Combating Burnout Through Global Service with Dr. Arthur Burnett

Podcast Introduction and Guest Overview 0:00

Welcome to the Doctors Making a Difference podcast, where we help physicians to be empowered with the tools they need to successful in medicine, in finance, and in life. Join us as we highlight doctors and other professionals around the world who are making a difference. So today you're going to hear an amazing podcast. Dr. Arthur Burnett has been a physician at Johns Hopkins for over 40 years. He has done medical service work in Africa and the Caribbean. Just such an inspiring and a genuine gentleman of a position.

And I'm so thankful that he took the time to do this. If you are a doctor who says, I am a little bit burned out, tired of all the chores of medicine and some of these things that kind of get us a bit frustrated and burned This is a good episode to listen to. Dr. Burnett's got a very practical approach on how to address some of these difficult parts of medicine, but how do you stay engaged in something that's such a unique career? And I'm delighted and excited to be able to share this episode with you, and I hope you'll really enjoy it.

So today I'm excited to welcome Dr. Arthur Burnett. Dr Burnet has been a doctor at Johns Hopkins for a lot of years. He's a urologist. I'm delighted to do so and thank you for welcoming me. Call me bud. I happen to be a urologic surgeon here at Johns Hopkins. Some broadcasting here from my office between surgeries. So I've been active surgeon, but I am a surgeon scientist. And that means I run a research laboratory, have been very involved in discovery. and bringing forward new science and advances in our field.

But my focus is men's health, neurology, and I've done that for many years. So thank you for allowing me to be part of your program today. Oh, excited to have you do it. Walk us through it because people listening range across the entire spectrum of physicians.

Dr. Burnett's Path to Johns Hopkins 2:06

Some are medical students, some are residents, and some of attending physicians who've been in it for quite a few years. So just briefly, how did you become a urologist at Johns Hopkins? It's a prestigious place to work and a really interesting career path. I consider what I've been able to do here at Johns Hopkins, as well as other aspects of my career profession that have been a series of opportunities and then recognizing these opportunities, and taking the time to understand that, appreciate that and make the most of these I came to Johns Hopkins following undergraduate and then came here to medical school.

And then for medical schools, they did well enough to continue on the faculty position. Then for many years doing that, my journey, I think, began with just interest back in my teenage years as I say, you know what? I have an aptitude for medicine. I'm the first in our family to go as far as medical. So really, really humble beginnings. That was an army ROTC cadet to even get through undergrad. I do very well in surgery suited me and met my talents and then neurology is kind of a sub-discipline within surgery and I could see where I can make some impact in the field where i thought men's health was such an important area to try and make advances in.

I thought there was a lot of discovery to be made in that discipline if you will and also the other thing you know very keen about is prostate cancer. which disproportionately affects men of minority backgrounds, in which I thought that I'd have a role over many years, and that has indeed played out. So you can see a number of factors came into play. Nothing too spectacular, but just taking advantage of opportunities and giving opportunities to be the best places I was able to excel and continue on.

If you think about it, at least when I talk to my colleagues, most of them have a story kind of like that. We grew up not as a physician, not in a family where there were doctors. Some people did, but a lot of people said, I want to make a difference. I wanna help other people. And so you kind match a skillset with your natural aptitude. Did you say you've been at Hopkins for 43 years? Is that right? That is correct. So I came here to medical school about 43 years ago. And frankly, I don't want to kind of derail the federal station too much.

I was an army officer and I got deferments initially. Then once I completed residency where I actually did some of this, the discovery work behind Viagra as a resident, believe it or not, it was very clear that I'm going to be a different kind a urologist, a Urology Surgeon Scientist. It was clear to my chairman that your commission needs to stay at Hopkins. And next thing I know, I was getting honorable discharges saying I'd been in the reserves for about 10 years. Just carry on as a surgeon at Johns Hopkins.

