Podcast Summary: AOFAS Orthopod-Cast
Episode: Overcoming Unexpected Mental and Health Stressors
Date: October 9, 2024
Host: AOFAS Podcast Committee
Panelists:
- Joe Park (Host)
- Brett Smith
- Nick Strasser
- Pam Luke
- Anish Kadakia (“Ankle Man”)
- Matt Conti
Episode Overview
This episode dives deeply into the increasing mental and health stressors facing foot and ankle orthopedic surgeons. The panelists—a blend of experienced and early-career surgeons—share candid stories and practical strategies about burnout, loss of autonomy, increased administrative burdens, and the all-consuming expectations of both the profession and patients. Emphasis is placed on self-care, boundary setting, and learning to let go of perfectionist ideals, offering actionable advice for surgeons at all stages of their careers.
Key Discussion Points & Insights
The Escalating Crisis of Burnout in Medicine
[01:24–03:20]
- Physician burnout is at an all-time high, and experienced providers are not being replaced fast enough.
- Contributing factors include administrative overload, declining financial compensation, diminished professional status, litigious environments, and relentless patient demands.
- Memorable Quote:
"As a professional, the rate of burnout for physicians is at an all time high. ...We're not replacing them fast enough... There’s a real potential in a decade we’re in a crisis within health care." – Brett Smith [01:24]
Loss of Autonomy & Value in a System Focused on Productivity
[06:40–08:42]
- Surgeons describe feeling devalued as merely “RVU generators” or “revenue producers,” rather than as skilled professionals.
- Loss of control over clinic templates and schedules is cited as profoundly demoralizing.
- Mentions a trend of physicians moving from hospital systems to private or cash-based practices to regain autonomy.
- Memorable Quote:
“Your administrators want you to think you’re just a number, you’re just an RVU generator... that really detracts from the value of what we are able to provide.” – Joe Park [06:40]
The Hidden Toll: Emotional Challenges Unique to Surgery
[03:45–09:36]
- Older attitudes of stoic endurance have evolved; physicians acknowledge burnout as a real and pervasive issue.
- Surgeons express how the emotional pride and respect associated with the profession has eroded:
"So when I tell my fellows and my residents is nobody cares about you. If you think anybody cares if you die tomorrow, the answer is no, except your family and yourself, hopefully..." – Anish Kadakia [05:05]
- The fragility of mental health amid unexpected personal and professional crises is discussed with candor.
- Cumulative, small stresses—such as negative patient interactions or threats of litigation—are powerful burnout drivers.
Strategies for Handling Bad Days and Difficult Interactions
[09:50–13:03]
- Panelists admit the challenge of maintaining professionalism and emotional stability after negative clinical encounters.
- The importance of self-care (“be kinder to ourselves,” “give ourselves a break”) is emphasized.
- Recognize it’s “normal to respond humanly” and the need to let go and move past bad moments.
- Pam Luke:
“We need to be a little bit selfish. ...To avoid kidney failure…” [12:06] (humorous tone)
Generational and Practical Perspectives on Exhaustion
[13:03–17:44]
- Matt Conti observes that the mental and emotional exhaustion of being an attending is far greater than training.
- Older surgeons reflect that today’s documentation burdens and the inability to ever “make a mistake” have amplified the cognitive load.
- Consensus that “mental exhaustion” is real and not about weakness.
- Strategies include early morning workouts, chatting with peers, long walks, or decompressing before re-entering family life.
“...The problem with our job is there’s no room for error and nobody allows you to be human.” – Anish Kadakia [14:34]
Setting Boundaries in the Digital Age
[17:44–25:50]
- Difficulty disconnecting from work due to electronic health records (EHRs), patient messaging, and constant digital access.
- Strong advocacy for refusing to give out personal phone numbers or email addresses to patients—using institutional channels only.
- Techniques:
- Turn off smartphone notifications for EHR systems
- Restrict patient access to designated windows
- Use support staff (PAs/MAs) to triage and filter communication
- Key Insight: Self-respect and boundaries are critical.
