Ep 38 - Diverse Income and Fulfillment: A Journey Through Medicine with Dr. Stephen Cohen

What if your passion could lead to multiple streams of income and prevent burnout? Join us as we explore this idea with Dr. Stephen Cohen, a distinguished colorectal surgeon whose career was inspired by his father, a retired general surgeon. Dr. Cohen shares his insights on the importance of having diverse income sources to maintain balance and satisfaction in the demanding world of medicine. He discusses the art of teaching, simplifying complex surgical concepts for students, and the necessity of continuous learning in the digital age.
 
 Our conversation broadens to cover the evolving landscape of healthcare, with an eye on the innovative strides in artificial intelligence and robotic surgery. Dr. Cohen provides a candid look at the challenges of malpractice insurance in Florida and shares personal stories of transformation, both in his career and in health, as our host recounts their journey from an unhealthy lifestyle to completing Ironman triathlons. This episode underscores the power of personal fulfillment and how a shift in perspective and lifestyle can lead to significant achievements and well-being.
 
 We wrap up with a heartfelt discussion on the balance between professional and personal life, touching on the impact of small lifestyle changes on health outcomes, like preventing colon cancer recurrence through diet. The interconnectedness of industries, financial wisdom for new medical professionals, and the value of teaching and mentorship in one's later stages of life are explored in depth. Finally, we express our gratitude to educators like Dr. Cohen, whose dedication to sharing knowledge enriches our lives and inspires future generations. Listen in to be inspired and informed by a conversation that celebrates the wisdom and contributions of our guest.

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Transcript

Josh Fertel

00:04

Welcome to the Angry Biller, a show where we explore the people and the businesses behind the scenes of healthcare, those men and women that are the catalysts that allow providers to concentrate on delivering exceptional patient care. Welcome to the Angry Biller. My name is Josh Fertel, I'm the owner of J3 Medical Billing and I'm your host. We are at the Visuals by Momo studio. 

00:26

The one thing I love most about this podcast and what I do is that I'm always learning things and I'm always running into people that can teach me about healthcare, business in general and the way to take care of patients, and I've made a new friend here with Dr Stephen Cohen, who's up in Virginia, and usually anybody who's listened before knows I do not prep right. I just want to have a conversation with the people that are nice enough to come on and we get to know each other and we learn things from there. But the thing about Dr Stephen that I've noticed is he's into so many things that really this is just I don't know where this is going to go, so we're just going to get started and see what we can learn today. So I appreciate you coming on. 

Stephan Cohen

01:13

No, it's definitely my pleasure and yeah, being into so many things definitely has been the norm really since I was in high school. I mean, my mom tells a funny story that even in high school, one summer I had four part-time jobs. 

01:30

I believe it I believe it and I don't know why I'm just wired like that for some reason, but I tell you, I've been involved for 30 years in teaching, training and educating medical students and residents, and that's one of the things I've even told my own kids and I tell the surgery residents I feel like they're my kids, because they're my kids' age is the best time to look for a job is when you already have one, number one and number two. Having multiple streams of income or multiple jobs, you avoid the thing that a lot of physicians are plagued with, which is burnout. Okay, that's fair. The thing about burnout is it's people you know in the medical field, or attorneys, that are highly driven to keep getting the next step. 

Josh Fertel

02:21

Right. 

Stephan Cohen

02:21

The interesting thing about doctors is you know you're always just looking for the next step. I needed to do doctors is you're always just looking for the next step. I needed to do well in college to get to med school. I needed to do well in med school to get into a surgery residency. I needed to do well in residency to get to fellowship, and then I need to find a job. And then the question is now what? What am I striving for. So that's part of it. 

Josh Fertel

02:44

I get it. I want to go backwards a little bit. What got you into health care? 

Stephan Cohen

02:48

Well, it was probably my father, who is a retired general surgeon still alive in Palm Springs, california. 

Josh Fertel

02:54

Nice. 

Stephan Cohen

02:55

And I watched my first appendectomy at age 11. 

Josh Fertel

03:00

Fun. 

Stephan Cohen

03:01

And that was thing one. And then the second thing was probably even before that, in third grade, because you know I'm a colon and rectal surgeon we could talk about why I got caught pulling the kids' pants down and my teacher said to me Stephen, you will make nothing of yourself if you keep doing this. Now look at me, yeah. 