No, it's neat and think about the incredible work you've been able to do with patients at Johns Hopkins, at the hospital. But even more than that, talk us a little bit through some of your international work. A lot of people say, I'm so busy in my own job and so, busy taking care of, people here. I don't have a lot, of capacity to take this skill set elsewhere. You're one of those unique souls who have said, ''I think I can take, this to people where they're at and meet the most needy people in the world.'' a lot closer to where they live.

So do you mind talking to them? I know that's a huge journey, but tell us a little bit about that. I'm glad to share some of that they've been blessed in so many ways. not just to go to medical school, but also to be able to maximize talent system. As a scientist, whereby I've been able make a lot of discoveries. I mentioned the Viagra story, I mention as well some of the other innovations I have done, including leading the penile transplant, drowsily being a urologic surgeon for here for years.

In doing that, the one thing I appreciated is that to bring forward advances, not just in our communities, or even regionally, who can do things around the world and recognizing what kinds of discoveries are possible and also in a humanitarian way,

International Service and Global Urology Work 5:53

elevate the best care where there have been underserved populations. So I bring all that together with some discovery work. I've been, they do a lot of work in the Caribbean, do lot work Africa, travel all over the where there are underserved populations, not just to be a surgeon and teach and then bring the best care within populations but also new science and new discoveries. I'll give you an example. In Nigeria, I've been able to bring forward with some collaborators some of the new scientists behind treating a disorder called priapism, okay, a urologic condition of prolonged directions, in patients where sickle cell disease is very common.

And we think about single cell disease as being a condition that, yes, we're aware of it. About a hundred thousand individuals in the United States have single-cell disease. To give you some sense of just the prevalence of elsewhere, in Nigeria, there's 150,000 births a year with single cells. And so the prevelance of some neurologic conditions are so great in other places around the world that if we can actually bring discovery work, science in my lab, would figure out the science of priapism. We figured out new treatments based on the signs.

They were rolling it out with populations where it has impact. So you're right. I not only just think of taking care of patients, patient by patient, here and around the world, but also bringing forward discoveries and then working with teams throughout the word, not just to train them, But also help get them engaged in discovery work, get him engaged at how we can make advances that'll have impact, Not just from their region where it's prevalent, or maybe teach us all around The world where these prevalent conditions exist.

Absolutely. Maybe rewind a little bit. How did you first do it? A lot of people listening say, hey, I'd love to go help people in another place, or I would love be able to take the time to do that. But you're busy. You're in debt. All these things. And you say how could I possibly do? It's something I feel like I've been really privileged. I have been able do some work in Uganda and Ecuador and I just found that so meaningful in my own life and loved it. But the majority of people listening have never done that.

Majority of our fellow physicians have not really spent time overseas and say, how do I even start? I don't know what I would even do. So walk us through it. Did you just happen into it or was it purposeful or how did it initially start where you started going to do international work? Sure. It's actually been very purpose. Much of how you get started is do you have the passions to want to this? And I think if any of us get engaged in some of these kinds of activities, the rewards are so great. The lessons that you learn, I consider the interactions I've had with many of these experiences to be very bi-directional.

And I almost feel like I'm taking the light more from the experience than what the host country may be thinking they're doing. Just in terms of helping me just be grounded, help me to understand what's valuable, helped me understand, what really impacts patients' lives. All these kinds of lessons are just so amazing. When I get started with it, early on with some international experiences, traveling, But with meetings, engaging with those in my specialty other places, hosting even students from other countries to come and spend elected time with me and just building relationships over time.

And so this dates back to my early faculty years and here at Johns Hopkins with that kind of at least approach that they were forming like, well, it seemed to have allowed that happening. Then I have gone farther now to start my own. a nonprofit called EuroMissionsWorks, an LLC, and a number of patients of mine understand what I do. Some have helped me, I've funded myself. And, uh, it just made me take them to a level that's far greater than maybe some of your audience wants to do this. But if you have some opportunities to understand where there's some, some connections or where, where are the other colleagues saying, yes, do you this and maybe come on a trip with us, maybe take advantage of that if he can.

