June 13, 2025 • 34 mins
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Is a 24/7 call one week per month sustainable for an entire career? This question strikes at the heart of physician work-life balance, career longevity, and personal wellbeing. From personal experiences, these schedules cause sleep disruption, cognitive impairment, and physical strain.
To be honest, a position paying substantially above market rate usually demands extraordinary sacrifice but as physicians we can create a sustainable medical career. Tune in to hear our practical strategies.
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Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:00):
If you missed the first segment, if you missed the
first question, we kind oftalked about what it's like to
get a locums gig for a veryshort period of time, if you're
just ending residency.
So if you haven't heard thatone, go back to the one before
that.
Now we're going to be talkingabout Dr Nate.
Speaker 2 (00:17):
Yeah, so you know I'm scouring Reddit right now and
spending some time here tryingto get some information about
how we can discuss things thatare kind of really on, like what
people are really talking about.
So from the Reddit medicine Idon't know what this means forum
, I forget what this all means.
But someone in Reddit tell mehow this works.
But this is in medicine.
It says how sustainable is 24seven call for one week per
(00:38):
month, procedural?
And it says it seems it seemssome procedural fields have a
model where attendings are oncall one week per month for what
I assume is 24-7.
Is this sustainable for anentire career?
People who have done it inspecialties where you're
frequently called from homewhile on call how intolerable is
the schedule?
So I will start off by sayingthis is not how I work.
(00:59):
I don't think trauma surgery islike this at all.
When they say procedure, I'mthinking when I see this I think
they're talking about likecardiology, interventional
radiology, like those type ofspecialties where you can be
home for a significant period oftime and then when you get
called in, it's really to do aprocedure and then go back home.
Speaker 1 (01:18):
But I feel like you kind of did this.
Speaker 2 (01:20):
Well, what I?
So, guys, let me preface thisby saying um when I worked, um.
I don't do 24 seven callanymore.
I don't like it.
Speaker 1 (01:26):
Right, but when you were at, so I would do, yeah.
Speaker 2 (01:29):
So one of my first gigs, the first jobs that I
worked, I would do 24, seven,right.
So I would work Monday 24 hours.
I would take in all the traumas, all the general surgery for 24
hours, from 7am until 7am.
The next morning 24 hours from7 am until 7 am the next morning
.
Then, technically, from youknow, once I sign out, which is
at seven o'clock in the morning,Tuesday, I'm off.
(01:50):
I'm on backup though.
Speaker 1 (01:52):
Right, but that's what I'm saying, like to say off
.
Is that right, or you're justbackup?
Speaker 2 (02:06):
OK, so I don't count backup as off.
So backup means I'm in thehotel or I'm in my house and I
am sleeping, I am recovering,but I cannot drink.
I cannot be more than 15minutes away, because the person
who's doing 24-7 call onTuesday in the hospital if
there's an emergency andemergencies could be like hey, I
need to go to the OR and do anappendectomy and a trauma comes
in.
Then the person who's on backup,which would be me on Tuesday,
you got to go in, I got to comein, I got to be prepared to come
(02:28):
in.
The likelihood of thathappening, though, is low.
I can't tell you what thepercentage is.
But the percentage is less than20% chance that I may have to
come in.
So let's say nothing, comes in,I'm just resting.
I'm eating, I'm watching TV, I'mrecovering and so forth, but I
(02:49):
got to have my phone on rightnext to me.
No-transcript, no duties, nobackup for 24 hours or for two
(03:13):
weeks.
Right, those two weeks werehell.
You know it was rough.
There could be two weeks whereyou know when you're on backup.
You don't get called at all.
There could be times whereyou're finishing your call at
seven in the morning.
So let's say it's Tuesdaymorning, I'm finishing up from
Monday and you know I get anappy that comes in at five in
the morning, or I get an appythat comes in at three in the
(03:34):
morning.
The next question is in yourmind is well, who's going to do
this appy?
Who's the best person to dothis Appy?
Should it be me, who's justfinishing Right?
So now we're talking aboutoperating.
Speaker 1 (03:46):
Our legs are shaking, our 27, our 28.
Speaker 2 (03:50):
Or should it be the fresh person who comes in, but
they haven't gotten a chance toround round, they haven't gotten
a chance to like, see and getto know any of these patients,
and then they're still gettinggeneral surgery.
Yes, so it's a tough.
It's so many mental gymnasticsthat I just didn't like it
anymore.
You know I don't like it.
So for me, I work at traumacenters, acute care surgery
centers that do 12 hour shifts.
(04:12):
You work hard for 12 hours andthen tag, the next person takes
care of it, so they're freshenough so that they can still
operate.
Or if you need to stay a littlebit later on, you're like on
hour 13, 14.
If you need to stay a littlebit later on, you're like on
hour 13, 14, 15, like you're notexhausted, right, and you can
still do an operation if youjust don't want the person
coming in, the night person, orvice versa, the day person to
(04:36):
get screwed.
So that's what I do, but 24hour seven.
I always imagine this for theprocedural type folks like the
folks who don't have to bein-house all the time right my
job, I have to be in-house right, right, except for when you
were backup right so like.
That's why I think like the irdocs who like maybe during the
daytime they just have regular,normal ir stuff, but at
nighttime I just noticed thatfor like a week straight you
(04:57):
know if you got a spleen thatneeds to be embolized.
If you have, you know somethingthat's extravasating that needs
to be embolized they come in.
And that's tough, but it's.
You know.
You always look at it as OK.
Can you work hard for a weekand then be off Right, Right,
it's tough.
There's so many differentfactors to think about this,
Like but are you really off forthat week Right After that week
(05:20):
is done, Right?
Speaker 1 (05:20):
After that week is done.
Speaker 2 (05:21):
Right After that week is done, you're probably going
back to a regular schedule whereyou're just doing that's what I
was going to ask.
Speaker 1 (05:26):
A regular 7 am Is that just the call, right Like,
is that just the call, or isthat how they work?
I think it's call.
Speaker 2 (05:34):
Yeah, excuse me, I think it's call.
Speaker 1 (05:36):
Yeah, I think the question is referring just to
the call right, because so, forthose of you who may or may not
kind of understand how you knowa lot of doctors schedules work.
You can be in the hospitalwhere you have a shift.
That shift doesn't necessarilyequate to call Right, is that?
Speaker 2 (05:59):
Yeah, yeah, yeah, you work.
It doesn't necessarily.
You get there at 7 am, you worktill like 5, 6 o'clock, right,
it doesn't always equate to callright.
Speaker 1 (06:06):
So call might be the thing that you do mostly at
night or overnight, right, butsometimes call can look like
you're just the person on allday for that particular shift,
which might be 24 hours.
Speaker 2 (06:23):
Right.
Speaker 1 (06:24):
Right or longer than 24 hours.
So for example me, I do a 62and a half hour shift from
Friday evening to Monday morningRight, so call can look a lot
different depending on RightRight, you know where you are.
Speaker 2 (06:39):
So I think it's definitely harder on the on the
services where you take a weekof call and you still are doing
stuff during the daytime.
Speaker 1 (06:47):
So that's what I'm saying.
Speaker 2 (06:49):
Let's say from 7 am to 5 pm.
You still have regular stuffthat you have to do, like your
IR doc.
And you still got to schedulestuff during the daytime, but
then from 5 pm until the nextmorning you might get called in
or you've possibly been calledin to do stuff, and then you
still got to come back in thenext morning.
And do 7 am to 5 pm.
Speaker 1 (07:10):
Yes, that's tough.
That is tough.
We see that in OB a lot.
