I Couldn't Run a Mile in Residency. #477

In this episode, we share our honest struggle with fitness as first-generation doctors - from not being able to run a mile in residency to building a consistent 5-6 day per week workout habit using the Atomic Habits framework.

You'll hear:

• Why Nii couldn't run a mile by year 3 of surgery residency (and the McDonald's breakfast ritual)
• The Atomic Habits identity shift: "I am an athlete"
• How to make working out frictionless (clothes laid out, space ready, zero decisions)
• Why working out is protection against burnout, not just exercise
• How stress, imposter syndrome, and work follow you home (and what to do about it)
• The 6-step system to build fitness consistency
• Renee's honest take: "I don't love working out" (and why that's okay)

If you're the first doctor in your family trying to build fitness habits and protect yourself from burnout without the boundary-setting model your colleagues inherited, this is your community.

Find us on YouTube: https://www.youtube.com/@docsoutsidetheboxpodcast

Mentioned in this episode:

• Atomic Habits by James Clear
• T25 Workout Program
• Beachbody.com

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Transcript

Cold Open: Fitness Reality Check

SPEAKER_02 0:00

So by the 30 year of my general surgery residency at Morehouse, I tried to get back in shape. And I started off by trying to run a mile. And I quickly realized that I may have been in over my head because trying to run a mile, I almost threw up. And what I realized is that all of those 24-hour shifts where I developed that retro where at the end of my 24-hour shift I would go and get McDonald's. Yeah, that was catching up to me. So I was a general surgery resident. You know, I'm a doctor. I know that, you know, you need sleep. I know that you have to eat well. Um, but I knew what to do, but I didn't know necessarily how to do it. Those are two separate things. Knowing what to do and how to do it are two separate things. So today we're answering the question that every doctor asks, but no one talks about honestly, which is how do you actually make time for fitness when medicine takes everything from you? And spoiler alert, it took me into my mid-40s until I figured it out. If you're new here, welcome back to Docs Outside the Box. I'm Ni and Dr. Renee. So listen, we're uh first generation doctors. I'm Ganyin. Hey, Shen. Ai Booboo. So we we didn't have the doctor parents to uh answer the questions that we had when we were going through medical school and residency. Um so we're creating the podcast that we wish we had. Yeah.

SPEAKER_00 1:34

I mean, you said it all. You want me to step in there and be like, yeah?

A Reddit Question About Calorie Burn

Residency Sacrifices And The Fast-Food Ritual

SPEAKER_02 1:37

No, no, you good. You good. Okay. So today's question actually comes from Reddit. I'm gonna go ahead and read it. It says, I'm a new attending, but between work and studying for boards, things can get hectic. Wondering if you all have tips for working exercise into your routine. I try to hit the gym and burn 600 calories each time. That's really hard, by the way. But it's hard to do it more than three to four times a week. And lifting and all are important, but I worry they don't burn as many calories as elliptical, treadmill. Basically, what's the most time-efficient way to burn calories? And do you guys prefer AM or PM workouts? So there's a lot to unpack in there. And I could tell you right now, guys, I work out very consistently. I'm nowhere near 600 calories even now. So that's that's a lot. That's a lot. And I didn't figure a lot of this out until my mid-40s. So if you're listening to this, wondering, like, well, what's the answer to this? Or you feel like you're struggling by yourself, I just want you to know that you are not alone. Um, I think, Renee, you can even talk about that also. Absolutely. Right? Absolutely. So I just want to take, let's start by before we even answer this question, I just want to say, like, I gotta take you guys back to my surgery residency and even a little bit before that. So just so y'all know, I was at a Division I school. Um, I ran track. I also did cross country. I was very physically fit um by the time I left residence, or excuse me, by the time I left college. And then I took two years off, and a lot of those habits really started to get really started to fall by the wayside. But I was still young enough that by the time I got into medical school, physically you couldn't tell that I was out of shape, but I was out of shape. I was out of shape, you know. So I would say if you fast forward to residency, I think if I go back and I look back at things, was I too busy to work out? I would have to say no. I think that there was time for me to work out. Um, I was very busy, but there were snippets where I could sneak working out in. It's just that to be really honest with you all, I was really focused on being the best resident that I could be. And I physically and mentally made a decision in my mind that, hey, like, in order to be the best resident that I'm gonna be, that there's gonna be some sacrifices. For me, that sacrifice was physical fitness. And I became really unbalanced, not just physically, but in other aspects of my life, which you can attest to. You keeping your mouth shut, huh? I ain't saying nothing. Yo, I I regret not eating better. Um, I regret Popeyes. I regret not making better. Yo, that Popeye's. Yo, it came to a point where I knew the secrets of if you got Popeye's chicken, don't put it in a plastic bag. Because by the time you take it home, being in a plastic bag and a cardboard, it would make the cardboard soggy, which would make the chicken not as crispy by the time you got home. What? Yes, yes, there's a science. Oh God. There's a science. Oh God. Yeah. So, like, there's a lot of decisions that I look back on. I regret not making better decisions on my exercise. Um, but as you know, sometimes second year and your third year, particularly in general surgery, y'all may know what I'm talking about. Your second year and third year are probably one of the toughest years because that's when you're in the ICU. I don't know if it if it's like that now, but I I think m a lot of general surgery programs really focus on your first years. You're kind of doing a lot of scut work, you're learning basic surgical techniques, but your second year and possibly even your third year, you're in the ICU, taking care of the sickest of sickest patients. For me, where I was at, it was a lot of 24-hour call. And at the end of my 24-hour call, I had this ritual. I would just go to McDonald's afterwards and fall asleep.

SPEAKER_00 5:31

There you go.

SPEAKER_02 5:32

That was it. Every single time.

SPEAKER_00 5:36

Well, man.

SPEAKER_02 5:40

So And just for the record, I knew better.