Yeah, I agree with you. Just to reflect on what you said, when I've done international work, i always come back feeling like I got more out of it than I gave because I donate the time and we take the, we pay for the flights and a lot of times we're providing some of the medical stuff. And so there's a financial and time expense, but I come every time saying I gained more from this than i gave. It sounds like you've discovered much the same. Oh, absolutely. Absolutely. I tell you, in our society here in the United States, everybody seems so troubled.

There may be many explanations behind that. And I'll put that aside for a moment, but when you go other places where, you know, the most basic way of living is shown, where relationships tell, for people to just enjoy each day, value these interactions, I think it's very refreshing in many instances. Yeah, I agree. I don't want to go on too much of a sidebar, but it is really interesting. It's not about how much stuff you have. it's about having a sense of purpose and people around you that you love.

And you need to have the basics, have enough to eat and drink and take care of the people you. But you're not going to be happier by having more stuff. So it was a really, interesting reflection for sure. When you traveled to folks that have very little by worldly standards. Oh, absolutely. You just said it beautifully. I think that probably is the unfortunate standard of measure which we have in our society that will exist in many unobtrusive locations. And they're some of the happiest people, the happiness people I've ever seen.

in some of these travels, and how much they help each other. And the other thing I'll just make a remark on is it teaches us as physicians, something I think is real important to us. The physicians in these communities are so civic-minded, civic minded. They're so thoughtful about what they can do for those kind of citizens and neighbors, they will actually buy medicines, bring in IV bags, do whatever it takes to just to make sure that their fellow person is achieving their best health. And while I can't tell you how impactful those kinds of things that I witnessed, that helps me just stay grounded on what our purpose should be.

That's where I derive a lot of purpose, things from experiences like that. Thank you for sharing that, would you mind talking specifically, what do you do with Euro missions works? I know you went early on in your faculty days, sounds like, and you had an opportunity to mentor students that would come to work with you at Johns Hopkins. And then you've branched out and done some of your own work. That's self-funded and you're trying to take this. What do you, what do those missions look like? And is it just you or do take a team?

What kind of work are you doing? Yeah, I do. Take teams occasionally. Otherwise I may just be in one position here or there with some special purposes here and there. I'll give you an example down in the Caribbean, which is not too far from where you are in United States, in our same kind region, if you will, was dismayed 25 or so years ago, going down there was some interaction medically. And to learn that urologic care there, I think, was not as good as it could be. It was acceptable, but not great.

I learned that for a population of three million people in Jamaica, there are 16 urologists. There were more uologists here at Johns Hopkins, one hospital center, than that whole country. And then I was able to see patients that they asked me to get involved with some of the surgeries who were living. with diversionary tubes and things like that for years, because nobody would have the opportunity or time to be able to fix some of these more serious things that they were living with. And so I took upon myself to say, you know what, the University of West Indies, which is the main center for training neurologists right there in Kingston, Jamaica, that I would start going down there three or four times a year, for about 20 years.

and just spend a week at a time working with helping them redevelop their urology training program, elevate how broad the forward with urologic care,

Building Training Programs and Lasting Impact 13:11

helping bring the American Urologic Association to Jamaica with supplies and other needs where other uologists are retiring and discarding their supplies. And we have built the manpower and the services and neurology rule that Jamaica then dispersed throughout the Caribbean in amazing ways in the past 20 or so years and have seen that come to fruition as such a reward. And so that's kind of the impact and how it's done, how I'm realizing that there is a need and I've been able to bring that to be part of my career all these years.

I've observed the same and it's really interesting when you couple the training with you go and do this service and you're helping people and but you are getting a lot of great feelings and positive feedback from it but think about the impact that has you could go into surgery on a few people a handful of maybe if you went many times you can get a hundred people that you'd help but if scale that impact by training people Now you're impacting probably thousands and thousands of people that have been through that training process and elevate the level of care across that entire region.