Josh Fertel

03:20

She didn't know. I think it was third grade and you wanted to be a surgeon from a young age. 

Stephan Cohen

03:25

Yeah, so I always knew I was going to surgery. My father's a retired general surgeon. I have three other brothers Right. All of them, all of them are doctors, all of them are surgeons, believe it or not. 

Josh Fertel

03:38

No, I believe it. I believe that's good. You know your dad was a good influence, right. 

Stephan Cohen

03:42

Right. So I was always around the hospital. I was always, and it's funny because a lot of my colleagues' kids very few nowadays go into medicine. But looking back and this probably wasn't true but it's what I remember I remember my dad always being home and having dinner as a family and you know talking about stuff and I know he worked hard. I know he was busy. It was crazy back in the 60s and 70s. But, my recollection was that he was always around and I think that stuck with me. 

Josh Fertel

04:14

Right, I got you, and then you transitioned into teaching. 

Stephan Cohen

04:18

Correct. So I trained at Boston University for general surgery and the Cleveland Clinic for Lauderdale for colorectal surgery. But I've always been involved in a teaching training, educating medical students and residents and a lot of my other job descriptions or things that I do now is really is an extension of that, because if I can't explain it to a surgery resident that they understand it, then I don't understand it. Right, okay, I can't explain it to a surgery resident that they understand it, then I don't understand it. 

Josh Fertel

04:47

Right, okay, I got you. 

Stephan Cohen

04:49

And we've all had good teachers and bad teachers, right? I mean, we've all been to school and you say, well, the teacher did, I don't understand it, then it'll explain it to me. They know it. But if you can't explain it, I think that's what makes a good teacher is being able to explain it. 

Josh Fertel

05:04

You're 100% right, and going through the trenches, so to speak, like you have, being able to speak their language has got to make it a lot easier. 

Stephan Cohen

05:17

Well, I think it makes me smarter, especially with the internet area. Remember back when I trained 30 years ago, there was no such thing as the internet. I had to carry the Washington manual book in my pocket. Now, if I tell the kids, well, this is what we do, this is that they're looking it up on their phone and say, but wait a second, there's a study that showed this. And what about this and what about that? It's like, okay, that's fine, so it definitely I need, I need to stay one step ahead. 

Josh Fertel

05:44

Right, for sure. And how are you doing that? 

Stephan Cohen

05:46

Well, I have to be smarter than them. So I keep up with the literature. I do everything I can to make sure that I'm keeping up, and one of the reasons that I like doing medical expert work, which is another one of the things I do is I have to be smarter than the attorney. 

Josh Fertel

06:02

Right is. 

Stephan Cohen

06:07

I have to be smarter than the attorney Me teaching residents and keeping up is no different than when I'm in a courtroom teaching juries right of why surgeons do what we do and what standard of care in terms of medical issues and disease process. If I can get them to understand it which most jury members, as you know, have zero medical background, they're not supposed to really. 

Josh Fertel

06:26

Right, right. 

Stephan Cohen

06:27

It, it it's. If I can explain it to them, then I've done my job. 

Josh Fertel

06:31

All these things that that you're into, which one is your passion project? What's the thing that you this is? This makes me feel good at the end of the day. 

Stephan Cohen

06:39

Yeah. So my goal has always been to have one chief surgical resident decide to become a colon and rectal surgeon, which is my main job, right? So what does that mean? In order to become a colorectal surgeon, you still have to do five years of general surgery training and during that time you can decide do I want to just do general surgery and practice or do I want to specialize? I can go into you can go into vascular, you can go into colorectal, you can go into bariatrics, you can go into trauma surgery, you can go into critical care. So my goal is to show these young learners how much fun it is to be a colorectal surgeon, that at least one a year from where I'm training go into colorectal surgery. So since 2017, I've been affiliated with VCU because they're affiliated with the hospital we're at. We've had seven surgery residents decide to go into colorectal surgery. 

Josh Fertel

07:38

Well, congratulations. 

Stephan Cohen

07:40

Before that, when I was at Emory, when I was associate clinical professor at Emory from 94 to 2014, there's at least 10 or 12 residents that decided to go into colorectal surgery, so I'm proud of that. 

Josh Fertel

07:55

Right. 

