Leadership Key to Scaling Your Practice & Overcoming Burnout

Introduction to Dr. Lacey and Physician Burnout 0:00

Everyone. I have daughter Brant Lacey today. Daughter Lacey is a gas anthropologist who's absolute passionate about helping physicians like myself succeed with business and personal finances. As a physician insolvency gastroenterologist, you really understands how overwhelming it can really be, to really step out of clinical training and into a career. And he's seen really firsthand the lack of education on how to run a practice, how to run your life, personal finances, and his coach, hundreds of families to succeed, and building personal wealth and super stellar careers in the spoken to physician groups and countries around the country on topics related to business and personal finance.

He's, the founder of the scope of, practice website. And his go goal is to help physicians learn how to grow their leadership skills, their business and personal finances. So it is my honor to introduce Doctor Lacey today. How are you doing? That's Lacey, a doctor, one I am excited to be here. Thank you so much for having me. It's it's stuff like this. It's summits like this and and conversations like these that really help, you know, physicians do better, be better, you know, and avoid that burnout that we're going to be talking about.

So I'm super excited to be part of this. Yeah. You know, when I, when when I started thinking about what I wanted to include on the physician practice I summit, the first thing I thought about was burnout. Because, you know, part of, like, upgrading a practice is you can't do it and be more burnt out. Right? And so I feel like there's technology that's available that we can adopt. There's all these different things that we can adopt to improve our practices. But today we're really going to focus on exactly what burnout doesn't like.

And I think it's different for each person because we're all different people, different personalities. Right. And so, you know, I think that I think that the, the let's, let's, let's kind of define burnout. Like what what is the definition of a physician burnout to you? Well, like I said, there's a lot of different ways to define it. I think it looks a little different for everyone. But as a basic concept, I think burnout is reaching a point where the amount of stress and frustration that you experience from whatever part of your life you're talking about.

In this particular case, your career exceeds the joy that you feel from working in that career. And so everybody has a different breaking point from that. From that standpoint, some people reset point very quickly, very early in their career. Some people it may take ten years. Some people it's specifically related to the job that they're at or the boss that they work for, or the staff that they that they have under them. And so it can it can incorporate a lot of different factors, but it's that tipping point where the amount of stress is no longer balanced adequately against the joy that you feel.

And that's what is bubbling up to the top. Right. And I think when I talk to other doctors, I think there's a perception the burnout is something that you experience only in your professional box. Right. But that's that's not necessarily true, right? No. You can experience burnout in, in work at, in, you know, at home. It with dealing with your community. So for example, I know a lot of people that have experienced burnout with youth sports, right. So I mean, we're we're both we're both in Texas.

And so, you know, between football and soccer and baseball, I, I've talked to a lot of families that have, you know, they're doing 20 to 30 hours a week doing baseball practice and baseball tournaments and traveling to other states and it's very easy to get burned out from that kind of thing, too. So, yeah, it can absolutely happen in any aspect of your life for sure. Right? You know, in medicine, and we see patients do this all the time. Is that if they get diagnosed with something, especially if it's like a cancer or something that's really sensitive, that could be life threatening, but a slower insulin course, they say that, oh, I'm a I'm a, I'm a cancer patient, not I'm a person who happens to have cancer.

Defining Burnout Beyond the Workplace 4:12

We're not. And I feel like with doctors and including myself, I'm totally guilty about this. I was like, oh man, I'm burnt out. But I'm not. Am I really burnt out? Or is burnout part of what I am? And do I have a choice and not being burnt out? What do you think about that? Yeah. So that is one of the key distinctions that I make that I think a lot of people, really miss out on. You see blogs, you see social media discussions all the time about physician burnout, physician burnout. And the thing that makes me the saddest is when someone says I am burnt out.

It it means that they have taken that on as a mantle, that it's become part of them. It's like a cloak that is enveloping them or it's, it's a, it's a fortress that has been erected to keep them, you know, huddled inside and it's it's really tragic when someone gets to that point because they see it as a core part of who they are, as opposed to something that is a temporary state, something that is, an emotional challenge, something that is related to the, the situation at the moment. Right. It's related to their their job of work, their boss, whatever.

And so what I always try to tell people is that the key thing is to identify the burnout or the potential for burnout, but don't identify as burned out. You start claiming that mantle of of burnout for yourself and it becomes part of who you are. It is much more difficult to shake, and that feeling becomes a cancer that just metastasizes very quickly and very quickly starts to consume your other thought processes. It can bleed over from work into home, into your community activities, and it's very, very dangerous.

