Are You a High Achiever or a Perfectionist? Here’s How to Tell (and Why It Matters for Your Burnout Recovery)

Are you truly a high achiever—or just a perfectionist in disguise? The difference could be draining your joy, your energy, and your mental health.

As healthcare professionals we pride ourselves on excellence, but underneath that drive is often a deep sense of “never enough.” In this powerful episode, Dr. Kara Pepper opens up about her own battle with perfectionism, how it masked itself as ambition, and what finally led her to change everything.

You'll learn:

• The critical difference between high achieving and perfectionism
• How perfectionism shows up in your work, boundaries, and even your rest
• How Kara created a career and life aligned with her values—and how you can too

 Listen now to learn how to break free from perfectionist patterns.

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Life After Medicine explores doctors' journey of finding purpose beyond their medical careers, addressing physician burnout, career changes, opportunities in non-clinical jobs for physicians and remote jobs within the healthcare system without being burned out, using medical training.

Transcript

0:00

This week I am in the trenches prepping for pivot potentials, and so I'm going back through the archives of the podcast and bringing back interviews I've done from people who are speaking at this summit. So today we're revisiting Dr. Kara Pepper's interview, which was done. Quite a long time ago, I have a very vivid memory of doing this interview from a cave hotel. In Cappadocia Turkey in December, 2022.'cause I remember being like, oh man, it's so echoy in here.'cause I'm literally in a cave. So it's been a minute and it's definitely time to bring back this conversation. Um, and I honestly feel like Kara Pepper is like the physician equivalent of Glennon Doyle. She is just so authentic and has this big heart with so much wisdom and. Every time I connect with her, I feel like I've learned a new truth about life. And her session for Pivot Potentials is called, you are Not broken, you are becoming, and it's the five stages of change. Now, we have not recorded this yet, so she's gonna do it live, but what she's done is she's identified and mapped out. This process for you, because she's noticed there's five predictable stages of change that doctors and all healthcare professionals go through when they're transitioning from this place of being overworked and exhausted to then moving into purpose and sustainability in their career. So in her session, you'll experience. A sense of relief from this shame spiral of like, why can't I figure this out? You'll also feel a sense of orientation because you'll know where you are and what is likely coming next, and you'll get clarity on what your next step is. Based on the stage that you're in, so you can move forward with confidence instead of feeling like you're floundering about in uncertainty. So if you have been feeling stuck or behind, or like everyone else has it figured out except for you, her session on Pivot Potentials is going to feel like a lifeline. So now without further ado, I'll go ahead and play her episode from back in. 2022 from the Cave Hotel and just knowing that if you resonate with her, with her message, with her wisdom, you're gonna wanna be at her session at the upcoming Pivot Potentials Summit.

Speaker 3: 2:25

Welcome to Life After Medicine, the podcast helping millennial health professionals leave the system and build a fulfilling career. I'm your host, Chelsea Turin, residency Dropout turned six, figure entrepreneur and World Traveler. I'll help you discover your unique path to making an impact without the burnout, because you were meant for more than 15 minute patient visits under fluorescent lights.

Speaker: 2:47

Do you feel haunted by the never enough gremlins that no matter how much you achieve or what you get done, it just never feels like it's quite enough. There's always more that you could be doing. This is exactly what we were talking about in this week's episode with Dr. Kara Pepper. You will learn about how she took the leap from traditional medicine into creating a telemedicine practice. That aligns with her values. How to distinguish between that healthy striving and maladaptive perfectionism that sucks all the joy out of life and why carving out space and time to rest is actually one of the most productive things that you could do and also much more fun. Let's get to the show. Hello, my loves. Welcome back to another episode of the Life After Medicine podcast. Today I have with me a very special guest, Dr. Kara Pepper. She is a professional ballerina turned physician and she used perfectionism workaholism to look great on paper. While feeling exhausted, overwhelmed, dissatisfied with the life that she had worked so hard for when she finally decided she deserves space for her in her own life, she created a medical practice. She loves on her own terms and has never been happier. She is a physician, coach and internist, and I am so excited to have a conversation with her today. Welcome to the show.

Speaker 2: 4:16

Hey, thanks for having me. It's so good to be here with you.

Speaker: 4:19

Let's just dive right into talking about your journey, um, with perfectionism. When was it that you first realized that you were struggling with perfectionism, and what did that look like for you?