Stephan Cohen

07:56

Because that's what turned me on to it. It's my mentors, the people that I trained with, you know. I realized this is a specialty. I realized I can do well in it. I liked them, right, right. I wanted to be like them. 

Josh Fertel

08:10

Right. 

Stephan Cohen

08:10

Right. So it's mentoring the young surgeons to go into the same field I am. I'm very proud of that. 

Josh Fertel

08:17

That's great. Do you keep in contact with them after they've started their careers? 

Stephan Cohen

08:22

I do, sometimes on a good note, sometimes on a bad note. I just got off the phone with one that got named in a medical malpractice case and needed my help. So it's either that type of thing or it's moving jobs and contracting. I have a lot of experience of doing things wrong. They know that. 

Josh Fertel

08:41

As do we all. 

Stephan Cohen

08:42

So I tell them yeah, I tell them, do as I say, not as I do. But yes, I actually keep in contact with most of them. 

Josh Fertel

08:49

Oh, that's good. So you're a mentor, You're their sensei, so to speak. So the malpractice I see that you speak about that a lot. Tell me how you got into that. As far as being, you're an expert witness. 

Stephan Cohen

09:02

Yeah. So actually my first time in the courtroom was as a surgery resident, when I was in Boston. I was subpoenaed to come to court to testify that what I witnessed in this patient who had a gunshot wound to the head, there was actually brains on the bed. I said, oh, I could do that, that's pretty cool. But then in practice, my senior partner asked me to review a case and I didn't even know what that meant. Right, I said what? What does that review a case? Well, you look at it, you tell it to the doctor, meet the standard of care. So that was my foray into it. 

09:36

But again to me, it it's similar to the teaching, right, because I have to look, you know, one, two, three years later, looking at the records, put myself in the position as the provider, standing there at the bedside. You can't look at this in hindsight. That's not fair, because a doctor doesn't know the outcome. Obviously, when I'm reviewing a case, I know the outcome because I know the story, but I can't let that bias me. So it's teaching. It's teaching the court, teaching the jury, teaching the attorneys. So it really just grew from there. 

Josh Fertel

10:11

You're a natural educator, I mean, that seems to be your passion. 

Stephan Cohen

10:15

Well, it's a lot of fun. So I think I got that from my mother. So my mother is a retired school teacher, so that's probably where it came from. It wasn't me, I just got it. 

Josh Fertel

10:23

Well, that's all right. No matter where it came from, it got it. So you're teaching them how to be residents. You're teaching them how to go into surgery. You're teaching them what to watch out for as far as malpractice. What else? What advice do you give to someone who says you know what, I just want to go into medicine. We know medicine is not easy nowadays. What kind of advice do you tell them? 

Stephan Cohen

10:43

Yeah, and that's a that's a great question. I mean, medicine is is a great specialty. I mean, medicine in and of itself is still an excellent field. Yes, it's you, and I tell the residents this all the time. You, you know, it doesn't matter what you go into. You want to be a doctor, you want to be a lawyer, you want to be a plumber, I don't care, right, you have to get up every day for the next 40 years and want to go to work. 

Josh Fertel

11:10

Right. 

Stephan Cohen

11:10

That's different for everybody. I like seeing people with their pants down. Not everybody likes to do that. 

11:16

That's fine have a bed to. You know, be useful. To coin the term from Arnold Schwarzenegger I don't want to take his term, but be useful. What are you doing to help people? Or what are you doing whether you're helping your family, or you're helping your neighbor, or you're helping, you know, a stranger. In terms of medicine, it's still an excellent field. So you know, things change over time. Right, the way we practice medicine 30 years ago is not the way we practice medicine today. Electronic medical record, minimally invasive surgery I mean a lot of things have changed. Things are going to continue to change in the next 30 years. Right, it's going to be very different. Artificial intelligence, 3d printing, robotic surgery I mean name it. Things are going to change pretty rapidly, rapidly, and you have to be able to keep up with that change. 

Josh Fertel

12:09

Yeah, no for sure. I like the fact that you've already pinpointed some things that are going to be coming up just from your background Malpractice I wanted to ask you about that because, again, you talk about malpractice a lot. In Florida, where we are a doctor doesn't need to have malpractice insurance, right. Do you have thoughts on that, as compared to the prepaid legal or the plans that are out there? 

