Hear about how Dr. Ryan Stegink found balance in his career through intentional choices and self-care and how you can do the same with your own wellness. 

Then, do you want to get home sooner from the clinic or hospital? With all your notes and charting done, too? Get your FREE PDF guide with 10 tips to maximize your clinical efficiency! https://mededwell.com/efficiencyguide/

[0:00] Do you love being a doctor, but all the charting and paperwork stress you out? You’re not alone.

[2:43] The importance of thinking through what you want to do and how to go about it.

[6:54] How to know what level of FTE you need for benefits.

[9:59] What are some of the things you need to know about your non-compete contract?

[14:08] Work-life balance vs. work-life integration.

[17:50] How to use your medical degree outside of clinical work.

[21:31] What happens to intellectual property? What happens to your profits?

[25:32] It’s ok to say “I’m really struggling”.

[28:49] Investing in self-care.

Above are the episode show notes and below is the transcript via www.otter.ai Some episode transcripts have been edited more than others, but they are up in the meantime to help those who would rather read and for searchability on the web. Extensive editing has not been prioritized as I seek to both produce regular content and maintain my own wellness. See the website disclaimer if you have questions, since this is all for your education and entertainment only. Enjoy!


Do you love being a doctor? But all the charting and paperwork, all of those workflow things? Do they stress you out? You’re not alone.

I want you to get my free PDF guide with 10 steps to getting your work done faster so you can get home for what matters most. You can get your free guide at mededwell.com/efficiency Guide. Get yours today. Welcome to the MedEdWell podcast, empowering physicians to get work done at work, then be able to reflect and choose what is important for both their life and medical practice. I’m your host, Dr. Ryan Stegink, general pediatrician, and life coach for physicians. Hello, everyone, and welcome to another episode of the MedEdWell podcast. Thank you so much for joining me for engaging with these concepts for sharing with colleagues, and working to take your next step in your wellness.

Last week, we talked about financial wellness, particularly for residents, but also for physicians throughout their career, talking about five different steps that you can take to lay some financial foundations.

And whether you’ve made mistakes or not, we all have at one level. But taking that next step forward is a key part to meeting your goals and to living in alignment with your priorities.

Today, we’ll be talking about a couple other domains of wellness, looking at professional and personal considerations.

So first, we’ll talk about professional things. As someone considers what specialty they want to go into, can be really helpful to think about, specifically the specialty or subspecialty, the type of practice, and then what level of full time equivalents or how much do you actually want to work.

First, I’ll start with my own story. So I was a categorical pediatrics resident. And I had initially thought,

maybe I’ll do primary care, maybe I’ll do hospitalist. And for a little while, I really thought I might do pediatric intensive care.

I really enjoyed how you could make a difference and look at some of the different settings the pathophysiology to make an adjustment to make a diagnosis. And then you could go do something about it. It was really intriguing to me.

I had dinner with one of my mentors and his wife, who had worked globally. And they said that my interest in doing global health and pick you in pediatrics, it said you will have plenty of opportunities to do problem solving. Wherever you end up in your career. There’ll be plenty of variety. And they said that doing ICU at least for me, and my goals might be more of a hindrance. I was also in a serious relationship at this point, and then end up getting married. And I’m really thankful for this advice from my mentor to consider whether I see you going on for subspecialty training, or going into primary care would be the best thing for me in my career.

So even though I ended up in primary care, and I’m really thankful that I did, I still went through burnout, about eight months out of residency.

The story I cover in some of my other episodes on the podcast, but suffice it to say that I had to make a change. And I had to decrease my schedule.

Now I’m at 85% point eight, five for my FTE. And it’s a much better balance.

But it’s going to look different for each individual for each physician. And so thinking about how to choose intentionally, on these different areas, is really critical.

I have residents come work with me on an almost weekly basis. And it’s a different one, pretty much every time.

Usually I’ll ask them about three questions. In addition to the clinical care that we see. I see what they’re doing as far as their specialty or subspecialty. I’ll ask if they have a plan for any loans, if they have some. And if they have a plan for disability insurance. Then I’ll share my story of burnout and just the importance of thinking through what you want to do and how you want to go about it.

Only in looking at specialty, is it about maybe potential salary. But really, it’s more about what kind of work environment will you have? Is this a very impatient heavy specialty? Do you do a lot of procedures is there a lot of call, nights and weekends? How flexible can the schedule the

practice type matters to whether you’re in academics, doing private practice, large or a small group, whether you’re doing locum tenens, or even direct primary care.