You know, I, so I'm guilty of that, right? I used to say, you know, I'm burnt out all the time, especially, when I'm trying to run my practice, start my practice, have multiple hurdles in it, and learn a lot along the way. And the, well, I think here's the problem. You know, I think the problem is that, like you said, you hear burnout in the media all the time. And here, oh, you know, 44% of doctors in the United States are burnt out, and now it's become like a normal place thing, right. And so why do you think it's becoming, like, so common, so it's very interesting that you asked this question.

I've asked this question of a lot of people who speak on this topic, extensively, and the sense that I get from people, both from thought leaders in this space as well as from just general physicians, is that this is not necessarily a new phenomenon that this has always existed to a certain extent, but it has taken on a new form. And there are the The Expanse of what really crushes people's souls when it comes to the reality of the administration of medicine has really just exploded in the last 20 years in a way that it really wasn't present for the generation of our attendings.

So, you know, it is when our attendings were in residency and in fellowship, you know, they were all working 100 hours a week. And so you hear a lot of the, a lot of folks who are in their 60s and 70s talking about, oh, well, you kids have it easy, all these workout restrictions and things like that. And there's honestly some validity to that. I don't think that's even an unfair critique. But what wasn't present back then was the degree of administrative hassles. The regulations, the metrics, you know, the the sheer amount and volume of paperwork.

It was just medicine, medicine, medicine back then. And you were exhausted because you were working so many hours, but you weren't exhausted because you were frustrated by your by the fact that you were basically becoming a scribe or a clerk instead of being a physician. I mean, I can work 100 hours a week as a physician, but I don't want to work 100 hours a week as a transcriptionist or as a social worker or as, you know, as a secretary. And there's nothing wrong with any of those professions, but that's not what I signed up for.

And I feel like that's a lot of what medicine has become. And I think a lot of physicians are reeling from that raw, and especially with the, embracing, globally, electronic medical records, and EMR, as you know, I think they had a good attention at first, but now, the tool is being used to do a lot of different monitoring, different things. And the practice of medicine is so different. And I think, you're right, because, you know, I'm sitting there, I'm typing, on, you know, I use the clinical words, I'm typing, my clinic works, and I'm John the way, and I'm doing my templates, stuff like that.

You know, you realize that there's there's a lot of burnout just from the documentation

Why Burnout Has Become So Common 8:54

and doing this, this paperwork that didn't necessarily exist before. So, you know, so I think the technologies change. So as the technology advanced, unfortunately burnout I think worsened as well. And not only that, there's social media. Right? So I think, there's something that, in marketing call it perceived value. So the perceived value of a physician, especially after 2019 and 2020, has gone down, this is a multiple, multiple to in surveys, the there's physician mistrust. There's actually physician to physician hate going on on social media.

You know, there is a lot of, just negativity talk, around the matter. And I think this is the time where everything is being questioned, the cancel culture of you. All right. And I think that what arises from the coronavirus in 2020 into 2021 is that an explosion in the next 5 to 10 years of a cancel culture that's really targeted at the highest level of professionals, which are our physicians and, and, other people, with in doctor degrees and stuff like that. Because of just such, value that's placed on individuality and voice rather than, looking at, powers of authority.

So I think that's, that's, that's a big deal, you know, going into 2022. And so but, I mean, I think the other thing is that, yes, there's technology has changed, right. But I think personal finance has also changed. Right. The way that, that, that money, is, is saved and all the distractions that are out there in cryptocurrency and all those different things that a lot of physicians like to talk about. In my circles, a lot of that has changed. And so let's talk about how does actual personal finance and financial independence actually contribute to to burnout.

So it's it's it's interesting. It's it takes a few different forms, but the primary form is just another layer of added stress. And so what I see from folks is that, you know, when you coming out of medical school, when you're coming out of residency, the average amount of medical school debt is over $250,000 and recognize that's average. There are a lot of zeros averaged into that. Right. So folks like me who are on, military scholarship, folks who are doing MD PhD programs, folks who got, you know, big scholarships, they're a lot of zeros average into that.

So the average amount of medical school debt is probably closer to 300,000, really. And so all of a sudden, you know, you get out there, you have your attending paycheck and and you're like, yeah, I'm making some money. And then you're looking, you're going, but I've got to pay $4,000 a month to Sallie Mae. Are you kidding me? Right. And it's been that is that is incredibly stressful. I mean, our attendings never had to experience anything close to that. I mean, the cost of tuition, the cost of living has just exploded.