Stephan Cohen

12:34

It definitely would make me nervous personally to not have malpractice insurance. 

Josh Fertel

12:39

Okay. 

Stephan Cohen

12:40

So I don't really know as a physician in Florida because I I review a fair number of cases on the plaintiff side. I do just as many on the defense. But I do enough plaintiff cases for Florida physicians that have lost right. The claim has gone against the doctor, for the patient. So I don't know how they navigate that Right Because I know, for example, you know when I was in Georgia or when I'm now in Virginia. It's a little different now for me because I'm a federal employee, I work at the VA Medical Center Right, so I'm covered by the Federal Tort Claims Act. But when I was in Georgia, when I had private medical malpractice insurance, you know there's a cap, so I had a one or a $3 million policy If and when I was named in a lawsuit. 

13:31

usually that's where they negotiate from that level Because, as a physician, you don't want to lose your house, lose your car, you know, lose your pay. You don't want to lose everything you have. Right and so and and everybody knows that right. So everybody knows that it's usually most cases settle Right. Most cases the insurance, you know, the insurance company settle. So I don't know specifically in Florida if a physician loses a two and a half million dollar medical malpractice case, right, I mean they're not writing a check for that, I don't think. 

Josh Fertel

14:04

No, they're not yeah. 

Stephan Cohen

14:06

Right. So I don't really know what the difference is whether you're a physician in Florida not caring, because usually they're going to go after the hospital anyway, because the hospital has the big money. 

Josh Fertel

14:16

Right. 

Stephan Cohen

14:17

Right. So if you're an employee of the hospital, which most of us are now, just the way medicine is they're usually going to go after the hospital. 

Josh Fertel

14:25

Yeah, no, I get it. That makes sense. That makes sense. Let's take a break. Grab yourself some more. I got some more questions for you. Visuals by Momo passionately brings your vision to life. With expert video production, we create impactful, community-focused content for businesses and nonprofits, helping you connect and engage with your audience. From concept to completion, our dedicated team is committed to telling your unique story with creativity and precision. Elevate your brand, making a lasting impression with visuals by momo. Visit visualsbymomocom or call 954-745-7922 to start your journey today. Your story, our passion, all right, we are back with dr stephen cohen, who is a just a plethora of knowledge on, on anything that has to do with health care. As far as I'm concerned, I see you speak a lot about diet, about health. Tell me about that. How did you start thinking that? How did you? 

Stephan Cohen

15:25

Yeah, that's a great story. So back in the 90s I was unhealthy and overweight. 

Josh Fertel

15:32

Okay. 

Stephan Cohen

15:33

And my wife, however, was not. So my wife, who's a very good athlete, started running and she got into biking and she got into triathlon and, believe it or not, my wife is qualified and completed two Ironman triathlons, working out all the time. But I defaulted to what most doctors say I'm too busy, I don't have time, I'm making a living right. 

16:01

Like we all say. But I woke up one day when she's working out and she's in great shape and I'm not, and I looked at myself in the mirror and I said I'm not doing that anymore. I mean, I didn't like what I saw and I was about 230 pounds and now I'm 170 or 165. 

16:17

And I said to my wife why didn't you tell me I look so bad she goes? You know, I didn't really notice what I didn't notice. So I said, fine, I'm not doing this anymore. So I started, started at 5K, then a 10K, then a half marathon, right. Then I did a bunch of marathons. I've run Boston twice and then I was starting to get mad at my wife that she was spending so much time training for her Ironman. 

Josh Fertel

16:45

Right. 

Stephan Cohen

16:45

That I could either get mad at her or I could join her. So I decided to join her. Good for you. So I actually have completed two Ironman triathlons myself. All right, nice Number one and three Number two in 2005, I got pushed off my bike, accidentally broke my collarbone, spent the morning in the emergency room. It's definitely not fun being the patient, I can tell you, because I'm not a good patient for sure. And it was really about that time after I had really stopped. We kind of got burnt out. We stopped doing triathlon. We were just working out, exercising, and a friend of mine wanted to get into triathlon. Okay, and I was. And triathlon's a whole thing. It's the swimming, it's the biking, it's the running. But there is a fourth sport, and the fourth sport of triathlon that nobody thinks about unless you've done it is nutrition. 