“You’re not a bad doctor if you’re not available 24/7. ...You’re not a good surgeon if you’re exhausted and tired every day.” – Anish Kadakia [26:59]
The Perils of People-Pleasing and Managing “Fancy” Patients
[30:06–34:57]
- Surgeons discuss the emotional labor required when dealing with “high-demand” or wealthy patients who expect special treatment.
- Importance of “setting the rules” and not devaluing one’s expertise by bending over backwards for anyone.
- Universal rules for all patients create respect—treating all equally, regardless of status.
“The more you bend over backwards, the more these rich patients, privileged patients, think you’re no different than the French fry maker.” – Anish Kadakia [31:31]
Communication Skills and Conflict Management
[34:57–35:45]
- Recommendations for resources to help improve difficult conversations:
- Verbal Judo
- Never Split the Difference by Chris Voss
- Empathy and directness, without sacrificing professionalism, are vital to defusing conflict.
Vacation, Delegation, and True Disconnection
[35:45–39:30]
- Most panelists agree that true vacations should mean zero patient contact; trusted staff or partners should take over all communication.
- Some, however, still check messages or respond to colleagues, but strive to avoid patient-facing work.
- Recognize that mental rest, time for family, and genuine absence from work are not just “allowed” but necessary for long-term sustainability.
Final Advice and Reflections
[40:13–42:50]
- It is “okay to be sick,” “okay to take time off,” and the myth of irreplaceability should be rejected.
- The profession does not define personal worth—family and health must come first:
“What we do is not that big a deal... your family and you come first.” – Anish Kadakia [41:09]
- Avoid social media comparison traps and unnecessary status anxiety; focus on personal and family wellness above all.
Notable Quotes & Memorable Moments
-
"Burnout is a real thing. So I've come around to that. ...I want to quit every so often. I'm just financially in disrepair, so that's not an option. But if I was financially stable, I'd quit tomorrow. And that's sad because I love this job and burnout is a real thing."
– Anish Kadakia [03:45] -
"I just come home and I just am completely fixed. ...It's the mental exhaustion of never being allowed to make a mistake... There’s no room for error and nobody allows you to be human."
– Anish Kadakia [14:08, 14:34] -
"The more you look at [patient reviews], the more you go crazy. If you want to be liked by everyone, you’re going to lose your mind. Don’t be a jerk. Yeah."
– Anish Kadakia [29:34] -
"You're not a bad doctor if you're not 24/7. ...you're not a good surgeon if you're exhausted and tired every day. It's not healthy. You're not a good doctor. So these people are not allowed to have you 24/7."
– Anish Kadakia [26:59] -
"It's okay to be a person. ...And nobody tells you it's not weak. ...It's absolutely weak to not recognize that you're not invincible."
– Anish Kadakia [41:09]
Timestamps for Key Segments
- 01:24–03:20 — The scope and urgency of burnout in medicine
- 05:05–06:40 — Emotional toll and isolation; loss of respect and status
- 09:50–13:03 — Self-care, professionalism, and learning to let go
- 13:03–17:44 — Generational exhaustion; practical coping routines
- 17:44–25:50 — Digital boundaries and assertiveness strategies
- 26:59 — "You’re not a bad doctor if you’re not 24/7."
- 30:06–34:57 — Dealing with “fancy”/demanding patients; importance of saying no
- 34:57–35:45 — Communication skills resources
- 35:45–39:30 — Boundaries during vacation, role of trusted teams
- 41:09–42:50 — Final reflections: Prioritizing yourself and your family
Takeaways
- Burnout is real, widespread, and driven by many modern factors beyond personal weakness.
- Establish boundaries early—professionally (with patients, digital communication, and admin) and personally (with family and self-care).
- Set realistic expectations for availability and allow yourself breaks from medicine without guilt.
- Understand that you have inherent value as a person, independent of your career.
- Prioritizing family, health, and self-compassion is not just acceptable, it's vital.
This episode offers honest, hard-earned wisdom for orthopedic surgeons—and indeed all healthcare providers—navigating the unpredictable and often draining realities of modern medical practice.