That's awesome. Right. And that exactly wasn't the rationale in all this, that I can go down there and just do complex surgeries periodically, but that's short-lived and short living meaning that how many years can any surgeon do that? 20 years, 25 years. And so if I can keep training and bring knowledge and work with them to develop surgeons, to be more specialized, not, they don't have to to specialize. You have the new things like I'm doing, like penile transplants, major reconstruction, but let's just get their best neurologic care.

Then that you can see that in manifold ways goes a lot further because now that person can be the best person right there in these locations to carry out urologic interventions and best management. So have you done that work primarily through your affiliation with the university or in the hospital? Or is most of this stuff where you said, I just need to spend my own personal vacation time and go be down there and fund this? How have constructed it? I've done this in collaboration because I think that always works well with the University of West Indies.

I know the urology leaders that have been brought through the university system there. And so it's almost like I have an adjunct role there, although I had never asked them to finance anything that I'm doing. They've been trying to just bring routinely to bring supplies and things there without any request that they finance any of that. So I just make it all happen, but do it in a class. Well, it sounds like you do regular work in the Caribbean. That's relatively close as far as world travel. When you the work, in Nigeria or other places in Africa, a lot more of a time commitment as for as travel, we've done some work like I mentioned in Uganda and it's wonderful, but by the time you get there, 20 something hours of flying and then pretty jet lag that first day and there's only so much you can we try to build systems there that don't really depend on us coming, but we come and support and help and then try and train the people there locally to carry that work on.

How have you found that to work when it's far away places like in Nigeria? Do you go quite often or how often do you have to go and Yeah, so my trips over there have been less frequent. So they are once or twice a year. They may be a little longer time when I go. Uh, they do require a lot of preparation, but they also involve kind of constant interactions. so I have interactions with a group that I, I had mentioned that do some collaborative scientific work, But also has impact on the ground. But I've interactions that Kevin's we're at a modern age here of even being able to do zoom calls, even internationally.

And I do that on a weekly basis with them. So we keep a lot of regularity going in old times, such that I'm informed of what they're doing as we train. Again, like we trained our residents here, you let the leash out a little bit further each time and let them come more and more independent. But we still stay collaborative and keep regular interaction. And that's how that worked for me, to have regular interactions even from a distance. I think it's amazing. I know you're living it, so it seems like it is routine.

But when I tell you that people that are listening are saying, you talk to somebody and dedicate time on a Zoom call every week for unpaid work overseas. You don't donate time three or four times a year to travel to an international location. Your advising them on regular basis. It all takes a lot of time. Super fulfilling. A lot people I talk too say, I'm up to here on time, and I feel like I am in debt, I can't even catch up and keep up with my life. So I guess as I unpacking this, this is incredible.

How do you find the time to do it? And how do find this stamina to keep doing it after all these years? Sure, it does speak to the fact that I probably do push the limits. And I'll be honest about that. More than most people do. Not trying to be any kind of macho man or anything like that, but I think that some of us, I do have maybe the blessings of great stamina, great physical abilities and so forth. I don't think it was that way. I think I get my adequate rest. I do adequate fitness things. So I'm not compromising my health, I don't think, so I would agree to know that nobody should be flipping their chest about, you know, how little sleep they get and how much they can get by on just a snicker bar a day or something crazy.

Staying Energized in Medicine and Finding Purpose 18:18

But so, what I'd do is regular, but it's just that I have learned how to be efficient with my time to, uh, collaborate well, I've used that term a number of times so I'm not doing everything solely. I certainly have I think since I found a four-day my term to where I put things in compartmentalized ways one many different times. They just know I got to get my focus on certain things at a certain time and then put thing down otherwise. Indeed I don't take as much long monthly a week they say yearly vacations that other people do.