And so, so that is, that contributes to burnout in the sense that it it weighs on you is another thing weighing on you. And the way that I kind of think about it, it's like, a wagon wheel, okay. Or like a bicycle wheel. You've got a lot of spokes that are going out. You've got a personal finance spoke, you got a career spoke, you got a family spoke, you've got a church spoke, you've got a community spoke. And if any one of those areas that spoke is broken, then the wheel is going to be flattened in that spot and your wheel is not going to spin. Right.

So each one of these is a critical component of the entire burnout model. And so it's important to have focus on each one of those in balance. And so with the personal finance aspect of things, one of the things that I find and you know, this is something I do a lot of coaching on, this is people just experience tremendous amounts of stress over, you know, how am I going to pay? How am I going to pay my debt? How like last year this came to really a big, big summit for people where a lot of folks are either losing their job or are worried about losing their job, or worried about getting replaced by nurse practitioners and or actually getting replaced by nurse practitioners, and all of whom I'm sure are very qualified.

But this job security, they thought they had forever, suddenly it's not so secure. And that adds another layer of stress, and then it just contributes more to the mental, and emotional weight that takes you away from other things. And so, you know, if I'm sitting there coaching a patient through their Crohn's disease and trying to work through with, like, which biologic are we going to choose and why isn't this working? If I'm sitting there thinking, man, I wonder how I'm gonna get to the end of the month and make my make my student loan payment and, the kids field trip managers expenses are just blowing up for me.

You know, I'm not focused on the patient. And so if you if you walk into a patient's room and you're dragging, you know, a huge student loan debt behind you, it's going to it's going to make your focus start to drift. It really pulls you away. And I think it it is one of the many things that contributes to burnout at work. I think most of us can identify with. I certainly can when I have to pay Sallie Mae a lot of money. And my wife and I, we met in medical school, which means, we doubled that $300,000 in debt coming out.

Right. And, and we, we were forced to come into situations where we would have paid off relatively early. But that took a lot of stress. Right. So, you know, speaking about that, you know, there's nothing one can do coming out of medical school and then even residency with with a large load of debt. Are there things that, people can do to avoid this type of burnout by looking at the finances? Yeah, there absolutely is. And I think it just starts with paying attention and just deciding to have a plan.

One of the problems that I find most often for folks when, when I sit down for an initial coaching session with somebody, one of the the most common things that people say is they feel stressed because they don't know what to do first, and then they don't know what to do next, and they don't know what to do. Three years from now, they don't have a plan. All they see is just this ruinous mountain of debt. And and just fear of the unknown. Or like, how fast can I pay this off? What is this going to look like?

How Debt and Financial Stress Fuel Burnout 15:18

You know, survival mode, man, we're just in survival mode. Absolutely. What kind of limitations is going to place on my career? What kind of, you know, am I going to be handcuffed to this job because I'm stuck and I can't I can't afford to go anywhere else because I need the money to be able to pay off my student loans. And so what I think is the most important thing that people can do is, is sit down and start to make a plan. And so what I do typically for folks is I recommend starting with a budget.

And I know that sounds very basic. And a lot of people hear that. I'm like, no. Right. It's it's it's, you know, it's one of those things that a lot of people are like, well, you know, I, I should be able to figure it out. You can't. It just it doesn't work. It fails. So often. It just it just is not effective. So it's really important to know exactly where you're spending your money, how much you're spending, and be intentional about it. So so starting with the budget I think is key. And then the second thing I recommend for folks is come up with a plan for eliminating debt and decide that it needs to be a priority for you.

So this business of, well, I'll just pay off the minimum amount I'm 30 years from now, it'll be gone. Don't leave that hanging over your head, okay? It is. It is just a lot of added unnecessary stress. So live like a student, live like a resident and just knock it out. Be done in three years or five years or whatever. And it is just so freeing to have that weight lifted off of you. And then just start making step by step plans once the debt is gone. Just start systematically every month, save for retirement, save for college for your kids.

Work on paying your house off early and just do it. Little by little every month. I mean, it's it's like it's it's it's it's just one step at a time. One step at a time, you know, but it over time, it will absolutely add up. But that's really the key thing is you got to have a plan. You got to sit down and make a deliberate step by step plan for how you're going to do this. Sounds like a really overwhelming task. I mean, it sounds it sounds overwhelming, but that's why it's so helpful to break it down into such into little smaller bites.