Josh Fertel

17:38

Okay. 

Stephan Cohen

17:38

Because nutrition can make it or break it. Okay, how many carbs do I take? How much fluid do I have to do? You are burning during a 12 plus hour race. Right, you are burning a tremendous amount of energy. 

Josh Fertel

17:55

Right. 

Stephan Cohen

17:55

So nutrition is a fourth sport, for sure. So my friend was telling me about these that, and I was telling him what I did. I use these goos and these are the bars and this is how I space it out and he was saying, no, that that's dumb, because there's something new. Now I said what are you talking about? Well, there's something called nutritional ketosis that you can actually do better by burning fat for energy. So what are you talking about? I'd never heard of that. 

18:20

Well this is back, you know, 2007, 2000. So I'm the kind, you know my background and I'm wired is trust but verify. So I said my normal is I don't believe you. I'm going to go do the research myself, but as it turns out, that's really kind of when the low carb thing started Right. 

18:39

And you couldn't find the foods in the store. But I did it. I actually it made sense to me. I was reading all the things that people were talking about. I started reading all the books of all the people that were writing about it at the time and I said that makes a lot of sense. I'm going to try it. So I actually went zero carb. 

Josh Fertel

18:59

Okay. 

Stephan Cohen

19:00

Zero carb, which is not, which was not easy. My wife said I'm an idiot. That's fine, I'm used to that, but I will tell you I felt phenomenal. 

Josh Fertel

19:09

Right. 

Stephan Cohen

19:09

And I had my fastest 5k and 10k time by zero carbohydrates. 

Josh Fertel

19:16

Right. 

Stephan Cohen

19:16

I was in nutritional ketosis. I was monitoring, I was seeing everything. I was drinking my bulletproof coffee before a race. It was like rocket fuel and my wife said what's the matter with you? Who are you? So that's kind of when it started. So I've really done the whole gamut. I've done zero carb, I've done low carb, I've done paleo, I did carnivore for two years. I was really hitting it hard as carnivore only. And you know and I've talked to a lot of people a lot of people ask me my opinion Everybody's body's different. 

Josh Fertel

19:51

Yeah. 

Stephan Cohen

19:51

Right. So for for me, the thing that I find the best really is a little bit higher protein, lower carbohydrate, and that's where it's good for me and it's not good for my wife. I mean my wife, if she's under 100 carbohydrates she is cranky and she is yelling at me, so I never let her go lower than that, for sure. But it was, you know, it's just reading and researching and experimenting and you know, seeing my own patients, I mean it. It is a disaster. Health care is a disaster, right, right. I mean I don't know how else to tell you, yeah, no, I mean what we, what we have seen in the last 50 years and when you start to read about it is you know. I mean we could talk for hours about this. I mean they, you know we unfortunately back with Ansel Keys that started the whole nonsense that eating fat makes you fat is the dumbest thing ever, right, and that somebody with an elevated cholesterol is a risk for heart disease is the dumbest thing ever, is a risk for heart disease is the dumbest thing ever. But it's medical dogma that has been passed down for the last 50 years. That's very difficult, I won't say impossible, but it's very difficult, even in my own colleagues. 

21:08

I've had arguments with my cardiology colleagues that are my age, that should know better. We had no nutrition in school. We just didn't the eat less, move more. That doesn't work. It's not the patient's fault, it's everything else. The choices out there is very limited. They make the bad food cheaper, so of course you're at the fault to that. And I did the same thing. I mean, go look at the food in the doctor's lounge. I mean it's just embarrassing. It's embarrassing and and I've I've said this for years when I was a third year medical student, right, and I asked a simple question because they said oh, steve, make sure this diabetic patient's on an 1800 calorie ADA diet. I don't understand why we restrict the patient's food in the hospital, but then aren't they going to go home and just eat anything they want? 

Josh Fertel

22:13

Right. 

Stephan Cohen

22:14

Oh no, oh no, don't worry about that, just make sure they're okay. That didn't make sense to me, right? We tightly control when we have you in the hospital monitor your diet, make sure your insulin's okay. What do we tell them when they go home? Right, we don't restrict their food. Most patients me included, when I'm a patient or my wife was a patient- Right we don't listen to the doctor, we just don't, right? 

