. And that's something that needs to be addressed. But before we get to that, solving the world's problems, that's pretty big.

And yeah, it's a little lofty for a podcast, right?

Yeah, exactly. Let's talk about what individual doctors can do. I think you set out a really great case study. So let's say there's a physician who joined the practice, and then there was an exodus, and now the workload has increased, but the pay has stayed the same. So the person says, that's me. How would you suggest that they approach this negotiation?

I mean, I think that's when you go to your employer, right. And you say, listen, short term, happy to help out. I understand in the next week or two weeks, you're not going to find a solution to this. However, this cannot be a long term problem where all of a sudden I'm just working. Right. So I think it's always important to be reasonable and understand that you can't leave patient care needs unmet. And I think when you come to the administration with that understanding and sort of fighting from the beginning, but just saying, okay, I understand we're in a tight place, I want to help out, but here are the conditions under which I'm going to help out right now. Maybe all of a sudden, for every extra call, I'm being paid X amount. Right? You're saving that money from not having another employed physician. What are we doing with the money in that bucket in the interim until you find another employed position? And there you're putting the impetus and the incentive on them to also refine that person. Right. Because if they Start seeing, hey, well, we're doing everything we can with three doctors that we used to be doing with four doctors. Guess what? Their incentive to hire somebody else and pay them a full benefits package and a salary is like zilch, Right? So I'm always like, come together with the other people that you're with and go to your employer and say like, well, we're saving this FTE per month and this amount of money is FTE used very much in the non physician world. So basically 1.0 job position as a full time job position is what we call an FTE. Right? So if you're saving that one FTE's worth of salary and benefits and all that stuff, how are you reallocating those resources to help us get through this period until you fill that one FTE position? Right? So coming at it with that rationale and saying like, you are asking us to do more, you're saving money on your side of things, how are you going to make sure that we're made whole on that side of things and we'll help for as long as we can with the understanding that we're incentivizing you also to aggressively replace us and replace the person that you lost? Because what we see is so many hospital systems are just not replacing the person that they lost. And then the other people are doing more because the minute they see that the other people can do more, it's like, why bother to rush to hire somebody? So I think having that conversation with them early, saying, like, these are the things I need to be able to do what you're asking of me and this is what my expectation is, okay, fine, you're asking me to take less vacation this month. I would like it written that those vacation days are going to come back to me later on. If I do more calls here, I expect to do less calls later. If I take all these holidays right now, I expect those to be made up for me, sort of laying out that groundwork for what the expectation is and saying like, I'm willing to be a team player, I'm willing to step up, but it needs to be reciprocated, Right? And I think that that's really, really important and on their side of things. If you look at what their options are, if you say no, then they have to go to Locum's physicians who are going to be much more expensive for the system if they can even find them, right? So where do you have leverage and being able to point out to them like, well, I do have the option of saying no, because I was really good about negotiating my contract from the beginning. And technically I don't have to be on call more than Q4, so I'm willing to do your Q3 call while you need me to. However, this is what the cost of that is going to be, right? So understanding that you say, well, if I say no, and I exercise my right to say no, these are your options. You're going to have to try to find a locums physician. Or let's say you're an ER that needs three trauma surgeons on call in order to maintain your level one trauma center status. And guess what? We don't have three anymore. Or we don't have coverage every night anymore. And you could potentially lose your trauma center status. Like, you've got leverage, right? But you got to be able to point it out, obviously, in a respectful way, but say, like, I do have some ability to say no, actually, and this is what the consequences would be. So how can we work together to make sure that neither party is being taken advantage of?

Nisha, this was a master class. Let me summarize this breakdown, because this is great. So first we have to address the mentality shift, because I think a lot of times people say, oh, negotiation. It's me just asking for what I want. That's an element of it. It's not you taking something. The way that you frame this is that you've turned this into a collaborative problem solving conversation. You entity have a problem. Doctors left, I have a problem. I'm overworked. Let's talk through how we're going to solve this problem. So we have to address that mentality thing first. Step one, go to your employer and have the conversation. We're not just going to sit here and think about it and complain about it for seven months and not do anything but go to the employer early. Because think about it, if you come up and you say, nine months down the road, the doctors left, it was really hard. It's like, was it really hard? Because the last nine months I've been making more money off of you, and you say, thank you. So you lose a little bit of credibility, taking longer to make that claim. And then I love the fact that you put in the reasonable approach because it's not an extortion or hostage situation where you're like, pay me or I'm not working now. And then patients are suffering. They're like, listen, I'm a team player. I'm going to keep doing what I'm doing. And I know it's not feasible for you to make a decision today. But we're starting the conversation and soon. We need to address something. We have to solve a problem here because this is not sustainable. And for me now as an employer, like that word sustainable is in my head because as business owners, we are professional firefighters. Bad things are happening all the time and we're all over the place. And there's a problem that I think might be a problem, but nobody said anything about it. I'll try to ignore that. Got so many other things to do. And so we have to be constantly saying, hey, this is an issue. And even though it might not appear that we need to address it immediately, just know it is not sustainable. So it might not be broken right now, but it will break in the future at a date not yet determined. That will surprise you and be another fire.

And I think that that bit, what you talked about in terms of, like I was saying, approach it early. I mean, when you hear that the other person is resigning right before, even if they get put in their three month notice or their six months notice, doctors tend to give a little bit longer notice, right? But let's say they've given their three month notice, then at that point you and your team go to the administration and say, what's our plan? Right? You don't wait for it to become a problem or you don't wait to just magically get a call schedule where you're on every three. And then you're like fighting backwards. You're saying, okay, before you guys make that schedule, what is the plan? Right? And just staying ahead of it. Because then people are kind of like, okay, well it is what it is. We'll address it later. That later just keeps getting pushed back and back and back and back, right? So you say like, no, we don't even want that call schedule to come out until we've talked about what the expectations are and what we're going to do with it. So being proactive and having the conversation.