Speaker 2: 4:30

I, I first realized probably much later than it was obvious to everyone around me. So, you know, what I considered normal was just. The desire to be better, right? That that's a kind of social message that we get as folks conditioned as women. Certainly in medicine you wanna be more excellent and so as a dancer, an artist, you know, there's no end to the evolution of just getting better what you did. So it was really kind of part of my DNA, um, as a dancer. And then when I was. No longer able to dance because of eating disorder related injuries. Um, and obviously just went to med school'cause that's what you should do after a group dance. Um, you know, all those behaviors came with me. So there's always more to know. You can always be smarter, you can always improve your quote, practice in medicine, lifelong learners. So it felt very natural and very healthy to continue to grow. At some point along the way where it became maladaptive, it. I would mute emotions with, right? So for example, you know, intern here is super hard. So instead of saying, man, I'm really struggling, this is a compassionate way for me to look at this really tough situation. My inclination was to get busy and work harder to try to avoid feelings of discomfort. And so hypertrophied over the early part of my career that really led to overworking burnout, burnout, sabbatical, I. Many years later realizing that I needed to find a different way, so. Here I'm probably in my thirties is a short answer.

Speaker: 6:06

But no, that's such a powerful way to describe it and, and I think I wanna just sort of repeat some of the things that you just said to make sure I'm understanding it, because I think the way that you're talking about perfectionism, there's just so much lessons to learn in there. So it sounds like, because a lot of people, we can have this healthy, what we consider a healthy striving. Right? Right. This sense of like, I wanna be better, I wanna be excellent. I don't wanna. I dunno, just sort of like settle into mediocrity. But then what you're saying for you is like when you noticed it was becoming maladaptive is when you used this quest for betterness to suppress emotional states.

Speaker 2: 6:48

Absolutely. So there's a really strong difference between high achievers, which are growth mindset, open to learning, okay, with failing and getting back on the horse and trying it again. And perfectionists that are largely driven by fear of not enoughness, shame, self-judgment, self-loathing. And if I can just be good enough, I don't have to feel those feelings of. So, you know, perfectionism really is just this like adaptive behavior, um, and a number of things, overworking, people pleasing, trouble setting boundaries, uh, you know, not enoughness, imposter, all that stuff. Um, we use it to like cope with things in our early life. With time, they can become maladaptive. Because if you're always trying to be better, you never allow yourself to rest. If you never think you're good enough, you never are able to celebrate your victories and really savor your achievements. And so it really sucks the joy out of your life. So the success we have is because of our high achievement, not'cause of our perfectionism.

Speaker: 7:49

Yes. Okay. Those, these are such important distinctions to make and I feel like this is definitely something I used to struggle with as well, is just that sense of never enoughness. Being the driver of all the behaviors. And, and I describe it to my clients as like having this push motivation, like of pushing because you're not enough and pushing to, you know, prevent people from finding out that you're not enough and, and all of that versus now what I experience more often. Is like a pull motivation where it's like I'm being internally pulled towards doing something. Yeah.'cause I want to do it. Like this conversation tonight, I was like, yes, I get to talk to Kara. This is gonna be so fun. I feel like a pull, not this sense of like, okay, I gotta rally and motivate myself to That's right. Record this podcast so everyone else thinks I'm excellent. It's just like this very different drive. That's right.

Speaker 2: 8:38

Yes,

Speaker: 8:38

and, and

Speaker 2: 8:39

it's the internal feeling that really distinguishes between the two.'cause on the surface it could just be working hard, but it's, why are you doing that? Right? Are you being mm-hmm. Pulled towards something that you're passionate about or are you running from, not enoughness, fear, imposter, you know? Mm-hmm. Those,

Speaker: 8:56

did you have a moment where it all just sort of. Came to a head where like perfectionism, it was just like, I can't keep living like this anymore. Or was it more gradual or what was that sort of journey like for you?

Speaker 2: 9:09

It probably was a series of moments. It was really, you know, like many things, there's, I. Things that we say we value, and then the things that are on our calendar. And so work was the outward expression of my perfectionism, workaholism, hustle, culture, keep moving. And so for me, that led to just epic burnout about seven years into my career where I literally couldn't get out of bed anymore. So right after New Year's of 20. Know, I had to call my practice and feel like a total failure and say like, I can't do this. I need some time off. And so I took a sabbatical, which I laugh now because you know this. Of time so you can heal and recover. I gave myself six weeks'cause that's all you're allowed to take in healthcare, right? Because that's maternity leave.'cause I thought I would have my whole life together within six weeks. Um, I did not pro tip anymore. Six, six weeks is enough time to not feel like you're on fire anyway. So it really was like a reckoning for me to be like, I can't do it like this. I don't know what I'm supposed to do differently. But this is not it. And so I, you know, I'm very open about the fact that I've been in therapy for over 12 years. I've had a coach, but I found coaching in that win window of time to be like, I just need more help than what I'm getting. Um, and that's what kind of started me on this journey. It really helped me unwind some well entrenched thought patterns that I had about my own personal worth, about what my behaviors meant. And in unpacking some of that, you know though, there's some stepping stones along the way, but it helped me really kind of uncover the why behind what I was doing. And ultimately that was not aligned with what I really valued. And so it gave me a reason to keep moving forward.

Speaker: 10:50

And what was the why that you uncovered?