But then when you finish withthat week, you may have the
weekend off, but then Mondaycomes and you're not on call,
but you're still doing 7 am to 5pm and you keep going yeah we
see that in OB Not so much 24-7call right, we don't really see
OBs on consecutively like thatbut you might have an OB service
(07:35):
that could have you on call two, maybe even three times I mean,
three is excessive, but two orthree times a week, you know and
then also have weekend call,maybe once a month or maybe
twice a month again, dependingon how many docs are in your
rotation.
Speaker 2 (07:54):
What does that do to you, like I know, when you do
your weekends, there's a feelingof how you feel on Friday
versus how you feel Monday.
Yeah, talk to me about that.
How, how you feel on Fridayversus how you feel Monday.
Yeah, talk to me about that.
How do you feel about that?
Speaker 1 (08:07):
So okay, so this is how it happens.
So I wake up on Friday, I'mhome, right, take the kids to
school, do all kinds of things,pick the kids up from school,
and I'm probably alreadystarting to get a little tired,
(08:30):
right?
So by Friday evening I'm okay,I'm okay, but there's usually
some people on the floor,usually a delivery.
That either happens on thatFriday or happens early Saturday
morning.
Okay, if it's early Saturdaymorning and when I say early
Saturday morning, I'm talkingabout the ones the 2 o'clock, 3
(08:52):
o'clock in the morning yeah, Istart to get a little bit tired,
you know.
So I might have to put my headdown, if I can.
I try to put my head downSaturday morning usually.
Speaker 2 (09:03):
And you have a call room and everything.
Yes, I have a call room.
Speaker 1 (09:06):
Usually by Saturday morning, I get my second wind
and I'm able to round on peopleyou do your bump what's the bump
?
Speaker 2 (09:17):
I can't feel my face, I'm just joking what?
Speaker 1 (09:22):
oh, ew me I'm talking about dad no, I know, no me,
what the hell okay.
Speaker 2 (09:30):
I'm like what's a bump?
I do my.
What do you call it?
Do the bump your Red Bull?
Red Bull, which everybody, I'mputting it out there, everybody.
Speaker 1 (09:38):
You know what Hold on .
You know Red Bull had a lawsuit.
Speaker 2 (09:42):
About what.
Speaker 1 (09:43):
Because it don't really give you wings.
Speaker 2 (09:45):
What do you mean?
Like literally, doesn't giveyou wings.
Speaker 1 (09:48):
That literally doesn't give you wings.
Oh my.
Speaker 2 (09:50):
God, guys, come on, Are you serious?
Speaker 1 (09:52):
If you noticed right, they don't have people flying
on the Red Bull commercialsanymore.
They don't have people oranimals or whatever flying and
it says wings, w-i-i-i-n-g-s.
Apparently there was a lawsuitabout Red Bull not really giving
you wings.
(10:12):
People figured out some sort ofloophole, like oh, I thought it
was going to give me wings, butit didn't Get the fuck out of
here.
Speaker 2 (10:19):
So yes, red Bull was involved in a notable lawsuit
concerning its slogan Red BullGives you Wings.
In 2013, benjamin See filed aclass action lawsuit against the
company, alleging that theslogan of the marketing claims
were misleading.
The lawsuit contended that theRed Bull's assertions about
enhancing performance,concentration and reaction speed
lacked scientificsubstantiation.
While the phrase gives youwings is metaphorical, the suit
(10:41):
argued that the overallmarketing implied tangible
benefits that the product didnot deliver.
Hey, so you could really sueover anything else.
Speaker 1 (10:48):
Oh, you know what.
You know who we're going to suenext.
Who we're going to sue.
What's the name?
A Holiday Inn Express.
Speaker 2 (10:55):
Why is that?
Speaker 1 (10:55):
Because, remember, if you slept at a Holiday Inn
Express, all of a sudden youcould do like all kinds of
physics.
Speaker 2 (11:00):
Yeah, I see.
Speaker 1 (11:00):
Anyway.
Speaker 2 (11:03):
But yeah, so real quick, before you move on, Guys,
I'm giving up my.
So I have a little bit of anaddiction to energy drinks Red
Bull or Celsius, ew, so and both, just I gotta give it up
Caffeine.
So I need you guys to keep meaccountable, because we all
family and if you guys want tosee me not get a heart attack on
(11:23):
this show, you want me to getthis stuff up.
Speaker 1 (11:25):
That would be nice.
Speaker 2 (11:27):
I probably go through a can a day.
Speaker 1 (11:29):
A can.
Yeah, I probably go through acan a day.
A can.
Yeah, I probably go through acan a day.
A can.
Speaker 2 (11:32):
Oh, like over the last month, probably a can a day
, Not even probably like a canevery other day, but how I was
like two months ago.
Speaker 1 (11:41):
Two months ago you were ridiculous.
Yeah, it was crazy.
Speaker 2 (11:43):
I was like going to Costco like yo, this is a good
deal.
Can I get my fix?
This is a good deal.
Speaker 1 (11:48):
I get my fix.
This is a good deal.
At the cashier we're like okay,can I get this?
It's like, sir, just use yourATM card.
Renee, you're the straight one,anyway, especially like a wife
who really doesn't drinkcaffeine.
Speaker 2 (12:01):
Okay, so tell us about what happens.
Speaker 1 (12:04):
So Saturday I get my second wind Right and I'm okay
to round.
Usually on Saturday I'm like,ah, chances are we're going to
get something that comes in.
And I'm usually right, we getsomething that comes in.
Either the patient is laboringor maybe she rules out and she's
not in labor, and then I'm able, usually on Saturday, to go
(12:26):
back to my hotel room for someperiod of time whether it's the
entire rest of Saturday intoSunday morning, that remains to
be seen.
By Sunday morning I'm usuallyback at the hospital, usually
rounding.
Maybe I'm doing a delivery inthe morning and then finishing
up rounding and again just kindof waiting to see if someone's
(12:48):
gonna come in.
Sometimes we have an inductionon Sunday.
They started putting in some ofthe inductions on Sundays, so
I'll start the induction and,depending on how I'm starting
the induction, I usually caneither rest up in the hospital
or I can actually leave and gosleep, and then Monday morning,
(13:12):
depending on, again, what'sgoing on, I'm either in the
hospital or I'm just signing outand that's it.
But that Monday morning I gotto tell you I'm tired.
Speaker 2 (13:23):
Yeah, I am exhausted.
I think that.
Speaker 1 (13:28):
I'm exhausted, so that I'm exhausted.
Speaker 2 (13:32):
So there are times where I feel like if folks
really knew how doctors workedin comparison to pilots, people
would be a bit concerned, a bit.
Speaker 1 (13:40):
Yeah, a bit.
Speaker 2 (13:42):
Because I think you know you know me already how I
feel.
I feel like residency does apoor job of training you for the
real world and I know thatpeople are like well, what does
that mean?
What I mean is yeah, I mean,the 80-hour work week is great.
Right to be able to train in anenvironment where you know
people are actively looking athow long you're working and that
(14:03):
if you go past those limits,you get an opportunity to either
go home or someone is lookingat how well you're studying and
so forth.
But I'll be very honest withy'all, like that's not the real
world.
So that's why I say it's agreat environment to learn, but
it's not.
They're not properly preparingyou to work in the actual
(14:24):
realistic world and I knowthat's a controversial take.
I'm ready for the smoke, I'mready for all that stuff.
Speaker 1 (14:29):
I mean, we worked in the 80-hour work week, so we
experienced it and the reason.
Speaker 2 (14:33):
I'm saying that is listen.
If you really want to see adifference, then you have to not
only just go after what's goingon in residency, which for the
past 20 years.
They have right, they addressedit like right before we started
residency, like 2004,.