You know, start simple. Start by making a budget. How much money are you bringing in every month? Ex great. So I need to allocate this amount for rent, this amount for food, this amount for utilities, this amount for my transportation and whatever else my expenses are okay. How much do I have left at the end of the month this much right. That's all going towards my debt. And then, you know, if I get a bonus, great. That's going to go towards my debt. And we just it's it you're you're breaking into a very simple chunks.

You're not looking at, you know, it's the analogy I like to use is, is the tool that you need is a lantern not a lighthouse. And what I mean by that is with a lancer. And if anyone's ever walked through the woods with a lantern or walked through the woods with, you know, just, like a very small flashlight, you can only see about 3 or 4 steps ahead of you. That's what you need. You don't need to be seeing 25 years in the future. Start small. What is the next step you need to take? Take one step, get there, and then take the next step and then take the next step.

But focus on one step at a time. Believe it or not, I've actually walked through the woods with Lance from The Price of Blue because I'm from China when I was a kid, right? So I don't know what. And I've done it from the Boy Scouts. So I guess you go, there you go, there you go. So, okay, I'm going to ask you now, I'm going to ask personal questions about me. Then, you know, I don't know, our debts paid off. You know, we did. We did the math. We let the lower means, we paid it off. But, you know, I feel like there's still a burn out because here's what's happening.

You know, I talk to my friends, I have this wonderful group of friends. I have this wonderful group of intensive care friends, and they're mostly like shift work docs. Right? So they paid off their stuff. You know, they've been in the business for a while. They're, some of them are in the mid 50s. But there's still have financial burnout is because I think the, their perception is this, is that okay? Well, you know, I would like to Maserati GranTurismo and I'm going to work 13 extra shifts. Right.

But what I tell them is that may actually burn you out because yes, that is one of the outcomes that you have. Or what is your what is your five, ten year plan here? And how do you, expect to get there? So I feel like a lot of doctors in the and after they got out of debt, there's still lost. Like, how should someone who's already out of debt. But having that mentality, I'll just work more. I'll have more hours. And he still get burnt out. Like how do you how do you approach a mentality like that?

What I find that is happening most of the time when people are in that situation is that they flip their budget upside down. So what you got to do is when you're choosing what you're going to spend your money on every month, and don't call a budget if you don't want to call it a cash spending plan or whatever. But what you need to do is start first with your long term goals. So long term goals are going to be retirement saving for your kids college, and paying off your house. Those are going to be most people's big three long term goals.

And so what you need to do is at the beginning of the month, you have X amount of dollars. And what you need to do is figure out, sit down and go through the process of figuring out how much money do I need to save every month for the next X number of years in order to be able to retire? With the amount of money that I want? How much money do I need to be saving every month to ensure that I can pay to go send my kids wherever they want to go to college or however you want to do that? How much money do I need to be saving each month to pay off my house?

In ten years, 15 years, 20 years? Those things come out first. Pay yourself first, then spend whatever's left. And the problem is that most of us and this is an exclusive to physicians, this is everybody, is that we we spend, spend, spend like, I want this, I want this, I want this, I need rent, any food, any utilities. And these are the things that I want. What's left over. Don't do that. Start with start with giving first. Okay? That's that's my first line on every budget is giving. You know what is the most what is something that you want to, you know, how do you want to give your money away?

You know, for me it's tied into my church. For some other people, maybe it's giving to charity, but that goes first, because if you don't put it first, it doesn't happen. And I personally think that generosity is one of the key features to building wealth, because generous people just are more successful. They are they are happier by and large. They are more attractive to be around. So put that first, and the next thing is saving and paying off debt and make that a priority. And then decide you're going to accept living on whatever is left.

But don't put the cart before the horse. That's one of the things that honest people are. It's very counterintuitive because because you're like, give first, right? And then pay yourself and then figure out some of the other stuff. And I think for most of us, it's the complete opposite, you know, me included. I'll tell you, though, the my first step outside

Building a Plan to Eliminate Debt 22:00

of the well of burnouts for me was contribution. Right? We started, contributing to, things and charities and events and stuff like that. And at that time, we weren't really financially anywhere, meaning to do that, but it gave so much clarity on what I really wanted to do, that it allow me to look forward to sitting down and actually planning something. And then I stopped thinking about that Maserati GranTurismo, even though I did get one. Ultimately, I stopped thinking about it, and I started thinking about what what can I do from a contribution side?