Speaker 2: 10:54

Our life is really short. Like we stared death in the face every day for a living. And I was living like I had an unlimited amount of. And I, you know, I'm an internist, so I take care of, you know, people of all ages, but you know, women my age were starting to get, you know, breast cancer in their late thirties, early forties. And I was watching this happen to people and living as if it could never happen to me. And so when COVID, I'd been making some changes, but when COVID happened, it really finally made me say, I can't live like this anymore. Eternally self-sacrificing myself for my job because there was no limit to what was being asked of us. And so, um, it really just helped me put that in perspective. My parents are aging, my children are now in high school, and I just, I didn't want to regret this really magical time in my life. And so my why was I don't wanna have any regrets. So that's, yeah, that's what started this process.

Speaker: 11:50

Wow, that, I mean, that's so powerful that you had that realization. Um, because I think a lot of people, like you said, they sort of live as if we have all the time in the world. Um, I put up a. Facebook post recently, and I was like, what would you do differently if you couldn't postpone living anymore? Because that's essentially how we act. We just sort of postpone living and we're like, oh, well, we'll get to that once, you know, we pay back our loans, or once my kids go to college, or once this, whatever milestone it is, and we just sort of delay living.

Speaker 2: 12:22

Living. Yeah. And I, I don't think we do a good enough job. Talking to early career physicians, residents, fellows, early attendings about this. Like we have this like path that we kind of have to go on autopilot to keep moving forward. There's just like an expected milestones of like graduation and residency and whatever, but then at a certain point, like we have permission to reclaim our life on our own terms, but no one's like. It's time. We just kind of have to figure it out. And so I, I think I kind of missed the memo on that one. I just kept doing what I thought I should be doing and it felt good to be, you know, achieve and support patients and do all that. But at the end of the day, like there's no space for me in my life and the things that made me a unique human, that made me a mom, that made me a, that made me, you know, I losing all of that. And that's really what hangs in the balance of. Decision is the risks and benefits. And for a long time, being a physician in a traditional way felt like it was really beneficial. But there came a tipping point, a series of tipping points where it just wasn't anymore. And I, I. And this is something that I do and I'm good at it and I love it, but it's not who I'm, there's so much more to me in this life, and I want space for that. That's what started this whole journey to today.

Speaker: 13:40

Yeah, and so, so you had this sort of like inner realization during that time, during that six weeks sabbatical, but then what did it look like to. To start living it out and to actually make the external adjustments in your life, like you were saying earlier, like there's what you say you value and then there's what's on your calendar. So how did you sort of start making that shift so that what's on your calendar really matched your values?

Speaker 2: 14:04

Yeah, I got it wrong a whole bunch of times. I mean, I did what, what seemed right? Right? Like I changed my schedule, I changed the number of days I worked, I changed my hours that I worked. I. Tried to, you know, find additional help at work. Like I did all the things. Not really wanting to fundamentally change the work I was doing. I was trying to make it work, right? There's this idea like that, you know, bloom where you're planted and I really tried to bloom. Like sometimes you just need a different garden and that was something that I wasn't really ready to admit. So I'm really glad I tried it and got it wrong a million times because I needed that information when it was finally time to take a big leap to say I've done it. There's nothing else I could have done to make this work. And so we say often in coaching, like you know, enough is a decision, not an amount. And there was no big moment. In fact, it was a tiny moment. I was in a, of course, unpaid after hours meeting talking about EMR and how to put in smoking cessation. Just, you know, mind numbing. We've all been in there and you know, they're trying to describe the new way to put in smoking cessation. We've had this conversation a thousand times and I literally said to myself. I can't do this anymore. And not that I can't,'cause of course I was doing it, but like I won't do this anymore. Like this is not what lights my soul on fire anymore and I could be dead in two years. Like I do not wanna be doing medicine like this. And so that's what started this thing of like, I've gotta find another way. And I was in the middle of the pandemic, which also had kind of shaken up us as people and shaken up healthcare and really given me time and space to. I been doing telemedicine well before, uh, the pandemic started, but for me it was this. Way to take care of patients in a meaningful way on my own terms. And so I just said, it's time. You know, I wanna find a way to take care of folks and take care of me at the same time. So that's what got me started thinking about opening my own practice and, you know, turned in my letter of resignation shortly after that smoking cessation meeting. And, um, you know, a year later, you know, stepped out on my own. So. It's been really incredibly powerful. And by that I don't mean easy like it was, it's been all the emotions. It's been terrifying. It's been uncertain. It's been financially, you know, you know, up and down. But it is absolutely life in the way that works for me. And it doesn't have to look like this for anyone else. I just know it looks like this for me because it suits what I value. So. It's been amazing.