22:41

There's a lot of studies that show patients will listen to about 50% of what you tell them, right? If I say no heavy lifting for six weeks, they're not listening to me. Come on, they maybe do it for two weeks, so it made no sense to me. But back to the food thing is you know you should see the food trays that we currently in our hospital and every hospital across the country what we give a diabetic patient their breakfast, their low carb diet Cheerios, orange juice, oatmeal and a bran muffin. 

Josh Fertel

23:13

That's a lot of carbs, right, right. 

Stephan Cohen

23:15

It's, you know, it's just, it's going to take a lot to move the needle, but we have to start somewhere. We got to start with education to make sure that the doctors, the dieticians because they're taught the same thing. 

Josh Fertel

23:29

Yes. 

Stephan Cohen

23:30

I've had, I will say, discussions some of it might be arguments, because I can be kind of mean at times on a purpose, but discussions of that's not healthy. I mean it's that's not the way you treat. You don't give a diabetic patient sugar. Would you give the alcohol patient just a little bit of whiskey? 

Josh Fertel

23:48

Right. 

Stephan Cohen

23:48

Just a little bit. Right, it's the same principle. And most people, me included, I'm an emotional eater. Right? You take one bite of that Oreo cookie. Now I want three, and then I'll eat the whole sleeve of the thin mints from Girl Scout cookies. That's the norm and that's most people. Yes, so the only way we're going to improve this. And again, you know, it started as an experiment, with myself wanting to be healthier. And again it started as an experiment with myself wanting to be healthier. And then, as the time has gone on, it's watching my parents, who are in their 80s that are autoimmune disease, sarcopenic so many diseases that in my mind, are preventable. 

24:35

If we're going to talk about health care costs in this country and we're not going to talk about prevention, stop the conversation. 

Josh Fertel

24:38

Makes sense. 

Stephan Cohen

24:39

Stop the conversation. There's nothing to talk about. Remember this was back in 2007, 8, 9, with Obamacare. They talked about all the healthcare problems, but nobody talked prevention. We're not listening If you don't talk prevention, then there's no way we're going to get a handle on healthcare costs. 

Josh Fertel

24:59

Is that a fixable thing in our lifetime? 

Stephan Cohen

25:02

I think so, I think so. It's small little things that can make a big difference. 

Josh Fertel

25:08

Okay. 

Stephan Cohen

25:10

It's, you know. And again, we could talk hours about the big pharma companies and advertising and the lobbying and everything. You remember the tobacco companies when physicians realized that smoking is bad for everybody. We shouldn't do that anymore, Right, Right, the tobacco companies brought the same scientists to the food companies. So, they're all interrelated, so there's a lot of things we can do, but starting the conversation is helpful. 

Josh Fertel

25:41

Gotcha. 

Stephan Cohen

25:44

And hopefully things will change. But I think it can change. I definitely think it can. I mean people know they're not healthy right, I mean my patients know when I'm looking at them, you know, and they are coming to me because they need colon cancer surgery and they're 50 pounds overweight. 

Josh Fertel

26:00

Right. 

Stephan Cohen

26:01

And I tell them they need to fix this Right. So it's interesting. So I have the conversation more in the past. 

26:08

In a patient that comes with colon cancer after we do their surgery, one of the tests we do to look for recurrence is a PET scan P-E-T. And a PET scan is we inject you with glucose? Why? Because cancer cells will take up sugar, right, so if they want sugar, that's the only thing they can live on. 

26:32

Why, if you've had colon cancer and you don't want to get a recurrence which nobody does, obviously why would you put something in your body that if there's a cancer cell running around it's going to feed it, it's going to grow and you're going to die, right, right, right. 

26:53

When you explain it like that, I said you know you have to be careful because if you go back to eating your standard American diet with all the inflammation and all the sugar that can potentially feed a cell, it's going to shorten your lifespan. If you know that that will happen and you can look in the future, would you look back today and make a change Like if I know you're going to get a recurrence in 10 years and die early, right, right, and I know it's easier said than done and that's why I get a lot of pushback from my patients. But, doctor, I love bread and I say I love bread too. I know you do, because I do, I know. But again, it's not all or none and that's why you have to look at it and it's the old cliche one step at a time, I don't do anything, 100% right. 