I think they started the 80 hourwork you have to go after how
doctors work in the real worldto have any type of you know
(14:55):
significant change.
Like to me, it's just the samething, like you're putting
lipstick on a pig Right bytraining residents.
You know, you guys know whatI'm talking about.
Speaker 1 (15:06):
It looks good in theory.
Speaker 2 (15:08):
But you're sending them out into the world
unprepared.
Speaker 1 (15:10):
Right, right so.
Speaker 2 (15:12):
I got, I got in order for the 24-7 discussion.
The big things that I that Ihave looked up is the sleep
disruption.
Speaker 1 (15:21):
Right, that's what gets me tired is the sleep
disruption.
Speaker 2 (15:24):
There is possibly some cognitive impairment.
There's emotional andpsychological strain I'm sure
you can tell when I've been onfor a while.
Like you know, I'm just off andvice versa.
There's also physical effects,right.
Some of these things are listedas elevated blood pressure.
(15:50):
These, these surveys byMedscape and so far you know,
you'll see things like repeatingthings over weeks and weeks of
these type of call.
Like you have increased chancesof burnout and depression,
right.
Sleep debt and circadianmisalignment, right.
So basically, like you, you'renot sleeping at night when you
(16:10):
should, right.
As a matter of fact, you'rejust like you're getting your
quote-unquote second wind, andlike that just means like you're
just not getting enough sleepright right.
Um, there's also safety risksthat we just got to be honest
about it, so it's just somethingin your car being really,
really tired.
Speaker 1 (16:26):
Um, I mean, I remember just even in residency,
right, we talked about like thewhole 80 hour work week, but
even even that right, becauseyeah, it's 80 hours One, 80
hours is a lot.
So you're, you're literallyworking, you know double what
majority of the country works inany given week.
But two, it, you also have tokind of look at when you're
(16:50):
working.
That right, we talked aboutcircadian cycles and so when
you're thinking about workingnight shift or you are working,
you know regular during the weekor during the day, the regular
shifts during the day.
But then you come back on a Idon't know, on a Saturday or a
Thursday or whatever it is, andyou come back on a I don't know,
(17:11):
on a Saturday or Thursday orwhatever it is, and you have to
work 24 hours, a 24-hour shift,right Now, you're kind of thrown
off, right.
And so I remember, oh man, Iremember this one time in
residency I was so tired, I kidyou not.
I remember I was on Route 1 andI fell asleep at the light.
Yeah, I fell asleep at thelight.
Speaker 2 (17:32):
I fell asleep at the light.
That's a boring-ass drive,though, too.
Speaker 1 (17:34):
Well, yeah, it's a boring drive, but I mean, I was
15 minutes away from myresidency program but I fell
asleep.
Speaker 2 (17:41):
You weren't excited to get back and call me and talk
to me and stuff.
Let me get so excited.
I'm so excited to finish myresidency.
Speaker 1 (17:47):
I definitely was not excited to talk to you in
residency, because in residency,ooh, ooh, like too much
information.
Speaker 2 (17:54):
You ain't got to share everything, yeah, but you
don't want that started if youdidn't want everything to come
out.
You should have started it.
Hold on a second, you on one.
Alright, listen, guys.
So this is a point where I talkabout.
Speaker 1 (18:03):
We'll ask your Logan's work wife.
What the hell going on?
Because?
Because who going live with mewhen I pop up on Dr Ne?
Speaker 2 (18:12):
Surprise mother****.
You just finished a 24-hourcall, okay.
So listen, guys, there's somemitigation strategies that you
can use.
This is where I always tellpeople, like when you're
negotiating a contract or you'relooking at something and you're
like man, like they're offeringme a lot of money to do X, y
and Z.
(18:32):
These are the things that youhave to start thinking about.
Is it really worth it to getthat additional 100K?
Is it really worth it to getyou know, whatever it may be in
terms of money, if it means thatyou are possibly sacrificing
your physical wellbeing, yourmental wellbeing?
So one thing that I would sayis you know when you're seeing
(18:54):
if you're going into a position,if you're going into a job, and
you see that this is apossibility where you may have
to do a week of 24-7 call, butyou know during the daytime you
still have to do your regularlyscheduled stuff.
Or when that call is overMonday, you're back on.
Right, like you have to makesure that.
You consider, like man, maybe Ishould really force, not income
(19:18):
, but really force that I getprotected post time time, post
call, time off.
Right, like yo, you're going togive me like 72 hours to
recover if I do 24 hours.
If, listen, guys, I'm notsaying whatever, you need a day,
24 hours, 48 hours, whatever itmay be Right, because if you're
telling them, listen, like,look, I'll take 50K less, but
(19:39):
I'm just I'm making sure that Iget two days off protected.
That might be, that might beeverything Right, that might
save your marriage, that might,you know, decrease the amount of
strain that you're putting onyourself and prolong your life
you know, nobody can everexponentially nobody can ever
tell.
Speaker 1 (19:52):
It'll help you see your kids more.
Speaker 2 (19:54):
Right.
The other thing too is, youknow, taking in, like you know
I'm talking about the energydrinks and so forth.
I'm a big, you know.
Like I've red flag for me, likeI'm taking energy drinks at
like seven o'clock at night andlet's say, for example, nothing
happens at nighttime.
Now you're up because you tookin caffeine, you took in an
energy drink when you could besleeping, and now when it's time
(20:19):
to sleep during the daytime,you're kind of you're off, you
know.
So limiting caffeine to earlyhours is good.
And then the other thing toothis goes back to contract and
just seeing how places look whenyou're interviewing them Team
based coverage to preventoverloading one individual is
huge right.
So at my facility or thefacilities that I work at, like
there's some locums positionsthat I look at now that say hey,
like you know, when you're oneperson on, you're handling
(20:41):
trauma, you're handling generalsurgery and you're handling
critical care, and I'm like well, how long am I doing that for?
Well, we need you to do it for72 hours.
Click, don't pass go.
Speaker 1 (20:51):
I don't want to deal with that Right.
Speaker 2 (20:52):
Those are literally three individual services that
you're taking care of and you'redoing that for 72 hours
straight, or a lot, or 48 hoursstraight.
That's a lot, that's a lot ofdecisions that you got to make,
so for me that doesn't work.
So for me I prefer, you know,for 12 hours I can cover trauma,
I can cover general surgery, Ican cover critical care and if I
need to transfer people out, Ihave that option.
Like these are things that youhave to consider and these are
(21:14):
things that I would recommend islook for places, particularly
when you guys just first get outright.
Look for places that haveteam-based coverage.
That's what you're looking for,but it may not be like that for
every specialty.
I know maybe ob may not be likethat and ir.
You know they can't afford tohave like two ir people at the
same time or cardiology, butjust something to think about
money and everything, man.
Speaker 1 (21:35):
Yeah, I mean, but what you're talking about is
scope of work yeah right isessentially what you're talking
about.
Speaker 2 (21:41):
What does that mean, though?
Like talk, no, scope of work,these big words, but you don't
know what scope of work.
Speaker 1 (21:45):
So explain it so explain it.
Speaker 2 (21:47):
That's why, when I talk like that's what she wrote
Okay, but I'm about to.
Speaker 1 (21:50):
But she wrote she was like dear knee and dear back
knee.
Speaker 2 (21:53):
I love how you explain stuff, especially knee.
Speaker 1 (21:55):
No, she didn't say especially knee.
Speaker 2 (21:57):
Scope of work Anyway.
Speaker 1 (21:59):
So scope of work, right.
What are you going to be doingduring the day?
And also what is the level ofcare, right?