Speaker: 16:34

Yeah. I, no, I love this and I love sort of like going through the, the play by play of like, okay, I know something has to change. Let me try to, you know, tweak all the little things to help me tolerate work more. I feel like that's, it's sort of like the toleration phase and, and it really is like, it's like you're trying to salvage something and Okay. During that phase. Um, looking back now, was there a part of you that knew that, wasn't it, was there a part of you that knew you had to make some bigger changes? I would love to just hear from like what you think. Looking back now,

Speaker 2: 17:05

I would say yes. And we live in this constant state of like fight or flight, right? Like we're always churn, always going, and it's hard to reach your parasympathetic intuitive problem solving creative space when you're living in this constant churn and burn. So I was there and so it was. Not impossible, but it was hard to even just give myself time and space to imagine what else was possible. To imagine what else it could be like. And so it felt very binary, like, I've gotta make this work or I'm gonna have to quit medicine. I didn't even, I couldn't even like imagine what the other possibilities were. And it was real grief to think about leaving, like I respect my partners that I worked with and I really like my patients that I was taking care of. Like people walked me through a of hard times and. I deeply cared about them and it felt like abandoning my practice and my patients to leave. And that was something I had to reconcile along the way. But the, the irony of COVID, because it grounded us. We had a period in our practice where we weren't gonna the office for two months. Me, as an introvert, I had all this time and space to myself to like sit and do telemedicine with for like an hour with patients if they needed it. It was really lovely and that's I think what finally got me. Settled enough, even though it was an uncertain, scary space. Think and imagine and wonder what was possible. And I don't know that I could have made the transition without that imagination and permission space because in the 60 plus hours I was working before that, like there was no, there was no room for that. Yeah, so intentionally creating time for wonder time for creativity. That's why like, you know, when we're in the shower, when we're walking a dog, like that's when these great ideas come up is because we have, we've settled, you know, our body is finally able to like dip into that parasympathetic space. So making that very intentional in my current life is, is part of my wellness. Yeah,

Speaker: 19:00

and this is so cool. I don't know if I've ever connected this before until you just said this, but it's almost like, like our intuition. Lives in our parasympathetic. Absolutely. Which makes sense. But I, I don't think I ever made that specific connection. And I knew it lived in the silence and in the space and stillness and in nature. But, but to also make that connection that like when you are I. Like when your nervous system is so upregulated and when you're in fight or flight, like downregulating, your nervous system is not just important for burnout, recovery, and you know, stress recovery and energy, but also for accessing your intuition. Absolutely.

Speaker 2: 19:38

Actually,

Speaker: 19:38

rest is

Speaker 2: 19:39

highly productive. Like if you feel stuck, you need to stop trying to do and just rest for a while. Allow your body to like get into that parasympathetic space.'cause that's when like play happens. That's when creativity, that's when intuition, that's when real solutions that you've not been able to think of when you're in do mode, your sympathetic mode. Mm-hmm. That's when they really appear. So the more I rest, actually the more productive I am. Who knew? Yeah.

Speaker: 20:04

Right. No, it's, uh, I totally believe that too. And that's what I'm starting to do now is is do like a scheduling sort of time blocking system. Yes. But do it in a way that is like, there's huge chunks of time for napping. There's like massage, like I do more self-care now that I time block than I did before because I, yeah. When I'm doing my calendar, I'm forcing myself to like schedule things out. So then I'm like texting a massage plate that I'm, you know, I'm like, okay, when's my rest gonna be? And when I see it. Outlined on there than I, than I do. I like literally have a time in my schedule called Nidra Nap, which is where I do yoga nidra and take a nap. And I was showing my, my thing on Instagram, my like time blocking. And I got so many questions about like, what's a nidra nap? And I was like, it's amazing. Everyone has to do it. That's so good.

Speaker 2: 20:53

Yes, so good. And I love that like what you're describing is like it's on purpose. I value myself enough to plan for this. I see the results, right? Like if we're so used to being in that frenetic churn, it feels lazy. It feels risky, it feels uncertain to say like, I'm just gonna quote, do nothing, when in fact it's not doing nothing at all. Like it's like telling the heart like, oh, you stupid diastole. Like, why can't you just stay in sly indefinitely? Like, we're not designed to do that. Like the only way you keep going is by resting. And so. Culturally in medicine, in America, et cetera, like we're just trained to push until we fall off the cliff and like we actually have this amazing moment in time where we. I tried it. Yes. That's how I know it doesn't work.

Speaker: 21:47

Yeah. No, and I'm the same way. It's like I feel like I actually had to go through it and try it. Yeah. And really live out the fact that it didn't work. Like people told me plenty of times that, oh, OBGYN's a really hard lifestyle. Style and like, are you sure you wanna do this? And like, I just don't listen. I'm the kind of person, I have been the kind of person maybe I can change going forward, but previously I've been the kind of person who learns things the hard way and I go through it myself and then it Yep. Raising your hand too. Yeah. And then it doesn't work. And then we learn a new way. So, so we were talking about your transition. Um, and how you, you're in that meeting about the smoking cessation and then you make the decision. How did you go through all of the, like the emotional processes to allow you to actually leave the practice and start your own telemedicine practice?'cause you mentioned grief, there's fear of uncertainty, there's like, how did you. Reconcile and deal with all of the emotions.