SPEAKER_00 5:43

No, I mean, yeah. I mean, the the saying is if you know better, you do better, but that's not always true. So you think that because I remember you being in the ICU, and I I remember you being Q2 in the ICU. That that was like the the mantra for that year of your second year, especially. But you think you would have had time to exercise?

SPEAKER_02 6:04

Yes, I think there was time for me to exercise. As a matter of fact, I mean, I I did start exercising, right? So, you know, like I I tried to, there were times where I would come home, I would try to go for a run, and I couldn't do it because I was out of shape. Right. So there's time, there's 30 minutes before I want to go take a nap or go sleep or whatever I need to do. There's time to do it.

SPEAKER_01 6:25

Yeah.

SPEAKER_02 6:26

I just didn't want to do it. Yeah, right. Yeah. So I I think when I finally realized that I started getting like a little gut, a push. Pooch, a little pooch in my butt. Yeah. Yeah. In my early 30s. It was bad. It was bad. That's dad were you. That's when, well, you got some spleening to do. It wasn't my finest moment. I'll leave it to y'all like that, man. So, and that's when I started doing P90X.

SPEAKER_00 6:53

Yes, I remember that.

SPEAKER_02 6:55

That was the craze. That was big back then.

SPEAKER_00 6:57

Yeah, I remember that.

SPEAKER_02 6:58

This is mid to late 2000s. So P90X, that's a 90-day exercise. You're mad DVDs, you're doing a different exercise every day. Six, six days out of the week, you're hitting it hard.

SPEAKER_00 7:09

Yeah, I tried that at lasting three days.

SPEAKER_02 7:13

Yeah, it's it's tough. But nobody works out like that anymore because the workouts are really tough. Yeah. Nobody does anymore. So now, if you go to most websites, if you go to most working out places, it's 30 minutes to 45 minutes, but 90 minutes every day, the time constraints, I think we're way more efficient with that now. But you know, for me, I I would look in the mirror. I wasn't healthy. I didn't like what I saw. I do P90X and then I wouldn't finish it and I'd stop. Or I did P90X and I didn't change my diet, which is what you saw. I remember would you you want to tell that quick story?

SPEAKER_00 7:46

Yo, you were doing P90X. You told me you were doing P90X, and then I ended up seeing I we ended up um going to New Orleans for a conference, and I hadn't seen you in like months. And when I saw you, your neck, yo, your neck was the size of the rock. And I was like, what the hell is going on?

SPEAKER_02 8:08

P90X and Whoppers.

SPEAKER_00 8:09

Oh my God. And so I didn't say anything to you, but you also were not in a very good mood during that time. It's probably because you were Q2 and ICU. Um, but you went to the bathroom and I started looking through your stuff because I was like, yo, is he on steroids?

SPEAKER_02 8:25

Yeah.

SPEAKER_00 8:26

I really thought you might be on steroids.

SPEAKER_02 8:28

Yeah, you look in the mirror. If I going back, I look in the mirror, the mirror didn't, yeah. I got so P90X got me, like it helped me bulk up. Yeah, you bulked. I bulked up, but my eating habits didn't change. Yeah. So as a result, like I was like trying to squeeze as much out of French fries and whoppers and the hell out of it. That was my pattern for years. Yeah. Start a program, see some progress, life gets busy, stop, start. You know, the I be I think people listening know what I'm talking about, right? And I think for me, as someone who was running and being athletic and being competitive at the highest level, to an extent, that's the part that made things worse for me. Because then I would be disappointed. You don't have the motivation, you don't have the will to make it happen, and you deserve this type of body. That was what would frustrate me. So that's residency. Behaviors didn't change, guys. Fast forward now. I'm in attending, I'm working locums, I'm even working at home, right? When I was employed, and I'm living in hotels, uh, which means that listen, when I get home from work, there's really no supermarket, there's no place to cook. So, you know, hint hint, I'm eating hotel food, I'm eating on the road, you know, I'm eating a steak, french fries, and wings. That's dinner. Every day, rinse, wash, and repeat.

SPEAKER_00 9:51

Sounds healthy.

SPEAKER_02 9:52

Yeah. Yeah. So, like, you know, the person at on Reddit who's actually asking that question about working out and trying to do 600 calories a day, they're actually ahead of where I was.

SPEAKER_01 10:02

Yeah.

SPEAKER_02 10:02

Yeah. That was way behind where you were at, whoever was asking that question. You know, because I I would work out for one day or maybe even three or four days, and then that's it. Any type of stress, yeah, anything that comes up, then that's it. I'm done for like half a year.

SPEAKER_01 10:17

So yeah.

SPEAKER_02 10:18

And I just, so that's I want people to really understand that I'm not sitting here saying like I have all the answers to make sure that, you know, you burn 600 calories a day, or that, you know, I know how to get you off the feet, because I'm sitting here letting you know that it took me until my mid-40s to figure it out. Right. And um, I think this person is obviously in residency. And the fact that they're at that point where they're being being as consistent as worrying about how many calories they're burning, kudos to you.

SPEAKER_00 10:46

But I think the majority of people are probably in my they're just like, how can I take a walk?

unknown 10:53

Damn.

SPEAKER_02 10:54

I mean, that's for me, that's two decades.

SPEAKER_00 10:57

Yes.

SPEAKER_02 10:57

That's two decades. Because we're talking 2002, I started med school. And it wasn't until what three or four years ago that I really changed. Yeah. And what is that change, Dr. Renee? Atomic habits. Damn right. Did I? Damn right, everybody. Atomic habits. Yes, yes. Atomic Habits by James Clear. Alfred, put that picture up there somehow. Listen, um, I read this book, everything clicked. Um, this book, in essence, I got my notes here. It teaches you that you don't rise to the level of your goals, you fall to the level of your systems.