So for OB, for example, right,you guys, in a trauma world, you
have you know level one, leveltwo, level three, right, you
mean for trauma activation, fortrauma activations, right, like
(22:20):
the higher, the lower, the levelthe more you know you should be
, the more resources areavailable.
Exactly, which means the busieryou're probably going to be,
whereas it's kind of the samething with OB, except we go down
right.
So the higher the level forNICU, right, the busier that we
are more likely going to be,because the NICU will kind of
determine what the OB service isgoing to be.
(22:43):
And so you have to kind ofdetermine well, do I want to be
at a level three NICU hospital,if you're, you know, if you're
doing OB?
Do I want to be at a level one,you know, or nursery, you know,
newborn nursery hospital whenit comes to OB?
And so you have to kind of justthink about those things.
Do you want to work office, doyou think?
Speaker 2 (23:02):
that people because I don't do office anymore.
Do you think people reallythink like that?
Because I think like you'vecome to were you initially.
You came in initially thinkinglike that.
There are certain types ofplaces that you don't want to
work at.
There are certain types ofexperiences that you just don't
want to deal with anymore.
I definitely didn't.
Well, I kind of thought aboutthat with level one versus level
(23:24):
two.
I was like I'm kind of burntout from the level one system.
I'd like to be at level twosyeah and so forth.
That was as far as I went, but Ithink what you just mentioned
is really important, whereyou're saying like yeah, like I,
there's certain types of nico's, which means there's only
there's only a certain level ofsick type babies that I want to
deal with or complicatedpregnancies I want to deal with
(23:46):
can you talk?
Speaker 1 (23:47):
more about that without using, like the big
buzzword, me Jeez, anyway.
So if you're in a level threeNICU, right, chances are you
have what they call anantepartum service or a bigger
antepartum service, whichbasically means that you have
mothers, you have pregnant womenwho are going to make up a
(24:08):
service, right?
So it's not just labor anddelivery, it's mothers who have
not and are not yet ready todeliver, and you're probably
going to have a whole floor fullof those women, right, that you
now have to take care of.
And so if they're havingcomplications in their
pregnancies, you have to nowdetermine like, oh well, should
I deliver her?
(24:28):
Should I not deliver her?
Like, you have to kind of gothrough this kind of rigmarole
and always think about the risksand benefits of either
delivering this woman or notdelivering this woman, and a lot
of times you're going totransfer them over to labor and
delivery, thinking, okay, thisis it, we're going to deliver
her.
And the next unit?
She doesn't do anything.
And you're like all right, well, transfer her back.
(24:49):
And the next unit, she doesn'tdo anything.
You're like, all right, well,transfer her back to the floor
because she doesn't look likeshe's going to deliver.
Oh wait, it looks like she'sgoing to deliver again.
Speaker 2 (24:57):
Transfer her back Like those decisions are
decisions that I'm like ooh,they were.
Yeah, they're mental gymnastics.
Speaker 1 (25:00):
That was fun in residency, Not so fun now.
I can do without that.
So I don't do level three NICUanymore, I only I do level two
and anything below that.
That's that's kind of where Iam, and sometimes we do get
antepartum patients, but it'snot a it's not a big service.
Yeah, it's not a huge serviceanymore.
Speaker 2 (25:23):
Yeah, I really wanted just I want the folks to really
realize that, like yo, youreally can do and work in any
way that you want.
Speaker 1 (25:31):
You can decide.
Speaker 2 (25:33):
You just have to know that you can look for it.
You have to then at the sametime know how to ask for it and
then kind of follow through.
Speaker 1 (25:42):
Yeah.
Speaker 2 (25:42):
And I think that's one thing that it took me a
while to realize.
Well, I didn't know I wasmoving in that direction.
I kind of was moving in thatdirection without really
thinking about it, when the onlyjobs that I was looking at were
level twos.
Me.
I like working with residents,but it just so happened that
most of the places that I was athad PAs.
(26:03):
I love working with residents.
Speaker 1 (26:05):
Me too.
Speaker 2 (26:07):
But the places that I'm at it's few and far between,
so I think that it's super andfar between.
So you know, I think that it'ssuper important for the folks
who are listening right now.
If you are in residency andyou're looking for a gig is you
know?
Just know that you know verythere's a lot of things that
you're going to take fromresidency, that you're going to
(26:28):
apply right the knowledge wise.
But in terms of the environmentthat doesn't necessarily have to
go with you, particularly ifthe environment that you are
working in is something that youdon't like you don't
necessarily have to replicate itjust because you know, you did
it in residency.
You can actually avoid thatstuff.
You can say well, I was in abig academic center, I like my
(26:50):
first job to be at a communitybased.
Or I don't want to work withresidents, or I don't want to
work with you know.
Whoever Right or I am, you know, I don't want to have to take
call.
Speaker 1 (27:02):
Right.
Speaker 2 (27:02):
There's some surgeons and procedural places that are
like I don't want to have totake calls, or family meds
internal meds Don't take call.
Speaker 1 (27:10):
I mean, I think it's really important to just know
what it is.
Yeah, I want to doing what it isthat you actually like to do,
by saying, oh well, but you knowwhat?
(27:30):
If you don't ever do X, y and Z, again it's like, well, I don't
like doing it, so what's thebig deal?
You know, if I don't like doingsomething, then I should have
the right not to do that thing,right, because there is value in
doing other things that youlike.
One in the main value.
I don't know about you, but themain value is you become very
(27:53):
good at the things that youactually like to do, right, you
become kind of the master of one, right, and so I think that
there's something to be said forthat If you're pushing yourself
to do something.
I think attending should bepushing to be said for that.
Speaker 2 (28:05):
If you're pushing yourself to do something that
you— I think attending should bepushing that more.
Speaker 1 (28:09):
Yeah, exactly, do what it is that you love.
Speaker 2 (28:11):
I know you're going to leave this residency, but
just know that there's ways thatyou can be really super good at
just a couple of things and bevery successful.
We're not going to look at youany other way and stuff.
Speaker 1 (28:22):
Right exactly.
Speaker 2 (28:23):
I think that comes with maturity.
I think that comes withmaturity.
Yeah, I think that comes withthe school of hard knocks and
you just realize the BS that youwant to put up with Exactly.
You may just say I'm going toput up with this, but I'm
getting rid of all this otherstuff.
Yep, we see that in trauma,actually, like any place that
wants to start a trauma center,you'll see that there's a
significant amount of people ata hospital that are usually
resisting the transition from ahospital becoming a trauma
(28:45):
hospital.
And they'll tell you bro, Icame here to avoid this stuff.
I don't want to deal with levelone stuff I don't want to deal
with level two stuff.
I just want to take care ofpeople.
I don't want to have to have tomake like like, for example,
like a lot of you know, withtrauma in critical care you have
to like the amount ofechocardiograms that get ordered
like, exponentially increase.
So now the people who read itare cardiologists, right.
(29:06):
So now they are having to readechoes in the middle of the
night or during the daytime andthey're like look, man, like the
way how it was before you guysgot here was you know, an echo
was only ordered by my serviceand we only ordered maybe five
echoes a week.
Now, all of a sudden we're upto like 30 echoes.
Some of them are stat, some ofthem need to be read, like at
two o'clock in the morning andguess what you know.
(29:28):
So it's just one thing toconsider.
Is guys like money ain'teverything.
Speaker 1 (29:33):
Yeah.
Speaker 2 (29:34):
A lot of times this is a really good question A lot
of times, your workingenvironment, how you get up, and
how you move.
Speaker 1 (29:39):
Look at the money last.
I'm telling you it's not andthat when I say look at the
money last, I don't mean thatmoney is not important.
Right, Just put.
Just because you put somethinglast doesn't mean that it's not
important.