It’s important to network and find out about the different availability, maybe practices that might not be a good fit. I recently was going to recommend a particular opening that I’d heard of. And then I talked to one of my colleagues, and they told me

that one I wouldn’t necessarily recommend for somebody

who’s has other options.

It’s also important to keep in mind that you may change jobs in the first few years. So thinking about where you want to be, if you want to move somewhere, just all of those life things, this may not be your forever job. And statistically, it’s not going to be

it’s important to look at how much you want to work, and how much you can afford to maybe decrease your schedule. Maybe your ideal FTE or full time equivalents may depend on the load of patient care, administrative tasks, other things or outside interests that you have or commitments that you want to be able to prioritize.

For the most part, your budget allows, you don’t have to be one point out.

Many times your human resources department will know what level of FTE that you need for benefits, they better know that. But for things we talked about last week, about the Public Service Loan Forgiveness requirement to be 30 weeks, and what your employer considers full time, actually, that’s 30 hours per week, and whatever your employer considers full time. So that’s different from the National Health Service Corps where you may have 32, patient facing hours, so that may be eight of nine sessions. So you may have a higher FTE requirement, or just different things that you can get to qualify in terms of whether you also were an administrative role, or are in leadership, or whatever it may be. But it just looks different. It’s just asking those questions and knowing, speaking of knowing, and you get into negotiating and contracts, if you don’t ask for it, you can’t get it. So it’s worth and ask. It’s important to know your MGMA data, for the salary for your area and specialty, to be able to bring that in when someone asks how much you think you should be paid. And then you can give a give a range and be able to advocate for why you bring value. How you bring value as an individual, with your gifts and experience. And what you bring to that potential employer, you want to speak to that. And medicine, sometimes it’s easy to think, Oh, I am about service, and helping others. But really, this is about finding you a good match, to be compensated for the value that you bring to that employer, into your potential patients. So it’s important to ask good questions during interviews, that you then use those answers to help match the needs and priorities, potential employers with those strengths and experience. In addition, as you’re looking at a potential contract that you’re offered, it’s important to get it reviewed by an attorney who does medical contract review. It’s not just that you have a family member who’s an attorney who does real estate or finance or something else, as far as their specialty. Medical contract review is really important. And even if you’re not able to change that much, it’s really, really important to understand what you’re signing. But it’s also important to know that if it’s not bad for you, that you don’t have to sign when you’re looking at some of the things you want to know and understand. Some of the things would be