SPEAKER_00 11:35

Correct.

Atomic Habits And Identity-Based Training

SPEAKER_02 11:35

So basically, it's like, listen, damned that with motivation, damned at with all the goal setting that you want to do. When life gets rough, when you get busy, when things fall apart, if you don't have a system in place, it all goes to hell. It all goes to hell. And that was my big issue after after reading the book was well, now I get back, get to look back on the retrospective scope and be like, all right, well, me making myself feel bad because I didn't have the motivation or there's this guilt. Like I was like, well, of course I was gonna fail because I didn't really have a system.

SPEAKER_00 12:07

Yeah, you you didn't have a plan, so you planned to fail.

SPEAKER_02 12:11

Yeah, yeah. So it I think the big breakthrough for me was I and I'm not gonna talk all about the book because I think you guys could read the book, but the most important thing is just changing your behavior based off of your identity, right? And he calls that identity-based habits, right? And instead of saying, like, I want to work out, right? That's what we all say. I get home from 24-hour call, I want to go work out, I want to go bust out 600 calories a day. How do I do that? My mindset changed to I'm an athlete, and therefore I need to do the things that athletes do. So it's a shift from like an outcome-based goal that I want to work out to more of an identity-based goal or identity-based habit. Do the things that athletes do. Right. And then you'll get you'll get the results. Right. So for me, that that was a big, a big shift. Um, everything followed, you know, and I think for me, starting off very small, I started off with T25, me and Sean T, we had a very strong relationship. But 25 minutes a day, six weeks, six days out of the week, that's how I started. Very simple workouts. The other thing too is I had to realize that I just wasn't in shape. So going out and running a mile wasn't gonna work out. I was in really bad shape. So 25 minutes a day, I knew that I could guarantee, or at least I knew that I can do that.

SPEAKER_01 13:44

Right.

SPEAKER_02 13:44

You know, and no matter what, I committed to it. If we went to New York, if we went to Jersey, if I went on locums, I knew that I could do 25 minutes a day. Even when we went to Ghana for medical missions trip, I was just gonna keep doing it 25 minutes a day, you know. And the key thing that took the pressure off of me was well, I wasn't happy with how I looked, but I took that out of the equation. So I didn't want to, I didn't care about how I looked. I just wanted to build a habit of every day knowing that for 25 minutes I was gonna do something.

SPEAKER_00 14:18

Right.

SPEAKER_02 14:18

So that's what athletes do.

SPEAKER_00 14:22

Yeah, you did it too.

SPEAKER_02 14:23

Did a good job. Yeah, yeah. I I think looking, so I did that what? I did that what, seven months or no, I did actually did it for like a year.

SPEAKER_00 14:31

Yeah, I was gonna say you did that for like a year because you repeated it over and over.

SPEAKER_02 14:35

Yeah. I did it, I did T25. T25 is a 60-day plan. And I just I had a calendar and I would just scratch it off, X it off, just to show that I was had this chain of um of doing the the exercises. But I think for me, you know, there were days where I felt great, there were days where I felt horrible, there are days where I felt like I didn't want to do it. But what I started to realize is is that this started to become very automatic. And, you know, the best way I could describe it is I knew I had to brush my teeth every day, but I also knew that I needed to work out.

SPEAKER_01 15:10

Right.

SPEAKER_02 15:11

So like that motivation was, I didn't have to motivate myself anymore. It was just, hey, like this is what happens. This is what you do. Yeah.

SPEAKER_00 15:18

It's kind of like when you get up and go to school, right? Like, yeah, you're motivated to become a doctor and things like that, but you know, like, well, I have to wake up and I have to, you know, go to lecture, for example, right? So you you get up and you go, right? You don't necessarily just go because you're motivated, you go because there's a system in place, and that system is that lectures happen at this time, and so in order for you to participate, you have to be there at that time. 100% agree with you.

SPEAKER_02 15:48

100% agree with you. The other thing that I think so besides the identity-based habits was making things frictionless. You remember?

SPEAKER_00 16:02

So I worked out especially in residency.

Remove Friction With Simple Setup

SPEAKER_02 16:05

Yeah, I worked out in my basement, I had a TV there, I had on that TV there was a USB drive that had all the different days of P90X in there. So now I have a place that I can work out. The place that I was working out, it was clean, and then like not too far off, I had a little hook system on the walls where all my workout clothes was, my shoes were there, and then in our basement we have a refrigerator. The water was cool. So, you know, it was a frictionless environment. It was very easy to go on exercise there, and then it made it attractive by having water. So I didn't have to go to like my bedroom to get my shorts just to go to the front of the house to get my sneakers. Like it, I was able to remove the obstacles that would make me fail, so to speak. And, you know, whether that's getting my clothes the night before or just hanging my clothes on that hook, it just became so smooth, and there's really no excuse not to work out. So the only thing that I I um I struggled with, but I don't even up to this day, I don't care, is I always wanted to get up at five in the morning and exercise. That shit ain't happening. I can't, I still can't do that.

SPEAKER_00 17:17

I think after a while, it doesn't actually matter what time, right? You just you just do it. Isn't that the most important thing?

SPEAKER_02 17:27

Yeah. Yeah. I mean, I think the you know the time part is trying to the time part is trying to be perfect, basically. I think it's another way for me to trip up. That's not the most important thing. I think now we're close.

SPEAKER_00 17:38

I think that would create a like a a friction. Yes. Right? Well, I didn't I didn't make it at five, so therefore I can't work out.

SPEAKER_02 17:47

Right, because now the kids are up, I gotta go to work, and the only time that I'm supposed to work out is between five and seven. So that's another excuse. I agree with you there. I agree with you there. So um I eventually, guys, I ended up graduating to harder programs. You remember? I went to the one that you like, that guy that you like.

SPEAKER_00 18:04

Which one?