But I say put the money lastbecause a lot of times when you
put the money first, you makethat so important to you that
you forget to look at all thoseother things.
Speaker 2 (30:01):
Or you put up with stuff, Right.
So the money if they're willingto pay you a million dollars
for something that the averageis like $500,000.
Speaker 1 (30:08):
You're going to have to earn it.
Speaker 2 (30:10):
You're going to have to earn it, but you're going to
be willing to put up with a lotof stuff.
Yeah earn it To justify gettingthat million dollars.
Speaker 1 (30:16):
Exactly earn it.
Speaker 2 (30:17):
And you're going to be like well, this is what comes
, along with the $1 million.
And you're going to be like butI looked at that $1 million
first, so now it's hard to gobackwards.
Exactly, but if you look atthis and be like.
You want me to work 30 days,for how Like I ain't doing none?
Of that I ain't doing that.
Speaker 1 (30:39):
I ain't doing it, then they.
I think about it, though youwould think about it, but you
would think about not gettingthat million dollars because,
listen, you can't get your timeback.
You can always make money inother ways.
Speaker 2 (30:48):
Yeah, there's studies , but you can't get time back.
There's a study that I thinkI've got to look it up.
Maybe chat, gpt or someone canwrite in and let us know.
But there's a study that showslike once you make a certain
amount of money, you make right.
Like I think it's like 75k orsomething like that.
Like most people are likeextremely happy at 75k, right,
(31:09):
but this must have been like 20years ago because yo the way the
price of the eggs tariffs.
But once you get past that pointright, once you start going
into 100k, 200k, 300k and wellinto you know where we're
talking about seven figures likethe level of the, the amount of
activity that people have likedramatically decreases because,
(31:31):
yeah, they have all that money,gotta earn it.
But you gotta earn it and a lotof times that may involve
giving up weekends.
Um, giving it giving upsomething that you may want to
do with your family going to avacation.
Earn it um, whatever it may be,you know, earn it and that's
when you're going to do withyour family going to a vacation,
earn it, whatever it may be.
You know earn it.
And that's when you're going tobe at work all the time, and
then that's when you will haveto have a work husband or a work
(31:52):
wife.
Speaker 1 (31:53):
Earn it.
Speaker 2 (31:54):
Earn it, earn it, earn it.
I got to look up that study.
But if anybody knows it, writeit in and we'll go from there.
Speaker 1 (32:03):
But nobody giving you a million dollars or whatever a
huge salary to sit on your ass.
Let's just put it out there.
Yeah, so you're going to haveto earn it.
Speaker 2 (32:13):
Well in clinical medicine.
Speaker 1 (32:16):
Well, that's what we're talking about, right,
that's what we're talking aboutNow, if you're the.
Ceo, that's a different story.
Okay, they literally paying youa whole six-figure salary to
sit on your ass in the black carthat they sent to you.
Speaker 2 (32:30):
Oh, you're going to get the show canceled.
You're going to get the showcanceled.
Speaker 1 (32:32):
Listen, listen.
Speaker 2 (32:34):
If I'm lying, then they can cancel me For all the
people who listen to this show,who are new yo shout out to
y'all we appreciate y'all onYouTube.
Sorry, sorry, but we're nottalking about anybody in
particular.
Everything, alfred, please.
On the bottom, just put likewhat is it?
Speaker 1 (32:49):
Description of fiction.
Disclaimer Description.
Speaker 2 (32:51):
Everything in these things are fictional, Fictional
Gang gang.
What do you call it?
Gang gang?
A lot of this shit isdramatized, but this shit ain't
Shout out to the person whowrote to us about the first
question, Dr Muna, Shout out toyou, and Surf Al, who wrote that
question on Reddit.
They didn't write it to us, butI just took it from Reddit.
But listen, guys, you know howto get in touch with us.
I'm going to read this againbecause I just want to read
(33:15):
again.
Guys, listen, I got a differentone right here.
Chat, GPT, help me fromphysicians who are breaking the
mold and redefining what itmeans to be a doctor today.
Whether you're a pre-med,knee-deep in residency,
knee-deep in running your ownpractice, Docs Outside the Box
is here to give you the toolsand confidence to take control
(33:35):
of your career and your life.
Got a question about studentloans, locums, non-clinical
careers or anything in between?
We want to hear from you.
Damn it.
Shoot us your questions, big orsmall, and we just might answer
it right here on the show.
Email us at we ain't got noemail or DM us on Instagram at
(33:58):
and this is your chance to getthe answers you need from people
who've been there.
No fluff, no filter, juststraight talk from doctors doing
things differently.
Speaker 1 (34:06):
Music swells.
Go ahead, Alfred.
Speaker 2 (34:14):
Peace y'all.
Catch you guys on the nextepisode.
Speaker 1 (34:16):
Go out and vote.
If you missed the first segment, if you missed the
first question, we kind oftalked about what it's like to
get a locums gig for a veryshort period of time, if you're
just ending residency.
So if you haven't heard thatone, go back to the one before
that.
Now we're going to be talkingabout Dr Nate.
Speaker 2 (00:17):
Yeah, so you know I'm scouring Reddit right now and
spending some time here tryingto get some information about
how we can discuss things thatare kind of really on, like what
people are really talking about.
So from the Reddit medicine Idon't know what this means forum
, I forget what this all means.
But someone in Reddit tell mehow this works.
But this is in medicine.
It says how sustainable is 24seven call for one week per
(00:38):
month, procedural?
And it says it seems it seemssome procedural fields have a
model where attendings are oncall one week per month for what
I assume is 24-7.
Is this sustainable for anentire career?
People who have done it inspecialties where you're
frequently called from homewhile on call how intolerable is
the schedule?
So I will start off by sayingthis is not how I work.
(00:59):
I don't think trauma surgery islike this at all.
When they say procedure, I'mthinking when I see this I think
they're talking about likecardiology, interventional
radiology, like those type ofspecialties where you can be
home for a significant period oftime and then when you get
called in, it's really to do aprocedure and then go back home.
Speaker 1 (01:18):
But I feel like you kind of did this.
Speaker 2 (01:20):
Well, what I?
So, guys, let me preface thisby saying um when I worked, um.
I don't do 24 seven callanymore.
I don't like it.
Speaker 1 (01:26):
Right, but when you were at, so I would do, yeah.
Speaker 2 (01:29):
So one of my first gigs, the first jobs that I
worked, I would do 24, seven,right.
So I would work Monday 24 hours.
I would take in all the traumas, all the general surgery for 24
hours, from 7am until 7am.
The next morning 24 hours from7 am until 7 am the next morning
.
Then, technically, from youknow, once I sign out, which is
at seven o'clock in the morning,Tuesday, I'm off.
(01:50):
I'm on backup though.
Speaker 1 (01:52):
Right, but that's what I'm saying, like to say off
.
Is that right, or you're justbackup?
Speaker 2 (02:06):
OK, so I don't count backup as off.
So backup means I'm in thehotel or I'm in my house and I
am sleeping, I am recovering,but I cannot drink.
I cannot be more than 15minutes away, because the person
who's doing 24-7 call onTuesday in the hospital if
there's an emergency andemergencies could be like hey, I
need to go to the OR and do anappendectomy and a trauma comes
in.
Then the person who's on backup,which would be me on Tuesday,
you got to go in, I got to comein, I got to be prepared to come
(02:28):
in.
The likelihood of thathappening, though, is low.
I can't tell you what thepercentage is.
But the percentage is less than20% chance that I may have to
come in.
So let's say nothing, comes in,I'm just resting.
I'm eating, I'm watching TV, I'mrecovering and so forth, but I
(02:49):
got to have my phone on rightnext to me.