Your non compete. How long is it? What radius from the clinical sites are just what? What distance does that entail? And many now allow, sometimes it’s at the state level laws requiring that physicians can buy out there noncompete be able to pay a certain amount, maybe it’s approximately one years of salary just depends so that you know, what your options are. Another important thing to ask about is malpractice coverage, either occurrence, base or tail. So occurrence would be where you are covered for the period where you are working for that particular employer. So many residency programs, this is the case where you have coverage for your 357 years of residency. And if there were a claim brought, in the subsequent years, that you would have coverage for that, as it relates to when the service was provided. Tail insurance, on the other hand, is insurance that is paid for often it’s more reasonable a lower rate, because it only covers you for that particular period of time, if there were a claim brought at that time. So say you worked for an employer for three years, and someone brought a claim five years down the road, you’d want to make sure that if you no longer work there, you can purchase appropriate tail coverage. And so that’s something that you can negotiate for, or include as a request in your negotiations, it’s just important to know these things as you’re talking to potential employers and considering a position. Another thing to know, is the amount of notice that’s required if you want to leave, or if they want to terminate your contract, without cause. So for many, maybe 90 or 120 days or more, just kind of factor that into what kind of notice you need to give, and just how it’s going to work as far as credentialing and the process of transitioning to a new position. If and when that time comes. You may go into a new position and say, I’m not going to be doing any outside business interests, or have any intellectual property issues. But think about what if I did? What would this contract mean, for me, and for the things that I might be coming up with, with creating with wanting to be involved with would this contract limit me three to five years down the line, if I were to sign this as is, you’d be surprised at what you can get written into your contract, if you’ve asked, or what you can get clarification on so that you can be proactive, if and when that time comes. So moving from the negotiating contracts, another big thing to think about in terms of wellness, both personally and professionally, his boundaries. These may be spoken or unspoken situations where if this happens, then I will do whatever it may be. We use boundaries and other areas of life. But here’s a few examples from medicine. There’s a patient that yells at disrespects or threatens my staff, I will let them know that that’s unacceptable, and may call security depending on what it is. If I’m at home and not on call, my electronic medical record notifications are off. And I may not be checking my email until I’m back. So a lot has been made lately of work life balance versus work life integration. And sometimes work life balance, maybe out of balance, one way a little bit more towards work or a little more towards the needs of your life outside of medicine. But I think it’s important to not fully go to the integration because particularly in medicine, least for me, there needs to be some separation, the ability to unplug and leave work at work. It starts with realizing this is important that medicine will take everything that you are willing to give if it really is a toxic environment, and your boundaries are being Cross consistently, or it’s just that serious, you do always have the choice to leave. But sometimes it’s an opportunity for self advocacy for how you can change the situation, or hold them to certain things, maybe in your employee handbook or things in your contract even. Because standing up for yourself and your boundaries, it allows you to honor your value as an individual. That then allows you to be able to care for others in medicine in a more sustainable way. Speaking of sustainability, we’re gonna move on to charting and workflows. So charting and paperwork are big contributors to burnout these days, it wasn’t my story, there are some things that you can do to make it go better. I cover things like these in my podcasts and different wellness and charting tips. And I want to give you a few of my high yield, high yield things to focus on. Because as you go through training, as you get out into being an attending the patient load increases. It’s just keeps having more and more more tasks, or charts for patients. And finding these charting and workflow efficiencies are especially important. It may include things like templates, and autocorrection. With dot phrases, bringing in appropriate and helpful other things from the chart. It could be preference lists, maybe a charting in the room. It’s important when you’re communicating, both with consultants, with colleagues with staff to close the loop to make sure that everyone is on the same page. I think this is especially important for me in primary care if there’s new orders beyond the typical flow. Or if there’s something that’s especially out of the ordinary, maybe I have a patient who’s traveling overseas and needs vaccine that’s not in the routine immunization schedule. The other thing that’s important for charting and workflow is to try and batch tasks. I get a bunch of paperwork each week, and I trying to do my paperwork, once, sometimes twice a day, I’m able to go through systematically and figure out which things do I need to sign, which things do I need to mark as reviewed, and which things need a more in depth evaluation of the chart, and something that I have to fill out. And then it could be batching, dictations, lab results, even working email. Finally, it’s important to ask for help. Whether that’s you’re really behind and see if a colleague could take a patient. If you don’t know what to do in a particular diagnostic situation, and you ask them to come see this physical finding with you can bounce ideas off. These are all things that can help you keep moving throughout your day and take good care of patients. Well, so just promoting your own professional wellness. These workflow things often are just about working together as a team about communicating and about having a growth mindset. It’s about curiosity and action. Just as in quality improvement, there’s these Plan, Do, Study Act PDSA cycles, about continuing to implement, to reflect and to take your next step forward as you look at your processes. And as you look at how you care for patients. Moving right along, there’s not just opportunities to use your medical degree to care for patients and families within the office within the hospital. But there’s also opportunities outside clinical work. Could be volunteering with community partners, serving on a board giving interviews for the media about particular medical topics. It might be teaching or precepting students or residents. I know physicians who work in industry and advise on trials or help develop products or it could be entrepreneurship, private practice or for me a podcast and coaching business. There are many ways that you can leverage your medical