SPEAKER_02 18:05

The work.

SPEAKER_00 18:06

I don't like that guy. The one who kept cursing? I'm like, my kids are in here. You sitting there in my living room, and this guy's cussing like crazy. She didn't like them. I did not like that.

SPEAKER_02 18:17

She liked them. Oh, he keeps why don't you keep doing that promo?

SPEAKER_00 18:19

I was like, it's a workout. Like, why are you cursing on the thing? I'm like, it's just a workout. Lift the barbell. You don't have to be like lift the effing barbell. Like, for what? I don't get it. And we know, okay, you're cool. It's fine. But why?

SPEAKER_02 18:34

Anyway. Well, I I so that was, but remember, that was the point. Once I switched to a different program, the I needed higher weights. Remember? All I had was weights up to like 15 pounds. And you finally were like, You're you've been so consistent. Why don't you get something heavier? And I'm like, Well, you think so? And at this point, it's been over a year.

SPEAKER_01 18:51

Yeah.

SPEAKER_02 18:52

So once I was very consistent, then I was like, okay, I can afford to buy, or excuse me, I have set the behavior enough to say it's time to get some additional equipment. Yeah. I know that I'm not gonna just leave it there. So that was another thing, too, is as we kept going and as I kept being more consistent, the programs were changing. They were more, they were more rigorous, I'd have to say. And then Renee was like, Yeah, like you can get a heavier dumbbell set. So I got up to like 80 adjustable set. That was a pretty penny, though. It was like$800. 80 pounds. Yeah, it was. Dang. It was cheaper. If I had known that, I wouldn't have told you that. Oh, please. It's cheaper than getting individual sets. But the key thing is I wasn't tracking calories at that time.

SPEAKER_01 19:39

Right.

SPEAKER_02 19:39

That's what I want people to really focus on.

SPEAKER_01 19:42

Yeah.

SPEAKER_02 19:42

Is that, you know, the person is worried, like the person who's writing to us, they're worried about calories, they're worried about the most time-efficient way. And I get it, right? Because, you know, like you want to be as productive as possible. You want to be, um, you want to be able to use your time as efficiently as possible. But, you know, what if you don't hit 600 calories?

SPEAKER_00 20:03

Right.

Why 600 Calories Misses The Point

SPEAKER_02 20:03

Does that mean the workout doesn't count? Which goes back to what you're saying. If I didn't wake up at five o'clock to do the workout, does that mean that I just don't work out? Right. So I think for you who's out there who's writing about 600 calories, I think you need to forget that. Because 600 calories is a lot. And I'm gonna tell you something right now. Like I run, there are days when I run like five miles and then I'll come in and do like a leg workout, and I'm maybe at 600 at that point. Maybe. So I think, look, I just think that you have to figure out well, what's the point of hitting 600 calories? What why do you want to hit 600 calories?

SPEAKER_00 20:38

That's that's my question is okay, why is the number 600 so important? Why not 500? Why not 300? Why not a thousand? Why not like why 600 um is the number? What is that going to accomplish for you specifically, except to be able to say, I burned 600 calories?

SPEAKER_02 20:58

Yeah. I I think that's the key, you know. And I will say this I'm at a point now where I've shifted my habits to identity-based, I've made things frictionless. I'm not too worried about calories. I think the thing for me right now is working out is basically therapy for me. And the reason why I consider it therapy is during that time, like I'm not taking phone calls. Even if the hospital calls me, I'm not working out during hospital hours anyway.

SPEAKER_01 21:27

Right.

SPEAKER_02 21:28

So even if they call me, I'm like, well, the person on call is gonna have to handle that. Right? Whatever it is. So it gives me a great excuse to kind of unplug. There are times when you call me and I don't pick up, but I think you kind of know, like, for the most part, if after work, yeah, then you're probably working out. I'm probably working out. And it's just that time where I mean, anybody knows when you're in the hospital, you get called for so many different decisions. Like, you know, do you give this person blood? Do you give this person, does this person get discharged? Like, I I don't have to run through the list, and I just I get decision fatigue. By the time I get done with my shift. So the ability to just put headphones on and just listen to a podcast and just work out, or just not even listen to a podcast, just work out and just not have to make decisions for me. That's therapy. For me, I I love that. Yeah. I love that. So the other thing, too, that I want to talk about is the other reason I consider it therapy is work takes so much out of you. You know, like everybody expects you to be a hundred percent. And, you know, whether you have a great outcome or you have a a not so great outcome, I'll leave it to you like that. You can bring it home with you. Oh, yeah. That follows you. Right? Sometimes I remember you always talking about you have notes when you have to write. You have notes that you have to write when you get home, or you have labs that you have to check.

SPEAKER_00 22:43

Yeah. Yeah.

SPEAKER_02 22:44

Yeah. There's it's it's a lot, right? Some, you know, we talk about, we talk about uh stress. The other thing that we don't talk about enough, I think, is just acknowledging obviously imposter syndrome. You know, I think clinically I don't have imposter syndrome, but I think I have imposter syndrome in other ways that you've helped me to realize. Oh, have I? As a husband, remember? You told me I have imposter syndrome.

SPEAKER_00 23:07

Get out of here, knee. There's a strange dream.

SPEAKER_02 23:12

The arguments with colleagues, right? All of those things follow you home. I see, I know where you're gonna go with this, right? So for me, when I'm at home, I'm working out. When I'm at, you know, even when I'm on locums, I'm working out. Or I'm video chatting with you guys. That's that's that's purely what I am doing when I get home. I just I need to just I I know that it's a stop. And I think that's part of the reason why I love shift work too. So that's another thing. Just so y'all know, as a trauma surgeon, I do shift work. So I think the majority of docs in general, they do shift work.

SPEAKER_00 23:46

Uh trauma docs, you mean?