No-transcript, no duties, nobackup for 24 hours or for two
(03:13):
weeks.
Right, those two weeks werehell.
You know it was rough.
There could be two weeks whereyou know when you're on backup.
You don't get called at all.
There could be times whereyou're finishing your call at
seven in the morning.
So let's say it's Tuesdaymorning, I'm finishing up from
Monday and you know I get anappy that comes in at five in
the morning, or I get an appythat comes in at three in the
(03:34):
morning.
The next question is in yourmind is well, who's going to do
this appy?
Who's the best person to dothis Appy?
Should it be me, who's justfinishing Right?
So now we're talking aboutoperating.
Speaker 1 (03:46):
Our legs are shaking, our 27, our 28.
Speaker 2 (03:50):
Or should it be the fresh person who comes in, but
they haven't gotten a chance toround round, they haven't gotten
a chance to like, see and getto know any of these patients,
and then they're still gettinggeneral surgery.
Yes, so it's a tough.
It's so many mental gymnasticsthat I just didn't like it
anymore.
You know I don't like it.
So for me, I work at traumacenters, acute care surgery
centers that do 12 hour shifts.
(04:12):
You work hard for 12 hours andthen tag, the next person takes
care of it, so they're freshenough so that they can still
operate.
Or if you need to stay a littlebit later on, you're like on
hour 13, 14.
If you need to stay a littlebit later on, you're like on
hour 13, 14, 15, like you're notexhausted, right, and you can
still do an operation if youjust don't want the person
coming in, the night person, orvice versa, the day person to
(04:36):
get screwed.
So that's what I do, but 24hour seven.
I always imagine this for theprocedural type folks like the
folks who don't have to bein-house all the time right my
job, I have to be in-house right, right, except for when you
were backup right so like.
That's why I think like the irdocs who like maybe during the
daytime they just have regular,normal ir stuff, but at
nighttime I just noticed thatfor like a week straight you
(04:57):
know if you got a spleen thatneeds to be embolized.
If you have, you know somethingthat's extravasating that needs
to be embolized they come in.
And that's tough, but it's.
You know.
You always look at it as OK.
Can you work hard for a weekand then be off Right, Right,
it's tough.
There's so many differentfactors to think about this,
Like but are you really off forthat week Right After that week
(05:20):
is done, Right?
Speaker 1 (05:20):
After that week is done.
Speaker 2 (05:21):
Right After that week is done, you're probably going
back to a regular schedule whereyou're just doing that's what I
was going to ask.
Speaker 1 (05:26):
A regular 7 am Is that just the call, right Like,
is that just the call, or isthat how they work?
I think it's call.
Speaker 2 (05:34):
Yeah, excuse me, I think it's call.
Speaker 1 (05:36):
Yeah, I think the question is referring just to
the call right, because so, forthose of you who may or may not
kind of understand how you knowa lot of doctors schedules work.
You can be in the hospitalwhere you have a shift.
That shift doesn't necessarilyequate to call Right, is that?
Speaker 2 (05:59):
Yeah, yeah, yeah, you work.
It doesn't necessarily.
You get there at 7 am, you worktill like 5, 6 o'clock, right,
it doesn't always equate to callright.
Speaker 1 (06:06):
So call might be the thing that you do mostly at
night or overnight, right, butsometimes call can look like
you're just the person on allday for that particular shift,
which might be 24 hours.
Speaker 2 (06:23):
Right.
Speaker 1 (06:24):
Right or longer than 24 hours.
So for example me, I do a 62and a half hour shift from
Friday evening to Monday morningRight, so call can look a lot
different depending on RightRight, you know where you are.
Speaker 2 (06:39):
So I think it's definitely harder on the on the
services where you take a weekof call and you still are doing
stuff during the daytime.
Speaker 1 (06:47):
So that's what I'm saying.
Speaker 2 (06:49):
Let's say from 7 am to 5 pm.
You still have regular stuffthat you have to do, like your
IR doc.
And you still got to schedulestuff during the daytime, but
then from 5 pm until the nextmorning you might get called in
or you've possibly been calledin to do stuff, and then you
still got to come back in thenext morning.
And do 7 am to 5 pm.
Speaker 1 (07:10):
Yes, that's tough.
That is tough.
We see that in OB a lot.
But then when you finish withthat week, you may have the
weekend off, but then Mondaycomes and you're not on call,
but you're still doing 7 am to 5pm and you keep going yeah we
see that in OB Not so much 24-7call right, we don't really see
OBs on consecutively like thatbut you might have an OB service
(07:35):
that could have you on call two, maybe even three times I mean,
three is excessive, but two orthree times a week, you know and
then also have weekend call,maybe once a month or maybe
twice a month again, dependingon how many docs are in your
rotation.
Speaker 2 (07:54):
What does that do to you, like I know, when you do
your weekends, there's a feelingof how you feel on Friday
versus how you feel Monday.
Yeah, talk to me about that.
How, how you feel on Fridayversus how you feel Monday.
Yeah, talk to me about that.
How do you feel about that?
Speaker 1 (08:07):
So okay, so this is how it happens.
So I wake up on Friday, I'mhome, right, take the kids to
school, do all kinds of things,pick the kids up from school,
and I'm probably alreadystarting to get a little tired,
(08:30):
right?
So by Friday evening I'm okay,I'm okay, but there's usually
some people on the floor,usually a delivery.
That either happens on thatFriday or happens early Saturday
morning.
Okay, if it's early Saturdaymorning and when I say early
Saturday morning, I'm talkingabout the ones the 2 o'clock, 3
(08:52):
o'clock in the morning yeah, Istart to get a little bit tired,
you know.
So I might have to put my headdown, if I can.
I try to put my head downSaturday morning usually.
Speaker 2 (09:03):
And you have a call room and everything.
Yes, I have a call room.
Speaker 1 (09:06):
Usually by Saturday morning, I get my second wind
and I'm able to round on peopleyou do your bump what's the bump
?
Speaker 2 (09:17):
I can't feel my face, I'm just joking what?
Speaker 1 (09:22):
oh, ew me I'm talking about dad no, I know, no me,
what the hell okay.
Speaker 2 (09:30):
I'm like what's a bump?
I do my.
What do you call it?
Do the bump your Red Bull?
Red Bull, which everybody, I'mputting it out there, everybody.
Speaker 1 (09:38):
You know what Hold on .
You know Red Bull had a lawsuit.
Speaker 2 (09:42):
About what.
Speaker 1 (09:43):
Because it don't really give you wings.
Speaker 2 (09:45):
What do you mean?
Like literally, doesn't giveyou wings.
Speaker 1 (09:48):
That literally doesn't give you wings.
Oh my.
Speaker 2 (09:50):
God, guys, come on, Are you serious?
Speaker 1 (09:52):
If you noticed right, they don't have people flying
on the Red Bull commercialsanymore.
They don't have people oranimals or whatever flying and
it says wings, w-i-i-i-n-g-s.
Apparently there was a lawsuitabout Red Bull not really giving
you wings.
(10:12):
People figured out some sort ofloophole, like oh, I thought it
was going to give me wings, butit didn't Get the fuck out of
here.
Speaker 2 (10:19):
So yes, red Bull was involved in a notable lawsuit
concerning its slogan Red BullGives you Wings.
In 2013, benjamin See filed aclass action lawsuit against the
company, alleging that theslogan of the marketing claims
were misleading.
The lawsuit contended that theRed Bull's assertions about
enhancing performance,concentration and reaction speed
lacked scientificsubstantiation.
While the phrase gives youwings is metaphorical, the suit
(10:41):
argued that the overallmarketing implied tangible
benefits that the product didnot deliver.