27:47

If you can be 80% right, or do it for five days, or do it for 30 days, do it for six, do it for three months. See how you feel. Nobody that I talk to that will make a change for 30 days comes back and tells me they don't feel good. There is no such thing, and I've done it. I've done it myself. The cheat days, the days that I will share pizza with my wife, I don't feel good that night. I don't feel good the next day, but as the next week goes by, when I go back to limiting those foods, I feel great. So I know that's right. 

Josh Fertel

28:23

Yeah. 

Stephan Cohen

28:23

And when you do that you go oh okay, well, I guess that makes sense. 

Josh Fertel

28:27

Yeah, no, you're spot on. You're spot on. So what's next for you? What's the next thing you want to tackle or accomplish? 

Stephan Cohen

28:39

Yeah, so that's a great question. I mean, yeah, there's always the thing. I mean I'm still waiting for my daughter to have give me my first grandchild, so we're working on that. But she told me not to bug her because I'm stressing her out, so I won't do that. 

Josh Fertel

28:51

Don't do that. 

Stephan Cohen

28:51

That's fine. But so the one of the things again, the teaching and training. I still like doing that. I like, I like finding things that can help them, that I haven't done in the past. Right, I'm working on a, on a financial talk. I'm going to give grand rounds next month to the surgery department. 

Josh Fertel

29:11

Oh. 

Stephan Cohen

29:12

And again, it's do as I say, not as I do. 

Josh Fertel

29:16

Right, right Right. 

Stephan Cohen

29:17

Finance, financial talk. 

Josh Fertel

29:18

I love that. 

Stephan Cohen

29:19

You know which? We all make the mistakes, and I did the same thing. 

Josh Fertel

29:23

Yeah. 

Stephan Cohen

29:24

I mean, and one of the main things I like to harp on them is, you know, as a surgery resident or any medical resident, when you finish graduation your salary is low. I mean I think they make $30,000 or $40,000 or $50,000. I mean I think they make 30 or 40 or 50,000. 

29:37

I don't even know what they make as a resume, right, well, you get your first job, you make four times that salary, right, right. And one of the mistakes that everybody makes and I did it myself, right is I have all this money now like, wow, right, I work, I work. And this is what we say I worked hard, I deserve something nice. Right, I worked hard, I deserve something nice, right, I worked hard, I deserve. So, yes, yes, you worked hard, but don't buy the big house and go into debt. Right, you don't need to drive a Lamborghini when you're a brand new attendee. Seriously, and for some reason and I still see this to this day that's what new doctors want to do, and they go right into debt and then they take 10, 15 years to get out of it. Medicine changes, reimbursements changes. They're counting on a high salary forever, and that's a dangerous precedent to do, because you don't know the future, you don't know what your finances are. So and that's one of the things I'm going to emphasize, Hopefully they'll listen- I love it. 

Josh Fertel

30:41

I love it and you know, I read somewhere that you know we learn all these things, and when we get to our 60s, that's when we start to teach, and you seem to have embraced that very well. You know and so thank you for everybody that you've ever taught something to. 

Stephan Cohen

30:58

Right. I guess the other way to look at it too and this is probably is my mother hates when I say this but you, if you realize your life in general, first of all, even though when you get to the end of your career, like when you finally retire which I don't know, that I'll ever retire, right For sure, but I'll always do something Right but nobody ever looks back and says, gee, I wish I worked more, right, right. So the other emphasis I make and this is really the generation ahead of me never did this. I mean my father's generation never did it. Our generation is doing it better, the younger generation does it the best. 

31:37

Right does it the best is really not letting medicine especially if you're in medicine not letting medicine consume your life but enhance your life. 

31:48

There you go, Don't put things off. I mean the surgeon that started the practice that I left in Atlanta Atlanta colon and rectal surgery. You know he started in the 50s, worked like a maniac, like most of that generation did, 120 hours a week, was always on call, made house calls because that's what they did back then, finally retired to do everything he never did. Six months later on the golf course, the big heart attack and that was it. So definitely the younger generation doesn't do that. So we have wellness programs built in. They're allowed certain times off and I have to fight with my own colleagues, my age, because they don't like that, because we never did that, but that's not a reason. 

Josh Fertel

32:38

You can't blame them for wanting to live their lives like that. 