SPEAKER_02 23:48

Or I think the majority of trauma surgeons do shift work. I think specialties. I think the majority of specialties, right, do short, right?

SPEAKER_00 23:57

No.

SPEAKER_02 23:58

No, no.

SPEAKER_00 23:59

OB does have people in the office.

SPEAKER_02 24:01

But are they the majority of people? The majority of physicians.

SPEAKER_00 24:06

Yeah, otherwise, like where are patients seeing doctors, Nee? Not in hospital. Patients have to go to the doctor's office. You might be right. You might be right. Yeah, your lens is definitely skewed now that you're a trauma surgeon. Like what? People go into like buildings to go see doctors even though their heads aren't cut open? Yes, Nee. But you talking about private practice docs? I'm talking about office, clinic. Yes.

SPEAKER_02 24:36

Yeah, you're right, actually.

SPEAKER_00 24:38

What is going on here?

SPEAKER_02 24:40

All right, what about the inpatient docs though? How about that? Let's do that. Most inpatient docs do shift work.

SPEAKER_00 24:44

Probably, yeah, especially now that there's hospitalists.

SPEAKER_02 24:47

Yeah, yes. I would say that.

SPEAKER_00 24:48

Yes. Inpatient, yeah.

SPEAKER_02 24:51

So work stays at work. I'm a big fan of that.

SPEAKER_00 24:54

Work stays at work. That's why we do Logans now.

SPEAKER_02 24:57

My health, my lifestyle, my family, that I'm in control of that. So, and I think for you all who are first generation doctors, as you all know, like we've shifted the focus of this show to really speaking to the struggles, the um, the wants of first generation doctors. Like this matters even more, right? Because I think if you don't have a doctor in your family, if you don't have family members who are doctors, like they're just saying, do whatever it can you can to become a doctor, right? Do whatever it takes. They don't really understand, they just know that you became a doctor. Yeah. And once you become a doctor, you are like elevated into this role. Obviously, financially you'll be taken care of also. But there's a lot of things that come along with it that may not be so positive. So I think our parents, you know, at least my parents, you know, they're so focused on you becoming a doctor that setting boundaries is not part of those things that they teach us, right? And I think as a result, like we don't know how to set boundaries in medicine, right? So saying like work is at work and that's it, no matter what, I'm not doing anything. That's that's a that's a tough, that's a tough line.

SPEAKER_01 26:05

Yeah.

Boundaries That Protect Against Burnout

SPEAKER_02 26:05

Um, so I just want you all to know that, you know, if you're talking, most people who are talking about burnout, and you know, you you're hearing the hospital talk about like, you know, doing yoga at work and you know, going to like some room to do like that's the wellness officer. That's BS, y'all. That is BS. I'm telling you right now, if you want to work, if you want to focus on burnout, like you gotta learn. I'm not saying you have to work out to protect yourself from burnout. Boundaries is one of the first things that you have to build to give yourself the peace, to give yourself the freedom, to give yourself the acknowledgement that, yo, I am possibly, I see burnout right there, or possibly I am in burnout right now. What can I do about it? So I think that's that's important.

SPEAKER_00 26:49

Yeah. I think, yeah, definitely the setting of boundaries. I think it becomes really, really hard. Um, and I had a discussion about this with one of my mentees who recently became an attending this year. And um, yeah, it it was hard for her. But I was, you know, I was talking to her about the fact that she now is done with residency and her time should be her own to be able to decide what she wants to do with it. And she's gotta realize that when she goes to work, that even in this even in configuring what her schedule is going to look like, you know, that she can say, hey, I want to have this time to work and I want administrative time to be this time. And if they can't accommodate that, she has to think about whether or not this is the right place for her.

SPEAKER_02 27:42

Well, the other thing too is she's got to take advantage of it too.

SPEAKER_00 27:45

Right.

SPEAKER_02 27:46

That's what I'm saying. I so I agree with you 100%. Yeah, you got to be able to say, look, I'm not in red, I'm not in med school or residency anymore. My time is my time, and it has to say that contractually. Great. Now that you have that, are you gonna take advantage of that? Right.

SPEAKER_00 28:00

But that but that's what we talked about. And she actually did. She actually went in, she made the change, she changed, you know, her clinic, you know, patient hours and incorporated more administrative time. Um and she sent me a message last week. I asked her, you know, what does she think her co-workers will think because you know what will happen, right?

SPEAKER_02 28:21

Yo, y'all some co-workers, colleagues in medicine. Yo, y'all are some catty crabs in uh, but let's keep it going. We changed the shift.

SPEAKER_00 28:30

Anyway, so she said that she thought she thought that they'd be happy for her. And we'll see. I'm waiting to see what the, what the how this plays out.

SPEAKER_02 28:40

All right, cool. So my thought process, guys, with working out is it's optional, and this is protection for me. So, boom, let's shift it to you, Dr. Renee. Let's not. Let's not. I left all this time. We got two hours to talk about you.

SPEAKER_00 28:56

We don't have two hours.

SPEAKER_02 28:57

Let's take Renee's perspective about working out. Let's go. Let's talk about what you've been doing.

Renee Chooses Purpose And Social Walking

SPEAKER_00 29:05

You know, I hate working out. I absolutely hate working out. Um, I don't mind, however, walking. I don't know. Do we have the same journey? No. Okay. Um in residency, it I just hated working out. One of my friends just uh texted me the other day. She's like, remember when we did P90X for like three days? And then we stopped because you pulled a groin muscle. And I was like, yo, that shit hurt for real. Um still does. That's why I can't do P90X. 20 years later. But um no, I I do not enjoy working out. Um, like formal workouts with machines and all this kind of stuff. I do enjoy activities, however. The problem is I can Do you feel like you're healthy? No, I don't. So the Do you think you need to be more active? Yes, I do. The problem is that I don't have I feel anyway that I don't have enough. I don't have enough opportunities to be able to like play the games, do the thing, do the activities, right? That's my problem. So yeah, that's my issue.