You know? And then that's the time where, I was actually trained under a Tony Robbins program, and there's talks about the six, human needs, and one of them is contribution, which is contributing to the community. Another one's significant and the one's variety, it's love and connection. But I was missing that contribution piece, and I didn't know where in my life was contribution. I wanted to really target the wagon wheels you talk about. Right. And making sure that each part of my life was fulfilled so that as the wheel turns, it's.

And it's nice and smooth and a contribution was missing. But the minute I did that, and I donated, to a human trafficking program, by the way, writing check. I'm like, I don't have this money, but here it goes anyways. But that triggered my brain. Like something about that trigger my brains want to do, sit down and get my life in order? I had the best talk with my family, my wife, my dad, my mom, like I've had ever and really just come clean about that. And it's really it's kind of a purging moment for me and completely unexpected because it's not my character to do that.

But when I, when I, when I nurtured my, my love for for contribution, that's where it is. And I thought I have plenty of contribution. You know, I'm, I'm an integrative medicine, primary care doc. So, we contribute a lot to our patients, and so. But contributing to to patients and, is, is a different part of the brain as contributing to society. I feel like and contributing patients is, you know, that's part of my vocation as part of my business. Right. And and I see it as something that's necessary for me to generate revenue, generate wealth, but contributing to society, just, just it's just like a different level, a different flame, if you will.

Different color. Flame. But have you, have you seen other people talk about something like that? Oh, yeah. Absolutely. And this, this, this holds true in all walks of life. So the biggest studies of millionaires that have ever been done, every single one of them shows that overwhelmingly, people who are millionaires are exceedingly generous with their wealth compared to the average person in America. And that's not an accident. And it didn't start when they became millionaires. So I hear a lot of people say, well, you know, they have a lot of money.

They can afford to give it away. No, they all started that habit when they were when they were really young, when they didn't have very much money. My wife and I have been I mean, we tied to our church and we've been doing that since we were in medical school and we were still paying off loans. And so and it was it was hard to watch that, you know, some days, you know, some days I'm like, okay, I know this is really important, but man, I wish I could just plunk this down on my student loan debt.

It would get down so much faster. But, you know, here's the thing. If you don't do it early when it's hard, you're not going to do it later when it's easy. I remember when I was so I went to medical school in San Antonio, and I remember there was, there was one week at church that one of the San Antonio Spurs came to visit. He actually talked about that. He said, you know, you know, people say it's a lot easier. Well, you make $10 million a year. Of course, he said it would not have been I would.

There's no way that I would be I would be willing to take on a million, $10 million a year if I had built up the habits, built up the muscles of of giving when I had $10 and $10,000 and then $100,000. So you got to start that early. And by and large, like I said, the people who are generous with their time, generous with their talents, generous with their money, are people who were more attractive to be around their people that you that you want to be like the people that you want your your kids to learn from.

There are people that you want to study under. There are people that you want to emulate. The these those are the people who tend to succeed. I mean, generous people are just more attractive people generally. And so I want that for people. I mean, you know, you know, how this goes. I mean, giving money away, that's the most fun you can do with money. I'd much rather be giving money away than than spend it on stuff. It's just it's more fun. But you did it in medical school and you had nothing. We had negative.

Right. Well, you know, it's funny, John John Rockefeller was, one of the was the wealthiest man in the world in the early 20th century. And he actually wrote about that. I said if he had if he hadn't been generous with you know, with his money when he was making a dollar an hour or a dollar a week or whatever was on, you know, his early job, he wouldn't have been able to be generous with that first million dollars. So, yeah, build those habits early and make that make that part of your life and then make and then, like you said, live beneath your means.

So decide that you're going to give money away. Decide that you're going to spend, you're going to save it, and you're going to invest it for your future and then decide you're going to live on whatever's left. You know, that provides a really good transition to the next thing I really want to talk about, because, when he decided to give some of this money away, you better include your spouse or your significant other in this conversation before you do it. Right. But which brings me to the topic for relationships.

But, man, I've seen so many relationships, go south through the end of medical school and throughout all of residency. And I feel like it's so commonplace. And, it was so normal, you know, and it's it was kind of crazy because, you know, I was a chief resident, and I hear residents like making bets on which couples in the last there are residency, you know, and no one likes to beat them to go through residency. You know, I'm almost like, I'm just as, let's talk about relationship for a second, you know?

Because I think relationships are is that one thing that we don't like to talk about? Even some months or friends? Because we almost feel shameful. I think that we talk about relationship, not talk about patients or cool cases with our other physician friends that it's it's sort of, faux pas, if you will. Right. But I want you to talk about, on this show.