My vacation may be some of these other things. But I do find time with failing and make it all happen but It's just been a lifestyle that I've been able to work well and sometimes you just start to fit things in and then do it with some regularity and it works out. So really that's, that my formula. I'm not sure whether there's anything spectacular I said there, I don't know if there any nuggets of some sort of super wisdom of, but it's a matter here. And I think of realizing, so this is part of my life that, brings me such joy and, and pleasure boards that that.

That I just make it all work. I, like I said, I want to just reflect on it as the podcast is called Doctors Making a Difference. And sometimes it's easy to read about somebody or we put somebody in and say, oh, this is somebody somewhere far away that did this interesting thing, but you're doing it. It's not something you just read. You've been doing, you've done it for decades. So I'm personally really impressed. I think our audience will say whoa, we need to go on a service trip once and put that in my journal.

We said I am just going to bake this into my life. This is just part of the thing. These are my friends across overseas or in different locations and have these genuine friendships and of course I talk to them I would miss them if I didn't and anyway I think it's really impressive and and also the fact that you didn' just do it for a couple years you've been doing it decades now really difficult but also very impressive for sure Oh, the way you describe it, it makes it sound awesome. It is awesome!

I'm kind of thinking, all right, maybe it is, I don't know. I am just doing things that is part of what I do in my life and I feel relaxed about it. And again, feel blessed and thankful that I've got good energy and stamina and good health to do all of it! I think all of us, doctors have busy jobs, no matter what you're doing. You're right in the middle of the details of somebody's life, trying to help them get better with whatever skill set you bring. But I thing the thing that keeps us going, sort of a fuel of physician is the fact that you are helping somebody.

And if you spend all your time thinking about insurance prior authorizations and documenting in your electronic health record, you'll get burned out real quick. But if you say, Hey, I'm helping somebody that is in real need and I have a skill that I can use to help them get from point A to point B and help him in their life. Boy, that keeps you coming back again and again, and then you don't worry so much about all the other things that drive us nuts. We no doubt I think as physicians we do have all these chores to do.

They go beyond residency. Yeah, chores. I try to keep things balanced. To find that having these variety of things I do, from being a surgeon with aircraft, discovery work, always excited with that, teaching residents, seeing just their development, driving, some enjoyment from that. Doing some of the military activities. All these things kind of balance each other. Fortunately the drudgery and the chores I couldn't have started to fade a little bit between all these things to put in perspective.

I'm going to start calling them chores. So let's shift for just a second. A lot of the audience are early stage physicians, folks who say, I am a medical student or I m an intern or maybe even a pre-medical student. What would you tell someone about the specialty of urology? People say I don't know if I could do Urology, it sounds hard or it's a long residency or there's all sorts of different people that look in different things. And you've been able to find something that kind of fits your aptitude, your interests.

I'm just interested in when you started out as a young man who said, I think I'd like to become a doctor. You became a urologist and you'd been to do all this stuff. What would you tell someone who's early on in their career or maybe considering urology as career on what are some of the pros and cons of that as specialty? out any subspecialty in surgery or your general surgery takes some time so for young people yes I think that yes our careers can be long in some ways and maybe there's just a sense that you have a little skin in the game early on if that's really what you think.

is your destiny. I kind of knew that I wanted to be a surgeon in medical school, I just didn't see myself in other subspecialty areas. And then just for young person, just to know that you have to dedicate yourself early on to certain activities to get you to where you could then kind to take off from there. It's one of these old adages of you got to lead from within, you can't lead for without. So you got to go through medical school, do well in that, enjoy the moments of your training on with your fellow residents, but be focused on that for those years.

Yes, it's a six-year training program in neurology, surgery, and then neurologic. Give those you do what you have to do, then kind of look forward to maybe the next 30 years of a career to follow. But stay focused with what your doing. Do a good job with that. See what some of us senior guys or guys a little further down the road are doing, But don't get too ahead of yourself. Just take it a step at a time. If it is really what she wanted, don´t give up on your dream. Stay with it. And, uh, and then just build it from there.