training to help others outside of the office, outside of the hospital. And this can be a great outlet for expressing your unique skills and personality doesn’t mean it’s for everyone. And it may look different in different seasons. But just be open to these opportunities as you have them come up, whether someone’s asking for you to go on the local news station and talk about why patients should get the flu vaccine, or some other new medicine or trial that’s come out and they want to physicians prospective, take those opportunities to really lean in and help the community. Because if we don’t put there, if we don’t put our voices out there as physicians, we’re gonna get drowned out by all those who want to speak on these things without the background and experience, the expertise that we have in medicine. But as you think about these opportunities outside clinical work, it’s important, really important, listen up per sec, if you’re gonna do some of these things outside of your current work, particularly if you’re employed, it’s important to have an outside service agreement, or whatever your HR calls it. Because it’s important to know that anything that you create, as far as intellectual property, like what happens to that, is that yours, because the university or your lawyer own it, too, they take a percentage of your profits. And is this running afoul of your ability to do certain tasks, you say, this is coaching, and not clinical medicine. This is being done on my own time. And it’s not interfering with my ability to execute my duties. Then many times, they’ll say, yes, there’s a process many times that we as physicians just aren’t aware of. So it’s important that you ask before getting into some of these things, there’s resources and communities to help you figure out how to step into some of these things. Whether it’s advancing your own personal brand, so that patients want to come see you could be developing some other outside opportunity. One of them that’s been particularly helpful for me has been Dr. Gunas, entre MD, podcast book, Facebook group, she also has a business school that’s been really helpful for a number of physicians. And there’s so many others that are really trying to encourage physicians, which is just an amazing example, that I’ve really benefited from myself. Moving from personal or professional, to now, personal wellness, because it can really help you. Just knowing who you are so easy to get caught up in the busyness of medicine, of life these days, that I want you to slow down, I want you to not forget who you are, why you went into medicine, to take time into consider what really is important to you. Who do you want to be? It’s important to find restorative self care practices may include exercise, sleep, nutrition, mindfulness, spiritual or religious practices, and meditation. Ultimately, it’s about taking these opportunities for self care and building them into your schedule. Maybe small steps, if there’s existing schedule constraints, whether you’re in training, you have other responsibilities with family or otherwise, just putting some of those big things that you say, this is a priority for me. Well, if it’s really that much of a priority for you, your schedule should reflect that. You look back on what happened. Were you intentional about putting that on there? And it’s not just for you, is it for me too. And I’m trying to get more, more back into having consistent exercise and good sleep hygiene. So there’s still work in progress for me. But I want to encourage you to start and to continue some of these habits that you can continue to vote with your action is your ACT For not your intention, your action of who you want to be. As we think about who you want to be, sometimes it’s really easy to try and project an image of who we want to be rather than acknowledging and really engaging with where we’re at right now. And I just want to encourage you that it’s okay to not be okay. It’s okay to say, actually, I’m really struggling. I’m really struggling with feeling burned out and overwhelmed. I’m really struggling with feeling anxious or depressed. I’m really struggling with processing a hard traumatic patient outcome. Or I’m really struggling with how this loved one isn’t here for another holiday season. When you’re instantly situations, when you’re really not okay. I want to encourage you to ask for help. You are not alone. Whether it’s talking to a supportive colleague, friend, partner, family member, maybe one of your mentors, I want you to find someone that you can talk to, could be finding a counselor or someone through your employee assistance program, your doctor, coach, even the mental health, wellness hotline 988 that’s been recently created. These are all resources out there to help you in times, that are really hard. We all face them at one time or another. And so helping to normalize that, to say these things are hard. And sometimes, you just need someone to come alongside you. Another great resource is a program called physician coach support, where volunteer position life coaches are willing to chat with other physicians who need to talk confidential on Zoom, and started by a neurologist, conductor, London yo, and is a great opportunity to help support physicians through this program. So wherever you’re at, with your professional, personal wellness, whether you’re still in training, whether you’re early career, whether you’re mid career, whether you’re late career, wherever you’re at, if you’re retired, I want you to think what from today’s episode really resonates with you. As long as you’re not driving, or operating heavy machinery, I want you to take a moment and close your eyes and think about what you need to change

is it advocating for particular thing that you need at work? You need a scribe you need raise. Because you haven’t had one for a certain amount of time and you’ve been exceeding your productivity expectations? Is it taking that time to invest in self care? To say I’m worth it. My future is worth it. My family is worth it. My ability to care for my patients well. However much longer I want to practice is worth it so that it’s not cut short because I got burned out and you decide to believe medicine rather than realizing you’re not alone. So I want you to write down what your next step is. And then tell one of those trusted people in your life that you can talk to see how that changes things for your wellness come month I want to thank you for joining me here on this really important episode of the MedEdWell Podcast. I’m really passionate about helping physicians take the next step in their wellness. And this is part of it. So, as we wrap up, I want to encourage you not only to subscribe and to share these episodes, but if you’re looking for one on one coaching, I want you to join me. I want you to invest in yourself. Whether it’s with me or with some other program, I want you to get the help that you need. So that you can really thrive. Look, look a call with me at the link in the show notes. I just really want to see physicians doing well. So as we head into the end of 2020 to get ready for a new year. I just want this to be an opportunity for you to invest in yourself to pause amidst the busyness of life to reflect and then to look forward. I can’t wait to hear about how this has made a difference for you and for others around you. Thanks so much for all you do. Have a great day. And now for our important disclaimer. Dr. Ryan Stegink is a practicing general pediatrician. But the MedEdWell podcast does not reflect the views, opinions or beliefs of his employer nor his affiliated University. Additionally, the MedEdWell podcast is for educational and entertainment purposes only and should not be considered advice regarding financial, legal student loan, medical or any other specific topic. In such a case, you should seek consultation with a certified professional in that particular area. Again, thanks for joining us on the MedEdWell podcast. Have a great day.