Speaker 2: 22:46

Yeah, thank you for asking that.'cause it was a really big emotional transition. So like I mentioned, I have scheduled support for emotional health. So I was meeting with my coach regularly. I was meeting with my therapist regularly at a circle of friends that I could be very candid with. I had. I sought advice from people who had done it before. Like, what do I not know? And some of the best advice I got was like, you are transforming and you can't expect everyone else to transform with you. So like expect that there's gonna be loss that you don't anticipate. And that for me, showed up with. Losing professional friends or circles of friends that maybe I had a certain dynamic in. And then, um, I transitioned. So there was that part. And then I also just gave myself time. Although contractually, I only needed to give 90 days, I gave nearly a year because I knew it would take time just to unwind, to practice that had been established for 14 years and I didn't wanna burn my colleagues. But for me, spontaneity sounds like a really good idea. It's like sounds pretty glamorous, but when I an Overthinker am being spontaneous, it usually is a way of emotionally muting. It's like I don't even wanna think or feel. I'm just gonna like do the thing and figure it out on the back end. And so I knew that about myself to say, I can't just turn in 90 days. I need to give myself time and space to do it, and I'm glad I did because I was absolutely exhausted when I finally finished on that last day. Not physically, not mentally. I was ready to let the practice go. I was emotionally depleted from the farewells, from the accolades, from all the things. And so I'm glad I had the support and I needed it. And I thought I was gonna take six weeks off because, you know, God forbid I take more than six weeks off. Um, between that and my new practice and within the first two days of that six weeks, I was like, this is absolutely not gonna be enough time. So I intentionally extended that. So I had a three month window and then did a slow onboard as I started the new practice, like literally two hours a day of work. Like that's all I can manage right now. And frankly that comes from a place of privilege. I planned financially for this transition, so I was able to kind of myself in that way, but I'm glad that I also planned in that capacity so that I didn't feel the pressure to start working before I.

Speaker: 24:57

That sounds incredible. I like, I'm drooling right now about the idea of three months fully off, and that's one thing I'm working on setting up my business for the coming years is to be able to take extended time off like that. Yeah. So I can go do hikes and off the grid travel and Yeah. You know, just yoga retreats and things like that. Uh, what did you do during that three months like. Not that you have to, you know, tell me any, like, it could be literally that you slept and napped and that would be amazing too. I just like literally wondering how you spent those three nights.

Speaker 2: 25:25

Yeah. You know, no, this was like, you know, I left my practice in the spring of 22, so, you know, we were in this like. Pent up desire to travel.'cause no one had been traveling much during, or at least I had not been traveling during COVID. So I did a ton of travel actually. Yeah, I went to see friends. I went to a conference, I visited family. I did a hiking trip with a dear friend. A friend say, Hey, do you wanna go on another hiking trip? And I was like, sure. She was like, okay, great. How about overseas? And I was like, sure. She's like. Great. We're leaving in three weeks, and so as I just mentioned, I'm not such a spontaneous person, but I did it and it was amazing because I could, right? So I did fun stuff. I allowed myself the fun and pleasure, but I was most worried about getting through the three months and then telling myself, you did nothing. I knew this about myself that I would feel, feel like I squandered this time and had nothing to show for it. So I literally kept a list. Of all the beautiful moments that I would wanna pick out of a day. And after three months I had pages and pages of things that were like, not remarkable, but they're the blanket that makes our lives really beautiful. Like sat and read a book on the porch, like watched a TV show with my son and didn't think about work. Like it was all those tiny moments that make a life worth living. Right? And at the end I had this enormous list of just. Beauty that I'd experienced. It was really amazing. And then lastly, I read a lot, which, you know, I've read every self-help book that can be there. But I read for fun. Did you know that's a thing you can read for fun, not medical journalist, whatever. And it's funny, my husband and I have been together for 23 years. He said to me, he was like, I didn't know you liked to read. Like I had no idea that I liked to read books for fun. So, you know, since then I've read 40 books since April, so it's like more books than I probably read in a decade. But anyway, there's a whole bunch of quote, nothing that is absolutely everything because it allowed me to rest.

Speaker: 27:17

I love that. I love that. Like when the nothing actually is everything. And I love that you kept the, the list of the, the beautiful things you experienced as a way to show yourself like this three months was not a waste because it's, it is easy to sort of look back and be like, what did I accomplish? And to, to measure the success of a period of time by like these types of benchmark metrics or accomplishments that we can write down, but it's like joy and rest. Like those are just as much of. Accomplishments, quote unquote, as anything else. And like learning how to do that and learning things about yourself that you like reading. Yeah. And, and just like experiencing life.