For sure, I'm glad you clarified because early is very subjective. Because somebody might listen to this and they say, okay, once they leave, then I'll have the conversation. But if you have notice, you would want to address this with a sense of urgency. That's a really important distinction. And then also getting into the leverage piece, this is critical because when you think about leverage, leverage is a tool in negotiation that allows you to get concessions. And sometimes people are unsure of how to use that and still maintain a good relationship. So you did a great job of Saying, hey, you have the leverage and you can use it because it's legitimate in the context of the situation. But you have to make sure that you're using it in a way that doesn't make the other party feel unduly threatened by the way that you're doing it. Right. Because you do have that leverage. But if you flex it too much, it might damage the relationship.

Right. I think for me, that piece of, like, the ability to walk away from the table has been so critical in my happiness in life and medicine. I feel like I get that thrown at me all the time. It's always been the dynamic for my job searches because my husband is in a very small field, so I'm always following him, right? So, like, when he matched for his fellowship at Duke, I then had to find a try, you know, a job in that small area, or when he took on his private practice position, I then had to find a job in that area because for me, I'm a radiologist, right? I can work virtually, I can work in person. There's a lot of different environments, and there's a lot of radiologists in every city. Whereas, like, for plastic surgery, which is what my husband does, there's a very niche market. So his job searches have always dictated my job searches. And I've run into this situation a lot where people are kind of like, well, we know we've got you in this area. We know there's only two openings in the state right now or in the city right now, or whatever that you could take, and your husband's already here, so you're going to take whatever we can give you. And I've had to kind of look them in the eye and been like, no, actually, I don't. I understand that you're saying I have no choice, but I'm telling you, I do have a choice, actually. Number one, I could do teleradiology. Number two, I can find a job that works in my. I could go do locums. I have all these other options. And honestly, if I don't earn money, I mean, I wouldn't be happy because I didn't have a job, but I don't need to earn money. So if you're going to give me a package that makes me feel devalued every day that I go and come into work, then I'm going to say no and wait for something, because I have the luxury of being able to wait. And so that tactical sort of, I understand your position. You're trying to get the best for you. Guys, I'm telling you, for me, that is going to be something that I'm going to resent every day. And I just don't want to put myself in that position. So I'm going to walk away from this right now. Let's stay in touch. If you have the time where you can give me what I wanted, I'd love to reopen this conversation. Otherwise, I'm going to wait until somebody has the job that I want it and I have the luxury of time, right? And being able to walk away from that, I have never, not immediately, within like the next half an hour, then gotten exactly what I wanted, right? So in the same way, right, with this whole concept of physician side gigs, people are like, what is side? Like, why do doctors need side gigs? Why does this matter? And I'm like, having the diversification and having the backup plans gives you so much leverage at the negotiating table, right? Because I can say to an employer, they know that I've got bills to pay or whatever, but I can say like, I make enough money through my real estate, I can afford to be without a job for X, Y and Z, or I make money from my business that I can be afford to be without a job for this amount of time. And the nice thing is, is nobody can make me do anything that I don't want to do because I'm not this one trick pony that has all my eggs in the physician income basket, right? So it's not that I think that any physician needs a side gig. I think we make really great money and we're all going to do fine in the long term. It's more, are you giving yourself leverage in a very challenging environment to be able to say, I don't actually need this job, or I can walk away, I can take a few months off, I can X, Y and Z. Because a lot of times the employer has been in this position where they're like, well, what are you going to do? Where are you going to go? Of course you're going to take this job. And for a physician, they're like, oh, you've got 200 something thousand dollars in student loans, right? The average physician has about $300,000 in student loans. And that's a lot of leverage that the employer has to kind of be like, we know you have fixed expenses. You can't not say yes, right? And if you are kind of like, well, actually, this consulting gig that I do on the side pays for my student loans. I can walk away, right? It gives you more of an ability to confidently say and have the meat behind it that in a worst case scenario, of course approaching the whole conversation as I don't want to walk away, but if you force my hand and make the deal that bad, then I will walk away. And for them to believe it because they understand that you do have the means to survive without them is really powerful.

Absolutely. Oh Nisha, this is so good.

This is so good.

I appreciate you. Before you go, remind the listeners again about the work that you do and the platform you've created.

Yeah. So you can find pretty much everything that we do or a jumping off point to everything we do within our communities@www. Physiciansidegigs.com. that'll link you to our communities, that'll link you to our resources, our educational events and all of those sorts of things. And then if you just want to learn more about me in general, I have a self titled site which admittedly is not updated very often, but we'll give you again the jumping points to www.nishamethamd.com.

Perfect. And one last thing have to say listeners. Nisha is very gracious because we had a spectacular conversation last year that some podcaster forgot to record. So thank you for accepting that.

I see the recording button in place right now, so I'm not running into that problem again.

I checked it like 10 times, Nisha. I was like never again. And shout out to Dr. Ekta Shah for letting me know. Hey, didn't you say you had Nisha on the podcast? Where is she?

She's a great member of our community. Yeah, when she heard I was coming onto your podcast, she was very excited. So yeah, I'm glad she connected us and made that happen again.

Absolutely. This is great. Thank you again and can't wait to have you back on.

Awesome. Thanks. Talk soon.

Wait, wait, wait, wait, wait.

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I'll catch you later.