Hey, so you could really sueover anything else.
Speaker 1 (10:48):
Oh, you know what.
You know who we're going to suenext.
Who we're going to sue.
What's the name?
A Holiday Inn Express.
Speaker 2 (10:55):
Why is that?
Speaker 1 (10:55):
Because, remember, if you slept at a Holiday Inn
Express, all of a sudden youcould do like all kinds of
physics.
Speaker 2 (11:00):
Yeah, I see.
Speaker 1 (11:00):
Anyway.
Speaker 2 (11:03):
But yeah, so real quick, before you move on, Guys,
I'm giving up my.
So I have a little bit of anaddiction to energy drinks Red
Bull or Celsius, ew, so and both, just I gotta give it up
Caffeine.
So I need you guys to keep meaccountable, because we all
family and if you guys want tosee me not get a heart attack on
(11:23):
this show, you want me to getthis stuff up.
Speaker 1 (11:25):
That would be nice.
Speaker 2 (11:27):
I probably go through a can a day.
Speaker 1 (11:29):
A can.
Yeah, I probably go through acan a day.
A can.
Yeah, I probably go through acan a day.
A can.
Speaker 2 (11:32):
Oh, like over the last month, probably a can a day
, Not even probably like a canevery other day, but how I was
like two months ago.
Speaker 1 (11:41):
Two months ago you were ridiculous.
Yeah, it was crazy.
Speaker 2 (11:43):
I was like going to Costco like yo, this is a good
deal.
Can I get my fix?
This is a good deal.
Speaker 1 (11:48):
I get my fix.
This is a good deal.
At the cashier we're like okay,can I get this?
It's like, sir, just use yourATM card.
Renee, you're the straight one,anyway, especially like a wife
who really doesn't drinkcaffeine.
Speaker 2 (12:01):
Okay, so tell us about what happens.
Speaker 1 (12:04):
So Saturday I get my second wind Right and I'm okay
to round.
Usually on Saturday I'm like,ah, chances are we're going to
get something that comes in.
And I'm usually right, we getsomething that comes in.
Either the patient is laboringor maybe she rules out and she's
not in labor, and then I'm able, usually on Saturday, to go
(12:26):
back to my hotel room for someperiod of time whether it's the
entire rest of Saturday intoSunday morning, that remains to
be seen.
By Sunday morning I'm usuallyback at the hospital, usually
rounding.
Maybe I'm doing a delivery inthe morning and then finishing
up rounding and again just kindof waiting to see if someone's
(12:48):
gonna come in.
Sometimes we have an inductionon Sunday.
They started putting in some ofthe inductions on Sundays, so
I'll start the induction and,depending on how I'm starting
the induction, I usually caneither rest up in the hospital
or I can actually leave and gosleep, and then Monday morning,
(13:12):
depending on, again, what'sgoing on, I'm either in the
hospital or I'm just signing outand that's it.
But that Monday morning I gotto tell you I'm tired.
Speaker 2 (13:23):
Yeah, I am exhausted.
I think that.
Speaker 1 (13:28):
I'm exhausted, so that I'm exhausted.
Speaker 2 (13:32):
So there are times where I feel like if folks
really knew how doctors workedin comparison to pilots, people
would be a bit concerned, a bit.
Speaker 1 (13:40):
Yeah, a bit.
Speaker 2 (13:42):
Because I think you know you know me already how I
feel.
I feel like residency does apoor job of training you for the
real world and I know thatpeople are like well, what does
that mean?
What I mean is yeah, I mean,the 80-hour work week is great.
Right to be able to train in anenvironment where you know
people are actively looking athow long you're working and that
(14:03):
if you go past those limits,you get an opportunity to either
go home or someone is lookingat how well you're studying and
so forth.
But I'll be very honest withy'all, like that's not the real
world.
So that's why I say it's agreat environment to learn, but
it's not.
They're not properly preparingyou to work in the actual
(14:24):
realistic world and I knowthat's a controversial take.
I'm ready for the smoke, I'mready for all that stuff.
Speaker 1 (14:29):
I mean, we worked in the 80-hour work week, so we
experienced it and the reason.
Speaker 2 (14:33):
I'm saying that is listen.
If you really want to see adifference, then you have to not
only just go after what's goingon in residency, which for the
past 20 years.
They have right, they addressedit like right before we started
residency, like 2004,.
I think they started the 80 hourwork you have to go after how
doctors work in the real worldto have any type of you know
(14:55):
significant change.
Like to me, it's just the samething, like you're putting
lipstick on a pig Right bytraining residents.
You know, you guys know whatI'm talking about.
Speaker 1 (15:06):
It looks good in theory.
Speaker 2 (15:08):
But you're sending them out into the world
unprepared.
Speaker 1 (15:10):
Right, right so.
Speaker 2 (15:12):
I got, I got in order for the 24-7 discussion.
The big things that I that Ihave looked up is the sleep
disruption.
Speaker 1 (15:21):
Right, that's what gets me tired is the sleep
disruption.
Speaker 2 (15:24):
There is possibly some cognitive impairment.
There's emotional andpsychological strain I'm sure
you can tell when I've been onfor a while.
Like you know, I'm just off andvice versa.
There's also physical effects,right.
Some of these things are listedas elevated blood pressure.
(15:50):
These, these surveys byMedscape and so far you know,
you'll see things like repeatingthings over weeks and weeks of
these type of call.
Like you have increased chancesof burnout and depression,
right.
Sleep debt and circadianmisalignment, right.
So basically, like you, you'renot sleeping at night when you
(16:10):
should, right.
As a matter of fact, you'rejust like you're getting your
quote-unquote second wind, andlike that just means like you're
just not getting enough sleepright right.
Um, there's also safety risksthat we just got to be honest
about it, so it's just somethingin your car being really,
really tired.
Speaker 1 (16:26):
Um, I mean, I remember just even in residency,
right, we talked about like thewhole 80 hour work week, but
even even that right, becauseyeah, it's 80 hours One, 80
hours is a lot.
So you're, you're literallyworking, you know double what
majority of the country works inany given week.
But two, it, you also have tokind of look at when you're
(16:50):
working.
That right, we talked aboutcircadian cycles and so when
you're thinking about workingnight shift or you are working,
you know regular during the weekor during the day, the regular
shifts during the day.
But then you come back on a Idon't know, on a Saturday or a
Thursday or whatever it is, andyou come back on a I don't know,
(17:11):
on a Saturday or Thursday orwhatever it is, and you have to
work 24 hours, a 24-hour shift,right Now, you're kind of thrown
off, right.
And so I remember, oh man, Iremember this one time in
residency I was so tired, I kidyou not.
I remember I was on Route 1 andI fell asleep at the light.
Yeah, I fell asleep at thelight.
Speaker 2 (17:32):
I fell asleep at the light.
That's a boring-ass drive,though, too.
Speaker 1 (17:34):
Well, yeah, it's a boring drive, but I mean, I was
15 minutes away from myresidency program but I fell
asleep.
Speaker 2 (17:41):
You weren't excited to get back and call me and talk
to me and stuff.
Let me get so excited.
I'm so excited to finish myresidency.
Speaker 1 (17:47):
I definitely was not excited to talk to you in
residency, because in residency,ooh, ooh, like too much
information.
Speaker 2 (17:54):
You ain't got to share everything, yeah, but you
don't want that started if youdidn't want everything to come
out.
You should have started it.
Hold on a second, you on one.
Alright, listen, guys.
So this is a point where I talkabout.
Speaker 1 (18:03):
We'll ask your Logan's work wife.
What the hell going on?
Because?