Speaker 2: 27:56

Yeah. I mean, the metrics are often handed to us, right? Like grades in school or RVU in our professional life, or dollars produced, right? And like. I produced none of those things. And if I was looking for that external validation, I knew I would be like sorely disappointed. And so to pre-decide, like this is what I consider a success, noticing the little things like I got all A's right and, and I think that's really the message moving forward for me, certainly. But for all of us, like life is messy. There's gonna be ups and downs. Like being happy a hundred percent of the time is actually not normal or realistic to. So for us to pre-decide like, what do I want this year to look like and feel like, like how will I know that I've quote, succeeded? Like maybe successes, taking everything off your plate. Maybe successes, you know, pausing and noticing the little things. Maybe it's rekindling relationships, but it doesn't have to be the metrics that the world expects of us. In fact, it's probably better if it's not. So

Speaker: 28:59

yes and no. And I think that's such a powerful part is like you get to decide your metrics. That's one thing I've like worked on with clients is, you know, creating their own values and then creating metrics through which they know that they're meeting those values. Yeah. It's like,

Speaker 2: 29:13

yeah.

Speaker: 29:13

And that can be such a powerful thing.'cause we like to check boxes. Yeah. But why don't you check your own boxes instead of the boxes someone else gave you.

Speaker 2: 29:22

Totally. Can I ask you like, what are your. What are your metrics of success?

Speaker: 29:27

Oh, for me, um, I love spaciousness is one of my values. And so if I have like a spacious morning that, and, and because I'm on a different time zone now, so for me, I work in my evenings, um, and I'm actually really gotten used to that and really love that because it's like. I do my morning stuff, I have my spaciousness in the morning, and then I get to do my work in the evening. So for me, one of my sort of signs of like a luxury life is I get to lay in bed and like watch a short Netflix episode and drink coffee in the morning. And that's like my favorite thing. Yeah,

Speaker 2: 30:04

right. Like and it didn't cost you any money. I mean, maybe whatever it costs for wifi, right. But like it doesn't have to be a big thing. It's usually those little things that are everything.

Speaker: 30:14

And yeah, to me, like luxury of time is the biggest thing that I didn't have in medicine, and so now it's, I just savor those moments where you feel like you don't have to be doing anything, and it's like, I can watch a community episode this morning while drinking coffee. Like That's right. It's silly. It's not for my personal growth, it's not for anything. I just get to chill and enjoy.

Speaker 2: 30:36

Personal pleasure is a good enough reason, right. Earn our pleasure. Like you have to work first and play later, and all those things, and so you know, you can just have pleasure. You exist, and that's okay.

Speaker: 30:50

Yes. So tell us about, so we talked about your transition going into telemedicine, you know, starting really slow with the onboarding and now that you're really in the thick of it, I guess we would say, now that you're like really, you know, you're in your, your day-to-day telemedicine lifestyle, what is like a day in the life like for you? How does it compare to what life was like previously?

Speaker 2: 31:13

So we talked a little bit about self abandonment earlier, just the necessary. Uh, compartmentalization that we have in medicine. Like, I know I have to pee, but I've got three more patients. Let me just get through that. Or, I know I'm having a really bad day, but I've gotta have this conversation with a patient and put my own needs on the on right. And so my life really felt like that before I left. Right? I'd wake up at five in the morning to start working. I'd work all day. I'd deal with the kids and I work in the evenings. And some of that work was stuff that I really loved. You know, I coach and you know, I'd see patients, but there just wasn't space. And turns out. I can't live five hours of sleep. I tried for, well, a, um, but turns my body about seven, eight hours. And then I work from nine to two and whatever shows up in that window shows up. So whether it's a coaching client, whether it's a patient at meetings, podcast recordings, for example, and then I take care of my children and then I take care of perhaps in the emails in the evening. But that's really it. The thing I wanted to solve for as I was leaving was the ability to just close my computer and not ruminate about what was going on in there. Not have this like overwhelming burden of work that I was trying to keep up with seven days a week. And so it's interesting. I was saying to my therapist recently, like, oh, it's just like great. I'm like, not even working. She's like, are you not coaching? I was like, yeah, no, I'm coaching. She was like, are you not seeing patients? I was like, no. I'm seeing patients like, how many days a week are you working? And I. Probably six. It's like, but how do you say that's not working? And I realized like my equation was work equals suffering. Work equals exhaustion. And so even though I'm currently working six days a week, like I don't feel the need for a vacation like this is a sustainable pace. I feel excited, dare I say, to show up at work on Monday because it's at a pace that is manageable. And there's space for me to like exercise, drink hot coffee, connect with friends, right? Take the dog for a walk at lunch. And so it, it is a sustainable pace. And so to build a practice where I could, you know, highlight a core value, which is generosity, to like pay that forward, to take care of people at discounted rates, or for free to be able to give back in a way that I find really meaningful. It really helped me align the things that I value, generosity, creativity, connection, and lifelong learning into a life that I don't wanna run away from at all times. So that's what it's like.