I know everybody, a lot of my junior faculty and others say, you know, how do you accomplish so much? And again, I, no, yourself, if you said that hard of pity, now I'll accomplish something. But really, this is just a career that builds over time. What I do is not what I did when I walked out of residency. It took time to build to where I am now. They just accept that reality and just built on things gradually taking one small bite to that bigger bites as time goes on. That's good advice. It's interesting when I talk to pre-med students or even if I talked to my kids or relatives, they say, oh, it's such a long road.

I don't know if i could do that. And my counterpoint is, if that's what you're made to do, a lot of people consider being a doctor almost a calling. If that is something that just really elevates you and you find that a powerful thing in your life, do it because the opportunity will not come back again later. Do it when you're young and get it done. And when do you think about the number of years, if you say, I'm going to be in my mid thirties by the time I get done with my training, you are going be your mid 30s by that time, no matter what you do.

So if it's something that really fulfills you and you want to do, and if there's, something, that if your the kind of person that just says,

Advice for Trainees and Mid-Career Physicians 24:18

That sounds terrible. I don't even like being a doctor and I just wanted it. Cause somebody told me I would make a lot of money being at a. Then find something else because you aren't going joy in it, but a lot of people, if you find that calling and you want to do it. Man, what an impressive, amazing career that you can have and help tremendously with just thousands and thousands of. And you've been able to that through your career. Oh, absolutely. If I could be an example of that, let me be that person.

But I think you're absolutely right. So if you go in a different direction, whatever it may be, certainly I wouldn't be proud of anybody, no matter what direction they go. I bet you right, the years will come and you've got to do something by the time you get in your thirties, but when you finish your training, gosh, you still got a good few decades, I hope, with every person to really develop that further and do some of this as fulfilling as that as this can be. if You see what some us who've done it now for years are trying to describe to you, just stay on that path.

That's great. I appreciate you sharing it. One of the things I wanted to ask as it relates to that is a lot of people get about somewhere between 12 to maybe 18 years into the career, somewhere a little bit mid-career. And they get frustrated by all the chores and they say I'm in debt or I feel like I can't get ahead or i'm not able to find some time to spend with my family and so people they feel Like they've got to really scale back or they got a change or some people just leave medicine all together because they Get overwhelmed by that stuff and So I wanted to hear about Any advice you have as far as your ability to stay in medicine, stay engaged, because you've been able to do it over a long career and it's no cakewalk.

It's difficult. So how have you been to find the stamina and energy to continue in a difficult career for this period of time? I guess there are a couple of things. One is that I truly do value having achieved what I've done in medicine. As I mentioned, I came from very humble beginnings, had to make my way through school. So for me, in a personal way, my, uh, i think that i've been able to achieve something here that's really special, very privileged to me to be able take care of people and impact their lives.

And so I reflect on that and understand that so it is a driving factor. At least for me personally, but at least, for others, I think you also might want to think about that we have a specialty that is so special, so unique. Many other people have walks of life where things can be quite fulfilling. We're taking care of people's lives and seeing them thrive. Yes, we've a lot of responsibility, yes, up and down days, the level of intensity of our current of work that I sometimes just meditate for a little bit and then recognize that.

we really have almost a blessing, a career. opportunities we've had, and that to me has been fulfilling in every way. Lastly, I would say that being a physician really is a specialty that gives you a lot of versatility. Just for a moment now, we can go off and do other things if you want. Go off to be a consultant. Go off and do humanitarian work if you're able to do it or want to, do some advocacy work. Go often do, some teaching here and there, maybe figure out some other directions to go in having that MD degree or a DO degree, or whatever you have.