Reframing Money: Giving, Saving, and Living Below Your Means 28:30

Let's talk about relationship for a second. And how do we make sure that our relationships are nurtured and strong? Because that definitely contributes to most people's burnout as well. I 100%, and it's it's one of those things that it can really sneak up on you. Because medicine is an all consuming profession, and if you don't have a medical spouse, it is hard for them to understand. So, you know, how can you? You can't predict when you're going to be home. You said you were going to be home an hour and a half ago.

Like, yeah, but then I get this call from the E.R. and the person was super sick, and then I needed to go do a spinal tap. And my my intern was having trouble with something. And, you know, they just, you know, stuff just happens. And so it's very hard and and so it's very insidious. It can really it can really just creep up on you. So it's something you have to be very mindful of and then be very intentional to come back. And I think one of the, the greatest pieces of advice I ever got on the subject is that the most important thing you can do is be present wherever you are.

So when I'm at work, I'm focused on work, okay? When I'm at home, I am not focused on work. At home, I do not bring my work home. I don't I don't answer phone calls except when I'm on call and my family understands. And that's something that we've discussed at length. And so you know, that's an expectation that when daddy's on call, daddy still works. But otherwise, you know, I put my I'm not on my phone. I'm playing with my kids. You know, we're going out in the backyard and hit the baseball. We're we're running around the house and doing pillow fights and just being goofy or whatever, but but be present.

Be fully present wherever you are. And specifically, I think it's important to make time. And that's one of the things that's really key. It's very easy. And this is you can kind of think of it like a budget, but but you need to budget time into your week specifically to spend time with your kids and spend time with your spouse. And it's it is so easy to let that time slip away. And it starts very small as well. I just need an extra 30 minutes tonight. I just didn't quite get to all my notes today.

All right, well, that 30 minutes becomes three hours over the course of a year or five years. Okay? It just consumes you. So you have to commit that you're going to only do work at work. You're only going to do home. At home, you're going to be present wherever you are and commit that you're going to devote that time only because once you're once your spouse and once your kids start to doubt that you're fully committed, when you're there, immediately that starts to erode the relationship. And so that's something we have to guard against.

And, you know, I think the the topic of resentment kind of comes in, right. And, and it has to do with our mentalities. And you see the same type of mentality in, people who serve in the military, you see the same type of mentality of police officers as the heroes mentality. And, and I think the heroes mentality is that I place everyone else before me for the greater good. But what ends up happening is that, heroes suffer tragedies. And a lot of times, the hero's tragedy is that those who are closest to the hero tends to get hurt the most.

Because now, not only are we putting other people ahead of ourselves, we're putting other people ahead of people who we perceive to be partners. Right. And I think that it's a very hard pill to swallow. But we see that all the time. And, and, you know, I even see this in professional athletes, these NFL players, the, that we work with, that there's an image to, to really uphold here. And they sort of perceived themselves to be that hero. And, and, you know, I suffer from that as well. And I think, I mean, look at you, look at coronavirus.

You know, doctors are called to the frontline, which is a very military term, right? Frontline doctors, frontline nurses and frontline, this and that. And you're expected to serve at a level. And that's so commonplace in media. But what's not heart about is the amount of trauma that actually develops going through medical training. Right? Going through residency. And that trauma just burdens, personal relationships. If you don't have that level of communication, does that make sense? Yeah, 100%. And so you've you've really got to be intentional about the communication aspect.

And one of the things that I think is really helpful is to set and maintain and adjust expectations on a very regular basis. So for example, it's very common when you're going through training that certain rotations are really going to affect you in a different in a maybe a challenging way. So so maybe you're rotating through the inpatient, hematology oncology ward. And so or pediatric sport. And so you're seeing a lot of really sick people, a lot of really tragic cases. Well, that'll weigh on you in a serious way.

And it's important to have an outlet for that and be able to talk openly about that with somebody. And if that's your spouse and they and you feel comfortable and they feel comfortable talking about that, then great. If not, then you gotta find a way to to unload that burden somewhere. Talk to somebody about it. But it's helpful, I think, to be able to set those expectations on and adjust them with your spouse on a regular basis. So for example, to say, okay, well, this month I'm on ICU and we're 24 hours on and it's every third day and I probably am just not going to see you very much.