Speaker: 33:50

I love that. And, and when you were describing it, what came to me is that like each day. Is a full life. Yes,

Speaker 2: 33:58

that's exactly right. It's how we spend our days is how we spend our lives like that. Like I didn't, that's the piece that I could not reconcile. Like I would absolutely regret working 12 hour days indefinitely, even if it's purposeful work, even if I like the people I work with, even if I love my patients. Like that's not how I wanted to reflect on my life. And so the things that I really value are present in every day now. Just me.

Speaker: 34:21

Yes. And it. And it's like you're not holding your breath every day and waiting for anything to be over. It's like you just get to be in the days. Yes. It's wild. You can be like. Content. How even in the mess did you, did you, um, do anything specific to allow yourself to, when you close your laptop, you're not thinking about work? Did you have to, like, have any processes to be able to do that or that just sort of naturally happened when you created a schedule that worked for you? What was that like?

Speaker 2: 34:55

It's several things, so I'll be candid. You know, I, I worked in primary care, outpatient, traditional medicine for the, until my career until this year. And there's just a lot of stuff that ends up in your lap as a primary care physician. You know, there's portal messages, labs, documents, calls, et cetera. And I've always, this is confession time. Kind of like envied our specialist who could simply say like, oh, just follow up. You have primary care physician about that. I'm just gonna take care of this one little area of your life. They're highly trained to do that, and I don't begrudge them, but that's a little bit what my life feels like now in that I have a small practice that the volume is simply smaller, so there's just not as much to take care of. I do a lot of eating disorder work, so I serve in a consulting role like a lot of folks still have a primary care physician, and so frankly, I get to be an intern without all the vol. Administrative work. So there is an inherent benefit to me in this practice. I had hired a virtual assistant as I left my practice UN until recently because I wanted to practice offloading that and realizing that the world was not gonna fall apart. And so that was also really helpful because I knew that there would be a catch safe in case there was like a red message that came in. So I built some scaffolding around that. But once I knew that those two things were okay, actually I. I just recognize that that is it's, and also. I don't take calls. So if you have an emergency in the middle of the night, like, please seek emergency care. And so putting some buffers around me so that I could look forward to work and not feel like it was a 24 hour a day job helped me facilitate that.

Speaker: 36:35

Yeah, I love that. No, it just sounds like some of the boundaries that you put in place and then just sort of the nature of your work in telemedicine allows you to just have. Freedom and that head space away because I know that's one thing a lot of my clients talk about desiring is like, I just wanna leave my work at work. Right. And sometimes when you're working from home, that can almost like backfire in a sense. And it can almost be like, yes, I'm working from home now, but that means I'm always working. And so yeah. I think it's cool to just really talk about like the nitty gritty of like how you did that. And it sounds, it happened fairly naturally once you transitioned to the type of work that you were doing.

Speaker 2: 37:13

The type of work made a big difference. But the bigger internal piece was me, like I'd been coming from this like fight or flight response. So part of the medication of that anxiety, frankly, was work. It's like I worried about work, so I worked more, which generated more work, which generated more anxiety and so the more calm and rested that I've become, like I realized like a lot of that anxiety about the work that's just generated by me. Like, yeah, there's true emergencies in what we do and like I can handle those, but I don't need to perseverate over the work like. I close eight hours. Yeah, the more rested I become, the more trusting I become that nothing's going wrong if I'm not checking my email 24 hours a day.

Speaker: 37:55

Okay. So that's really powerful too. So then that's like the inner work of learning to regulate your nervous system and Yes, and just rest, even when you feel like I can't rest'cause it's not all done. But then sort of developing that habit and learning that you can, and then you do it and then the world doesn't end, and then building that into every day.

Speaker 2: 38:15

And having realistic expectations. I mean, I recognize it may sound privilege to not be able to take call, but there's an article that came out this summer looking at the average number of hours. A primary care physician needs to work every day to do all the things that are expected of us. Good news, it's only 26.7 hours per day of work that we need to do. And, and for me it was so validating because I was like. Oh, like what we're trying to do is literally not possible. Like I've tried, you know, I've gotten the burnout prize for that. Like it is not possible. So if it is not possible, I get to pre-decide. This is all I'm able to do. Again, enough is a decision, like this is what I'm able to do. And that's it. And for the patients who want 24 hour daycare, that's great. There's other doctors who can do that for them. But if they want me, like, this is what I'm able to offer you amazing care, but in a way that's not gonna take me in the undertow. And so I don't know, like some, I think that's just it, like having really realistic expectations.'cause the perfectionism for me just made me think I could do it all. And I never mm-hmm. Preci what was actually humanly possible. I was trying to be super human.