Stephan Cohen

32:41

They do that because no if I, we didn't know better. I mean, the young residents look at me and ask me how did you do that, working 120, 130 hours a week? I said I didn't know any of that. Right, I know what I signed up for. That's what it was. I didn't have a choice I could have. I could have either done what I did or I could have gone work to Baskin-Robbins, which I did in high school. That's fine, that was my choice. 

33:06

Yeah, I love that. That was a great job. I love working at Baskin-Robbins. 

Josh Fertel

33:09

My mom ran Baskin-Robbins. She put me through college at Baskin-Robbins and Friendly's. 

Stephan Cohen

33:14

Yeah, friendly's, but it's just change, it's just different. So it's good it's. You know as much work as I do. I still am home every night for dinner, right. We still go on vacation, nice, you know, and I do make time to do the things that I don't want to miss because, remember, you're only two generations away from people never remembering you. I never knew my great grandparents. Okay, and most people. You're lucky if you knew your great grandparents, right. But think about it Did you know your great grandparents? I actually did. 

Josh Fertel

33:49

I actually did, they were. 

Stephan Cohen

33:52

That's unusual, yeah, I actually did. 

Josh Fertel

33:53

They last a long time. My great grandfather was 104 when he passed and I had a son, and I had a son at long time. My great-grandfather was 104 when he passed and I had a son and I had a son at that time, See that's unusual, it is, but in general most families you are two generations, Right? 

Stephan Cohen

34:08

No, you're right. They don't even know that I existed and I'll be a picture. Oh yeah, that old guy, yeah, that's him. So you know, leave a lasting impression the best you can. The more lives you can touch, the more people you can help. It's, you know, it's worth it. 

Josh Fertel

34:26

Two more questions for you. Is there anybody that I can connect you with that you would like to meet? 

Stephan Cohen

34:33

I don't know the answer to that question. I'll have to continue to see you on LinkedIn. There you go, and I'm sure there will be somebody and I will reach out to you, because I know where to find you now. 

Josh Fertel

34:42

There you go, that's fine. And last, I always like to ask if and I know you're going to have a great answer for this If I had a magic wand, Dr Stephen, and I can give it to you and you could do anything you wanted with it, what would you do with it? 

Stephan Cohen

34:56

Oh boy, yeah, to do with it. Oh boy, yeah, that's, that's a great question yeah, I think, if, yeah, if I had the magic wand, within an instant I would, I would, you know, start at every level Patients, doctors, dieticians, everybody in politics, everybody to go back to the 1920s. Right, not necessarily go back, but have that mindset of food is nutrition and food is health. 

Josh Fertel

35:25

Right. 

Stephan Cohen

35:26

And that would eliminate all the needless, you know the medicines that we did, that we still do now. Right, that would eliminate all the chronic illnesses. We can get back to the roots of you know Hippocrates, which is, you know, food is medicine. Yeah, and that would be a game changer, because what would happen is that you know going. So what's going to happen? The one thing I talked about is what's going to change the next 30 years. The whole medical space of longevity and people living longer is going to change the paradigm in the future, there's no doubt. But it's not going to be. You take a pill and you live to 120. No, no, no. You have to start with the basics. 

Josh Fertel

36:12

Change your habits. 

Stephan Cohen

36:14

Right. You have to make sure you do resistance training to not lose muscle. You have to make sure you're eating the right way, not eating everything out of a box, getting rid of ultra processed food. Then, with some of the other things that are coming whether it's sauna use or other disruptors that will stimulate some certain proteins in your body. Now you're going to live to 120. So my magic wand would be, all of a sudden, on day one, everybody is paying attention to what they're eating. We have no more toxic substance in any of our food or water. That way we can live to 120. 

Josh Fertel

36:55

Love it. I knew you weren't going to let me down with that. 

Stephan Cohen

36:58

Thank you. 

Josh Fertel

36:59

Thank you so much for coming on. You are an educator, which is such a noble thing that you do, passing on your years of experience, and I appreciate it, and I thank you for anybody that you've ever had a conversation with, and I'm hoping that you'll come back again soon and give us some more stories. 

Stephan Cohen

37:18

All right, very good. Thank you so much for the opportunity I appreciate it, you guys, dr steven, thank you. 

Josh Fertel

37:23

Thank you for listening today, please.