But we've got I've got I've got two days off in a row, two weeks from now, let's take the kids and we'll go camping or let's see the kids and we'll go see your parents or whatever. Right. So but, but there's some give and take there. And I think having some grace as the, the non physician spouse, but and also having some, some intention to try to commit more to your family on the part of the physician spouse is really important. So it's really it's really about give and take. And so you got to have you got to have both things.

And the thing I always tell people is that the number one thing that you can do for your spouse is commit to love them and support them no matter what, because as soon as you start to lose that trust, everything else is gone. And so when you're in a if you're the non-medical spouse, let's say, and you're in a, you know, you're in a challenging rotation or a challenging season. So like your surgery intern year, for example, is just going to be rough.

Protecting Relationships and Communication 35:06

It just is. Right. And so having some grace for your spouse and some understanding for what they're going through is really valuable. And so but then recognize that those situations are going to change. And so your expectations should be able to change with it. But I think the more you can have those open and honest and frank dialogs about it, you know, the more that you'll tend to be able to come together and overcome just anything that comes your way. I think a lot of people listening, including myself, have gone through, those stressors as well.

So, dude, how do we start, like, rehabbing ourselves? Like, what do we do? So, it depends on what the situation is. But a lot of times, again, it just comes down to very open and honest dialog. And so it's it's addressing what, what hurts are there. Okay. And what what areas have have you failed to meet expectations or has your spouse failed to meet your expectations? Are your expectations realistic? What are your feelings? What baggage are you carrying? What are what are the ways that you need to feel loved?

What are the ways that you are trying to express love? That maybe your spouse isn't isn't understanding or catching? And so having those conversations becomes really, really important. And so this is where just having those, those dedicated times for just you and your spouse becomes really important. So are you are you committing to have times where you know, there's there's no kids, there's no TV, there's no phones, there's no work. It's just we're just hanging out, you know? We're just we're just talking. Right.

And so and maybe it's not every single day that that's going to be possible and that's okay. But but commit to making that kind of thing a regular thing. Keep those lines of communication really open. Otherwise you'll end up in a situation where, you know, you basically are existing separately, but living, you know, living together but living separate lives. So if you're constantly growing married roommates, I call it. Right? Yeah, exactly. Exactly. That's the worst. Yeah. If it's both. The only way that that that a marriage relationship can work or that any kind of relationship can work is if both people commit to putting the other person's needs ahead of their own.

If either person violates that on a regular basis, then the relationship is is headed for a problem. And so but if both people are constantly committed to making sure the other person's needs are met, if they're constantly focused on how can I serve them better, how can I love them better? How can I encourage them more? Then then the relationship will just work, serve each other. It sounds like. Yeah, yeah, yeah. And so, you know, we talked about personal finances. We talked about, relationships and we talked about all those intervening factors that, you know, relate to burnout.

But I kind of want to talk about you because you're interesting person. You're a gastroenterologist and you're talking with me on a podcast right now. And, you know, you are doing coaching and stuff like that. Like, I look at you, I'm like, how are you? How do you do it all with such grace and talk about this like, what is it, the seek? What is your secret in doing this? You know, it's funny, I ask myself that a lot. Like, where do I find the time to do all this stuff? One of the thing, one of the exercises I like to recommend for folks that I think is really helpful is there's 168 hours in a week, so take a week or take two weeks and catalog what you do every hour of every day for a week.

How many hours are you sleeping? How many hours are you driving? How many hours are you, spending time with family? How many times or how many hours are you working with your spouse? How many minutes are you spending on patient phone calls? How many minutes are you spending on social media, on answering emails, on watching TV, on eating and catalog every single activity? Okay, then take a month's worth of your credit card receipts, okay? And your your bank checkbook and see what are you spending your money on.

And then tally all that stuff up and what you're spending your money on and what you're spending your time on are your current priorities. If you show me your calendar and you show me your credit, your credit cards, and your checkbook, I can tell you what your priorities are. And maybe that's not what your priorities, what you want them to be. Okay, but that's what they are currently. And so I think it starts with having with taking a very hard look in the mirror and saying to yourself, okay, am I spending my money and my spending my time on the things that I really want to be spending my money in my time on?

And if the answer is no, you got to figure out how to realign that. And so for a lot of people, what that ends up looking like, for example, at work. So you're asking how do you find the time is just becoming more efficient at work. And I as soon as I said that right there, a third of the audience roll their eyes into the back of their head and say, oh, here it goes. You got to be more efficient. I got to I almost was. I see a 25 patients in 45 minutes, you know. And so and I get it. Listen, I get it.