Speaker: 39:21

Yeah, I think that is so validating. I love that you mentioned that there's, I love that there was a study around it and I love that you told me about it because that's something I'll tell my clients as well that like, it is physically, and I think we all know this on some level, that it's physically impossible to do all the things, but like we almost wanna just prove that we are the ones who can, like we're the super special superhuman ones who can do all the things.

Speaker 2: 39:46

Yeah. And we do. I mean, I could look at my own life as like, well, you know, I used. Literally when I had my first child, I had her eight, uh, 16 days after I finished residency. So I literally thought, well, like I've been awake 30 hours at a time, taking care of critically ill humans. Like, how hard can a baby be, right? Like now, 14 years later, I'm like, oh my God, I was such an idiot. But like, I truly believed it couldn't be that hard. What? Just being awake for an hour, no big deal. I used to be away for 30 hours. And so we look at our dysfunctional lives as proof that we can and should continue to have that dysfunction and, and sometimes we just need to reality check that. That's,

Speaker: 40:22

yeah, I love that. And so, okay, so I feel like we could talk all day about all the different things, and there's still so much that we need to cover in future episodes going forward, so we'll definitely have to have you come back on. Um, but what advice would you give somebody, and obviously you've given so much advice throughout, but if you could distill it down. To just like a few nuggets, what advice would you give to someone who is, you know, feeling that burnout, feeling that exhaustion, but they just don't know what to do about it or don't know where to start?

Speaker 2: 40:52

First step is to really just get quiet, which will be very uncomfortable, and to say like, what is it that I need? And to start developing that, a trophic muscle of listening to yourself and, and the needs can be really small. Like, I am thirsty. Okay, I'm gonna go drink some water. Or like, I need help because I'm overwhelmed. Okay, go fix that problem. And the more we start to really strengthen the language around our needs, articulating our needs, and then being able to make authentic changes around that, the easier it gets. It doesn't mean that it's. Simple or painless. It just means like our life matters. And if you are like me who had done everything by the books and had the gold stars to prove it and couldn't figure out why I was so miserable, it's because I had made a habit of abandoning my own needs and not even listening. And so it took relearning my inter inner compass, relearning how to listen to myself to be able to even know what I wanted because. In fact, out there was really scary. I was more comfortable with like the misery that I knew within my life, but to be able to say, I am worthy. This is more to my life than just this. And to be able to take just one next tiny step. So I guess for your listeners, for their advice, like what is that next step? Is it. Just saying no to the social obligation this weekend that you don't wanna go to. Is it sending an email to a mentor and saying, I just wanna talk through some things, like what's next for me? Is it I'm gonna make a habit of like going to bed because I deserve rest? Like, I don't know what the thing is, but like you do whatever is on your mind right now and that's the thing. And then just take that next step and then see what opens up for you, and then take the next step and see what opens. It'll be somewhere. Yeah.

Speaker: 42:45

I love that. And it's, it's literally like learning a language, like learning to listen to your own needs and your own body and your own what, like your inner voice? I call it my intuition. Mm-hmm. Like learning to check in with that. Mm-hmm. It's a whole new process and it's a whole foreign situation, so you're gonna feel confused at first. Like I remember being like, I don't know if this is my intuition or what this is, but this is something I'm feeling. Let me try to act on it. Yeah. And so it's like there's a, you know, it's a disorienting process initially, but it's so worth trying to figure out how your body communicates to you, what your inner compass is saying, like what your needs are. I think it's so important.

Speaker 2: 43:24

We're intentionally taught to ignore that. So the more you start to relearn that skill that we are born with, yes, coming back home to yourself, um, the better and better life gets. It's really amazing.

Speaker: 43:36

How does your inner compass communicate to you?

Speaker 2: 43:39

Hmm. So I know, um, when she's speaking, because I have this visceral sensation. It's not like some woo ghost thing. It's like when I close my eyes and get quiet, I feel that there's this like solid anchoring sensation in my torso, like in the core of me. It's like, mm-hmm. This is true. Like that's what it feels like if if true head of visceral sensation, that's what that would feel like. It doesn't mean, oh, this is gonna be hard or this is gonna be scary. It just means like, yep, that's right. It's like truth embodied in my body. And when I don't have that sensation and I feel a little. The solution is get quiet, do something that upregulates my parasympathetics, go outside, do some exercise, do some yoga, whatever. Like allow myself to settle and then check back in.'cause the answer will always be there.

Speaker: 44:34

That's so powerful. Thank you for describing that.

Speaker 2: 44:35

Thank you so much for having me. It's really a gift and it's beautiful to watch you do what you're so inspired to do and and have that ripple effect into our community. Thank you for all of it.