SPEAKER_02 30:23

What about what about structured programs? So for example, was was it a pen? Oh actually, you did T25. We did it together.

SPEAKER_00 30:30

Yes, we did do that.

SPEAKER_02 30:31

So is it the structure that's an issue? Is it that you don't like working out like that?

SPEAKER_00 30:35

I don't like working out like that. Like I feel like the working out is not purposeful. It's not purposeful. Like, I don't know, like the action of it is not purposeful. Not that it won't yield a result, it's not that. I just feel like I need to be working towards something, right? Like if I played basketball, I would play basketball because I want to shoot the ball in the basket enough to be able to beat the other team. Like that's a purpose, you know. Like the year I was doing um uh dance, right? That I I enjoyed doing that, you know, because at the end you get to put together a dance routine. Like it, it served a purpose, right? So I enjoy doing things like that. There's, you know, there's there's just a lot of different activities. So I I like those kinds of activities where I'm actually burning calories, but I it's I'm not burning calories for the sake of burning calories. I'm burning it for some other purpose.

SPEAKER_02 31:34

Okay, so let's talk about uh six months. There were six months last year. What yeah, last year. Six months last year where you are extremely consistent with walking. You wanna talk about that? Let's talk about that. Yeah. How far, tell them how far you would walk, who you would walk with, talk about that.

SPEAKER_00 31:50

Yeah, so every morning after I dropped my kids off from school, I would pick up one of the other moms who lives about a block away from us. And we would just walk. We'd walk the entire neighborhood. And we'd walk and talk, we'd talk about a lot of different things, you know, our children, you know, things going on in the world, just just everything we would talk about. And we would go about sometimes over five miles. We would walk. And it wouldn't, it wouldn't seem like anything. But after about an hour and a half, we'd look, how many steps, how many miles did we go? I'm like, wow, you know, we walked this much. Um, so that and you're sweating. You're no, yeah. We weren't like we, it's not a stroll. It's not a stroll. It's definitely a brisk walk where we're we are sweating, we're huffing and puffing, like we are walking, we're booking, we're moving. So that was, you know, that for me was really fun. Part of it that the part of it that was the most fun was that we were walking and talking, right?

SPEAKER_02 33:01

So it's like social time.

SPEAKER_00 33:02

Yeah, social time, right? You have adult conversation, especially because I'm home with the kids, you know. So some adult conversation. Yeah, I got you there. Um, so yeah, it was it was cool. It was cool.

SPEAKER_02 33:14

But what happened after was it six months?

SPEAKER_00 33:18

Yeah, it was probably about six months. Actually, what happened was the winter hit.

SPEAKER_02 33:21

Yeah.

SPEAKER_00 33:22

And I don't like being cold. So anybody got indoors for me to walk? That's not a treadmill because I can't stand treadmills. Um, but yeah, the winter hit. We had a particularly bad winter this year. Particularly bad. But funny enough, the other day when the weather got nicer, we started walking again. I didn't even tell you we started walking again.

SPEAKER_02 33:50

You came home and you were like, I could tell your I could tell your shoes stink. So that's why I knew it was like something's going on again.

SPEAKER_00 33:56

Anyway, um silly.

SPEAKER_02 34:00

So what do you really want to say?

SPEAKER_00 34:03

Anyway.

SPEAKER_02 34:04

So Renee's been watching couple. Renee's been making me watch couples therapy with her. So that's why our niece is watching.

SPEAKER_00 34:13

Our niece is watching couples therapy at our house. That's what's happening. And if you want to watch it, you can watch it. I've watched it already, but I'm not asking you to watch it with me.

SPEAKER_02 34:23

So I think the the reason why I wanted to highlight Renee's story and journey, mainly because it looks so different, right? Like that is okay. Both are valid, right? Like I love consistent working out. My only issue is I like to work out knowing that I'm gonna be competitive in something. So I set a goal. My goal is I want to be able to break 20 minutes into 5K, and I want to be able to bench 250 pounds. So I already set like a physical goal, and I'm building, I built a system to get me to that point. You are different, you don't work that way. No, but you found something that drove you, which is the socials time, you know, to walk around the neighborhood and so forth. And I think that's what for you, it's like you want to move. You just don't want to be punished.

SPEAKER_00 35:11

Right. Like I want to work out, but I don't want to be like in the middle of like 10 push-ups, like, why am I doing this? What, like, what's the purpose?

SPEAKER_02 35:20

Yeah. I think that's an issue that a lot of doctors figure out, or a lot of doctors have, is you know, we are in essence trained to feel, we won't say it, but we're training like we're perfect. And when we don't reach the goal, or if it feels like it's unattainable, then we think that we're failing. Right. So for you, you obviously you don't have this issue, but someone could be like, well, if I can't work out consistently like me, or even me, then why do it? Or if it's me and I'm looking at somebody else and I'm like, well, why can't I work out like that person, even though I'm doing five to six days a week consistently for three to four years, then it's not worth doing at all. And that's that's crazy. And I I don't think that that's failing. I just think that we're all of figuring it out. That's it. You could say it's a failure.

SPEAKER_00 36:03

It's failing to work out in that.

SPEAKER_02 36:05

I'm glad you said it. So let's let's let's actually answer the question. So the person is asking also what's the most time efficient way to burn calories? A.m. or PM workouts, how do you fit it in? So here is my take. Sorry, I'm thinking, just start running everywhere you go in the hospital. I love it. I love it. I love it. You know, I can't I have a I have a my watch, you know, tells me I uh 10 10,000 steps in a 12-hour shift.

SPEAKER_00 36:39

If you want 600 calories, just run.

SPEAKER_02 36:43

Run to every code.