But let me ask you this. What's the alternative. Right. What's the alternative. So either if you want something different, if you want a different situation, you have to do something different. It's the only way it can work. And so you either have to figure out how to leverage your EMR better. You need to offload some stuff to your staff, and you train your staff to bring you, problems after they've been at least partially triaged. You need to automate as many things as you can to eliminate, unnecessary systems.

And that goes for everything. And so, and so if you can do some of those things, you'll find that you free up time in the middle of the day. But it starts with taking a really hard look and seeing what are you actually spending your time on? What do you wish you were spending all your time on and how can you make? How can you start to make that conversion?

Delegation, Priorities, and Personal Systems 41:00

Once you see where that gap is, you'll know where it is. And so if it's if you're spending 30 hours a week, you know, driving your kids to and from activities, maybe you're taking on too many activities. Maybe you need to make some hard choices and limit that as the same thing with your money. If you're, you know, if all your friends are debt free and they've got a big nest egg built up for retirement, they're starting to, you know, go part time at work and you're, you know, you're not doing that.

Is it? Because you have too big a house and too big a car and too much money in your private schools for your kids? None of those things are evil, by the way. I mean, if you want, if you don't put your kids in private schools and get a cargo, do that. You know you'll drive your Tesla, you'll drive your Maserati. That's fine for me. But you know, there's only so much money. There's only so much time. And so if you're spending it in one area, you're not able to spend it in the others. So you just need to decide what your priorities are going to be and just decide to commit your resources to those goals.

So super, super powerful. And I think, you know, just like, us log in time and call it track it to hack it. Right. Get out, track everything you got track time, track your finances. Create a budget and track your habits and everything like that. Because we honestly don't know. Because 95%, what we do on a daily basis is driven by our subconscious. Ever since we were three years old. Right. And so, and so when I actually sat down and did it and I put and I actually put my time into categories we call called categories of improvement and and which categories I wanted to improve that really allow me to fine margin all of a sudden where I was like, oh, okay, I was doing this, I, this is completely unnecessary, and completely unessential and, you know, complexity became the enemy of my progress ultimately.

And I really just had to simplify things and see what's truly essential. But thanks for coming on. You know, I like to ask at the very end, the same questions for most people is if you were to talk to yourself three years ago, what would you say to yourself? What are the lessons you learned in the last three years for yourself? I think the the biggest lesson I would say at work is delegate sooner and more often. So I'm, I'm the kid from high school that was in a group project and said, I'll just do all the work and let everybody put their names on it, because I don't trust anybody to do as good a job as me.

I'm that guy. So. So, yeah. And I think a lot of us in medical school, for a lot of us that are physicians, I think are like that. And, that's something we have to let go. And we have to decide that, you know, A-minus work is good enough. B-plus work, maybe good enough. Okay. If it's something that's coming from your staff, if it allows you to do A-plus work on the things that only you can do, that is massively worth it. And so I had to learn to start letting go and trusting my, my team more, and offloading more from my plate so that I could spend more time focusing on educating my patients on casting vision for the for the, for the company, for strategically planning how we're going to hire and expand, and frankly, for being able to spend more time at home.

And so, and so that's the first thing I would tell myself is, is, you know, there's definitely find ways to delegate,

Final Advice and Where to Find Dr. Lacey 44:06

automate or eliminate things at work as much as you can. And then the second thing I would say is, is, you know, keep in mind, you know, what your priorities are. And for me, my priorities are my faith, my family, and my work in that order. And so, you know, be sure to be to, to continue committing time to those activities, you know, make sure, you know, set aside time to be able to go to church on Sunday. Set aside time to have, dinners with your family, set aside time to go visit your relatives.

Set aside time to have devoted time just you and your spouse and do those things because it is definitely worth it. I think those would be the big two things I would say. Awesome. Thanks a lot for being on. Appreciate it. How do people find you and reach you so the scope of practice.com is the website people can access the the blog archives, the podcast, all the, all the stuff is there and something I'll, I'll offer to anybody who's interested, free thing, a free guide that I put together just for this purpose, for, folks that are suffering from personal finance burnout.

I've got a PDF guide this called three Critical Tools to Level Up your family's finances will help you set a budget. I'll be set some long term goals and start having some of these money conversations with your spouse in a way that doesn't end in a fight. And so people can download that if they want, the scope of practice.com/no money fights. So the scope of practice.com/no money fights. And you can also get everything else on the same website there. Awesome. Thank you very much for being on appreciate it.

It was an honor. Thanks so much for having me I appreciate it. Thank you. For.