This is something that really other walks of life, other career positions don't always easily allow you to. I write books even. That's another thing I do from writing another book on men's health. So I think we have so many different directions we can go on as physicians. privileged to have gone through medical school and bring your knowledge even as a physician in your special area. There's got to be opportunities out there, a variety of kinds, even if it's walking away from patient care for a while.

Look for these opportunities and find some fulfillment. And really, my word is, be grateful, baby, that we've got a career that allows us to ask. That's good advice. Be grateful, understand how versatile that degree actually is, and you can capitalize on the experience you have no matter what your specialty is. Hopefully you find your way back to patient care eventually, but if you need to leave patient and do something that's adjacent to medicine, there's a lot of opportunities, like you said. Anyway, I think it's interesting to read about stuff, have done it, who are doing it and are in it for decades like you have been.

Anyway, I know somebody listening will listen to this and say, man, i'm inspired. I want to be able to have that kind of impact through my career and I'll power through the chores so that I can have the impact. And just to reflect on one other thing, it is a position of great. personal privilege to say I'm so involved in the details of somebody's life and they count on me in my own life. I am so thankful for the doctors that have helped me and I've spent tens of thousands of hours. So when it was my moment to need surgery, my moments to help, I was so grateful for those docs that I spent thousands and thousands hours so that they're ready to do it.

And so we do have this really unique position as physicians. Uh, really appreciate your reflections on that. Yep, and I take that to heart. I know it sounds flowery and maybe too fantastic to really be believed, but I think these are true words. So we talked about the Euro missions works and the work that you're doing. Are there ways that other doctors who are listening, maybe there's another urologist listening or there who says, Hey, I really want to get involved. Is there a place that someone could go and say, Oh, want learn more about this?

Or do you take other with you or how can other people get in involved in the works you are doing or similar work? Yeah, so among neurologists, certainly our national organizations like the American Neurologic Association get on a website there.

How to Get Involved and Closing Remarks 29:38

The American neurology association is a foundation that really has a lot of humanitarian connections. So certainly a resource for me to look up my name, drarthaprnd.com and visionsworks. com as well. websites here at Johns Hopkins, and just quickly look at Johnson Hopkins Urology and Finding. So if there's any sense that somebody wants to connect, that'd be fun. But there are a world of opportunities in so many different directions. Outside of Urology, those in various other disciplines probably have similar sorts of outlets they can pursue.

There may be other organizations you can look up, church organizations, community organizations and other sorts things to get involved. We feel like maybe that's something that might expand your sense of what you want to do in life. These are directions I might suggest. Yeah, no, thank you for your suggestion and for sharing that. I want to just, as we wrap up, think about just a little bit of a call to action because, again, you've demonstrated this career, this path that allows you to build all these different angles into it and find things that are fulfilling.

So if you're a doctor and you are listening and saying, hey, I'm not finding my joy in my job anymore because I am so overwhelmed by all the chores or I just need to change something. Try going on an international service trip, just try it once or twice. That's something that for me has rekindled my joy in medicine and I've been able to stick with it for about 10 years or so. And I hope I keep doing it as long as you have Dr. Brunet. I think that's amazing to be able do it decades like you. It's a really wonderful way to get involved and helping people.

You're not doing for financial profit, you're doing because you are there to help people in a real pure and straightforward way and it's admirable. I appreciate your kind words. And yeah, these sort of things I think you do knowing that you're not going to get a lot of appreciation, but that's not what counts. As long as you feel a sense of fulfillment for it, it's the right thing. Awesome. Thank you for spending the time today. I look forward to following your work and keeping in touch. and I'd appreciate you taking the to share that.

thank you so much. It's my delight to be part of your program and please let your audience hopefully derive something of substance from this and carry on with their best lives as well. Thanks for tuning in to the Doctors Making a Difference podcast. And thank you for what you do to help your patients and your community. Your work truly helps so many people. We produce this content to have the tools you need to stay in medicine and to highlight the amazing work being done by physicians around the world.

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