SPEAKER_00 36:44

Run to every code, run to every code, run to every consult. Run to the run to everyone, run to the ORS.

SPEAKER_02 36:49

Run to the documents, run to do the consent.

SPEAKER_00 36:51

Take your HP running.

AM Versus PM: Do What Works

SPEAKER_02 36:53

I think the patient's gonna lose up with this document. So look, we gotta reframe this goal. And that's what I or reframe the question. I would say not how do I burn the most calories. Um, I think it should be how can I build a habit that I can sustain?

SPEAKER_00 37:10

Yes.

SPEAKER_02 37:11

I think that's the key, right? Because what happens is if you focus too much on calories, and then we talked about it before, you're working hard. Like 600 calories every day. First of all, you're not even supposed to work out like that. You're not supposed to burn, like burning 600 calories means that there's a certain level of exertion that you're doing that you cannot do every day on a daily basis. You are going to burn out. And I think that's cut out a meal.

SPEAKER_00 37:35

That's one way to burn 600 calories. Just don't eat, don't eat dinner, don't eat lunch, don't, don't eat something, but don't do that either, because that's not good.

SPEAKER_02 37:44

I think you should be asking yourself, and even you, I think you should be asking, what can I do consistently?

SPEAKER_01 37:48

Yes.

SPEAKER_02 37:48

Even if it's small. For me, it was T25. Yes. It doesn't have to be perfect, it just needs to be consistent. And that's the way I would look at it, right? So if the answer is walk walking 15 minutes three times a week, then you start there. If the answer is 25 minutes of bodyweight exercises five times a week, start there. If it's just, you know, walking with your, you know, your was it the parent mom over wine, you know, like you guys are doing.

SPEAKER_00 38:10

You can't walk in wine, you know, then I should have edited out after show.

SPEAKER_02 38:16

Walk in wine. There you go. All right, a.m versus PM workouts. This is a struggle for me. I would like to work out in the morning because I feel like once you get the hard part done, then you have the rest of the day. Here's where I struggle, particularly when I'm home. If I don't work out in the morning, I oftentimes find out that I'm working out when the kids are home. Right?

SPEAKER_00 38:40

Which um kind of defeats the purpose of you being home to spend time with the kids.

SPEAKER_02 38:45

I want to spend time with the kids. And some people say, well, you can incorporate them into your workout. But if you know my kids, my kids be trying to disassemble the adjustable workouts, they're jumping on my back while I'm trying to do squats. It's it's a bit distracting now because they're still very young. I I would just say what I've learned is that listen, you just work out when you actually are going to do it. That's it. You could do AM, you could do PM. When you know you're gonna actually do it, that's when you should do it. So for you, it's what? When the kids get dropped off.

SPEAKER_00 39:11

Yeah, when the kids get dropped off. Like if if it doesn't happen, then yeah, like if I'm not walking after they get dropped off, I'm not walking. It's pretty much done.

SPEAKER_02 39:21

What do you think about that like successful people wake up at 5 a.m.? You know that whole morning? Like I want to wake up that guy. I want to wake up at five o'clock so bad, but I think, yo, when that alarm goes off at five. Nah, I want to be asleep at five. I'm good. Yo, I'm good. But see, the reason is the kids are not up that that like you could do so you can accomplish so much during that time, I feel like.

SPEAKER_00 39:41

Yeah, and you could be real sleepy by nine o'clock, by 9 a.m. So you could do that too. You could do a lot of things. You could do a lot of things. I mean, if I if I went to bed every night at eight, nine o'clock, yeah, I'd be up at five. But I don't, so I'm not, and I don't miss that.

SPEAKER_02 39:59

All right. So let's let's give a list. I'm gonna I made a list of the things that make my system, right? This is so someone could listen to and say, hmm, okay. So I would say this this is at the most basic of everything, and this is not even a step, I just have it as a foundational step is you gotta change your identity first, right? I had I had trouble with that. I know, but it works. Yeah, I had trouble with that. Maybe that's why you couldn't build a habit.

SPEAKER_00 40:25

Right, but I think Can I just for a minute?

SPEAKER_02 40:28

Of course. Go ahead, go, go ahead and riff.

SPEAKER_00 40:31

Riff just for a minute. So I like the book. I read the book. I read the book twice, but I do think that creating the identity actually is a friction for me because I don't have that identity that I want to build. Like, what am I?

SPEAKER_02 40:48

I'm just gonna I'm gonna I'm gonna ISO in on you. I'm gonna ISO in on you. Go ahead.

Track Progress And Don’t Break Chains

SPEAKER_00 40:52

I haven't figured it out. It's been three, four years. I've not been able to figure out what is this ideal identity that I should be, you know, aspiring to. Like I don't have it. For me, that's a friction.

SPEAKER_02 41:06

Okay, so I think basically what you're telling me is if you were an alcoholic and you were an alcoholics anonymous, which works, right? Like you would be stuck on just admitting that you're an alcoholic. Even though they say that's the steps that you need to take. Like that's the first step that you would need to take. My identity there would be I'm an alcoholic. But if you can't identify it though, right? Because that's the hard part for people, is saying step one, I'm an alcoholic, right? So same thing here.

SPEAKER_00 41:30

But that's I did an identity is not a problem.

SPEAKER_02 41:34

Don't you think that is a problem for you?

SPEAKER_00 41:36

No. My problem, if you want to say my problem is I can't find an identity, but I know what my problem is. What is your problem? My problem is that I don't like working out. That's my problem.

SPEAKER_02 41:48

But do you think you need to be fit?

SPEAKER_00 41:50

Yeah, I would like to be fit. I'd be, I'd like to be healthy.

SPEAKER_02 41:53

Yes. Right. So you do you believe that this do you think that this system could work?

SPEAKER_00 41:58

The system could work, but I'd have to skip the step of finding an identity. I think I'd have to skip that step. But didn't you try that and it didn't work?

SPEAKER_02 42:06

You skipped the step of getting an identity.

SPEAKER_00 42:08

Yes, I did skip the step of having an identity.

SPEAKER_02 42:11

So then follow the damn system then.

SPEAKER_00 42:12

Well, no, because you we didn't talk about all the other things that I didn't do in order for the system to work. Okay, so that's what I'm talking about here. I'm talking about the system. You can I know it. I'm just saying that that one step for me was friction.

SPEAKER_02 42:25

Got you. Don't listen to Renee. You want the book to work for everybody. Hold on, let me make sure I go back to this thing. Okay. All right. So I would say first, change your identity first. I think that's the most important thing. I would say that. Step one, start small. Um, I would say don't commit to burning 600 calories six days a week. Um, I think that is setting yourself up to fail. I would say start at like 10 minutes, 15 minutes, something that you can't say no to, something that's really easy that you can't say no to. Um, and I think the key thing is remember that during this process of starting small, like you're chasing the identity. You're not, you're not chasing the results, right? Building the identity is the most important thing. Two, make it frictionless. Have the clothes laid out, know exactly where they're going to be, make sure it's also attractive, right? You want to make sure the room is clean. You want to make sure that the TV and the DVDs or the USB uh flash drive and the water is cold, all of those different things that would make you be like, I don't want to do it. You want to take that out of the way.

SPEAKER_00 43:34

And or if you're not doing it at home, make sure if you're gonna do a gym that you pick a gym that is not so far out of the way.

SPEAKER_02 43:43

That's what I'm talking about.

SPEAKER_00 43:44

You don't want to go there. So you want something that is on your way home or something, but just whatever it is. Find a fitness for me. You know, make it make it attractive to go to. Oh, yeah. Cars gassed up. Make sure, make sure all the things.

SPEAKER_02 43:59

Yeah, it's Not going to work if you have to drive 45 minutes away. Correct. Right. Or, you know, whether it's before work or after work. So for me, the gym is along the way going back home. Um, it's only five minutes away from my hotel room. Even when I work out here at home, the gym is only 10 minutes away. Not even, it's like five minutes away. It's right next to ShopRite. So it's it's very simple, it's very frictionless, and it's very attractive. Yeah. The next thing is step three is track it. I use the simple calendar. If you go into the room, the next room over, you'll see old calendars from several years ago where literally every workout that I completed on the calendar, I would put an X. And that X became proof that I actually could do the work, right? It showed that I created this chain. I created this series of work, and I did not want to break the chain by having a space with no X in it. So I think that that gives you the credibility to show that, well, I'm changing my identity, I'm doing the workouts, and here's the proof. So I think it's very simple, but it works. It works for me. So um, and then step four, don't break the chain for more than one day. So what that means is you can make a mistake and miss a workout for one day. But once you start going two days in a row, now you've already started on working on a new habit, which is negative from what you were working already on, right? So missing one is fine, but don't miss two days in a row. Step five, celebrate the small wins. Right. For me, the small wins was first, could I finish T25 in 60 days? Then the next step was, could I do T25 again without getting injured? And then eventually I shifted to something else. Um, don't wait until you, you know, I'm gonna wait until I do 20 pounds, I lose 20 pounds, or I run a marathon. You know, remember that every time you go out and you exercise, anytime that you finish a week, you know, you are casting a vote for yourself with your new identity. I am an athlete or whatever, you know, you, Dr. Renee, want to use.

SPEAKER_00 46:08

Listen, if you can give me an identity, I'll consider it. You don't know.

SPEAKER_02 46:15

You're like, I don't know. I I think for you, I would say that if you spent a bit more time in the identity part, I think that it would help you to justify exercising even when there's nobody else around, or even when there's not a social component to it. That's what I would think. I think that your your your identity, whatever it would be, would drive you enough to say that knee's not here, my friend with wine is not here. Why are you saying what? Let me go and do this. You know what I'm saying? That's what I think. That's what I think. That's what I think. Well, we'll see. Well, I think we we kind of beat this with a dead horse.

SPEAKER_00 46:56

No, we don't beat with a dead horse. You beat a dead horse.

SPEAKER_02 47:00

I'm not good with the colloquialism. Is that is that the way you say it? Colloquialism? Yes. I'm not good with it. I am like a first generation. I'm not good with any of those things. But I'll I'll say this though. If you're a first generation doc and you're struggling with this, you're not alone. Listen, um, we didn't have doctors, or excuse me, we didn't have parents who kind of modeled this behavior for us in terms of like balancing, you know, being a doctor and all the we didn't have any of that stuff. We just figured it out slowly but surely. And we just want you to know that, you know, we're here for you guys. So we're figuring this out together. Dr. Renee obviously is still trying to figure it out. Um, and I think the one thing to take from this is the boundaries that you can create by exercising or by doing something that brings you um pleasure, that brings you joy, that brings you an opportunity to de-stress. I'm telling you right now, healthcare will take a lot out of you. And if you don't put your hand up, if you don't put a boundary up, it'll take more, right? Whether that's your energy, your mental health, um, it will follow you home if you don't, if you let it. Yeah. So, Dr. Nay, you got anything you want to say?

SPEAKER_00 48:02

Uh, maybe I'll go out and walk after this. Walk away, far away from this daggone house.

SPEAKER_02 48:10

Well, listen, if this episode helped you, I want you guys to drop a comment. Let us know what's your biggest struggle with fitness, um, or maybe even setting boundaries. Right. We read every comment. Sometimes we make episodes based off of those comments. And remember, we're building this community of first generation doctors together, all right? I appreciate you all watching. Dr. Renee, you got anything you want to say? No, I appreciate you all, too. All right. We'll see to you, we'll see you guys on the next episode, y'all. Peace.