Because who going live with mewhen I pop up on Dr Ne?
Speaker 2 (18:12):
Surprise mother****.
You just finished a 24-hourcall, okay.
So listen, guys, there's somemitigation strategies that you
can use.
This is where I always tellpeople, like when you're
negotiating a contract or you'relooking at something and you're
like man, like they're offeringme a lot of money to do X, y
and Z.
(18:32):
These are the things that youhave to start thinking about.
Is it really worth it to getthat additional 100K?
Is it really worth it to getyou know, whatever it may be in
terms of money, if it means thatyou are possibly sacrificing
your physical wellbeing, yourmental wellbeing?
So one thing that I would sayis you know when you're seeing
(18:54):
if you're going into a position,if you're going into a job, and
you see that this is apossibility where you may have
to do a week of 24-7 call, butyou know during the daytime you
still have to do your regularlyscheduled stuff.
Or when that call is overMonday, you're back on.
Right, like you have to makesure that.
You consider, like man, maybe Ishould really force, not income
(19:18):
, but really force that I getprotected post time time, post
call, time off.
Right, like yo, you're going togive me like 72 hours to
recover if I do 24 hours.
If, listen, guys, I'm notsaying whatever, you need a day,
24 hours, 48 hours, whatever itmay be Right, because if you're
telling them, listen, like,look, I'll take 50K less, but
(19:39):
I'm just I'm making sure that Iget two days off protected.
That might be, that might beeverything Right, that might
save your marriage, that might,you know, decrease the amount of
strain that you're putting onyourself and prolong your life
you know, nobody can everexponentially nobody can ever
tell.
Speaker 1 (19:52):
It'll help you see your kids more.
Speaker 2 (19:54):
Right.
The other thing too is, youknow, taking in, like you know
I'm talking about the energydrinks and so forth.
I'm a big, you know.
Like I've red flag for me, likeI'm taking energy drinks at
like seven o'clock at night andlet's say, for example, nothing
happens at nighttime.
Now you're up because you tookin caffeine, you took in an
energy drink when you could besleeping, and now when it's time
(20:19):
to sleep during the daytime,you're kind of you're off, you
know.
So limiting caffeine to earlyhours is good.
And then the other thing toothis goes back to contract and
just seeing how places look whenyou're interviewing them Team
based coverage to preventoverloading one individual is
huge right.
So at my facility or thefacilities that I work at, like
there's some locums positionsthat I look at now that say hey,
like you know, when you're oneperson on, you're handling
(20:41):
trauma, you're handling generalsurgery and you're handling
critical care, and I'm like well, how long am I doing that for?
Well, we need you to do it for72 hours.
Click, don't pass go.
Speaker 1 (20:51):
I don't want to deal with that Right.
Speaker 2 (20:52):
Those are literally three individual services that
you're taking care of and you'redoing that for 72 hours
straight, or a lot, or 48 hoursstraight.
That's a lot, that's a lot ofdecisions that you got to make,
so for me that doesn't work.
So for me I prefer, you know,for 12 hours I can cover trauma,
I can cover general surgery, Ican cover critical care and if I
need to transfer people out, Ihave that option.
Like these are things that youhave to consider and these are
(21:14):
things that I would recommend islook for places, particularly
when you guys just first get outright.
Look for places that haveteam-based coverage.
That's what you're looking for,but it may not be like that for
every specialty.
I know maybe ob may not be likethat and ir.
You know they can't afford tohave like two ir people at the
same time or cardiology, butjust something to think about
money and everything, man.
Speaker 1 (21:35):
Yeah, I mean, but what you're talking about is
scope of work yeah right isessentially what you're talking
about.
Speaker 2 (21:41):
What does that mean, though?
Like talk, no, scope of work,these big words, but you don't
know what scope of work.
Speaker 1 (21:45):
So explain it so explain it.
Speaker 2 (21:47):
That's why, when I talk like that's what she wrote
Okay, but I'm about to.
Speaker 1 (21:50):
But she wrote she was like dear knee and dear back
knee.
Speaker 2 (21:53):
I love how you explain stuff, especially knee.
Speaker 1 (21:55):
No, she didn't say especially knee.
Speaker 2 (21:57):
Scope of work Anyway.
Speaker 1 (21:59):
So scope of work, right.
What are you going to be doingduring the day?
And also what is the level ofcare, right?
So for OB, for example, right,you guys, in a trauma world, you
have you know level one, leveltwo, level three, right, you
mean for trauma activation, fortrauma activations, right, like
(22:20):
the higher, the lower, the levelthe more you know you should be
, the more resources areavailable.
Exactly, which means the busieryou're probably going to be,
whereas it's kind of the samething with OB, except we go down
right.
So the higher the level forNICU, right, the busier that we
are more likely going to be,because the NICU will kind of
determine what the OB service isgoing to be.
(22:43):
And so you have to kind ofdetermine well, do I want to be
at a level three NICU hospital,if you're, you know, if you're
doing OB?
Do I want to be at a level one,you know, or nursery, you know,
newborn nursery hospital whenit comes to OB?
And so you have to kind of justthink about those things.
Do you want to work office, doyou think?
Speaker 2 (23:02):
that people because I don't do office anymore.
Do you think people reallythink like that?
Because I think like you'vecome to were you initially.
You came in initially thinkinglike that.
There are certain types ofplaces that you don't want to
work at.
There are certain types ofexperiences that you just don't
want to deal with anymore.
I definitely didn't.
Well, I kind of thought aboutthat with level one versus level
(23:24):
two.
I was like I'm kind of burntout from the level one system.
I'd like to be at level twosyeah and so forth.
That was as far as I went, but Ithink what you just mentioned
is really important, whereyou're saying like yeah, like I,
there's certain types of nico's, which means there's only
there's only a certain level ofsick type babies that I want to
deal with or complicatedpregnancies I want to deal with
(23:46):
can you talk?
Speaker 1 (23:47):
more about that without using, like the big
buzzword, me Jeez, anyway.
So if you're in a level threeNICU, right, chances are you
have what they call anantepartum service or a bigger
antepartum service, whichbasically means that you have
mothers, you have pregnant womenwho are going to make up a
(24:08):
service, right?
So it's not just labor anddelivery, it's mothers who have
not and are not yet ready todeliver, and you're probably
going to have a whole floor fullof those women, right, that you
now have to take care of.
And so if they're havingcomplications in their
pregnancies, you have to nowdetermine like, oh well, should
I deliver her?
(24:28):
Should I not deliver her?
Like, you have to kind of gothrough this kind of rigmarole
and always think about the risksand benefits of either
delivering this woman or notdelivering this woman, and a lot
of times you're going totransfer them over to labor and
delivery, thinking, okay, thisis it, we're going to deliver
her.
And the next unit?
She doesn't do anything.
And you're like all right, well, transfer her back.
(24:49):
And the next unit, she doesn'tdo anything.
You're like, all right, well,transfer her back to the floor
because she doesn't look likeshe's going to deliver.
Oh wait, it looks like she'sgoing to deliver again.
Speaker 2 (24:57):
Transfer her back Like those decisions are
decisions that I'm like ooh,they were.
Yeah, they're mental gymnastics.
Speaker 1 (25:00):
That was fun in residency, Not so fun now.
I can do without that.
So I don't do level three NICUanymore, I only I do level two
and anything below that.
That's that's kind of where Iam, and sometimes we do get
antepartum patients, but it'snot a it's not a big service.
Yeah, it's not a huge serviceanymore.
Speaker 2 (25:23):
Yeah, I really wanted just I want the folks to really
realize that, like yo, youreally can do and work in any
way that you want.
Speaker 1 (25:31):
You can decide.
Speaker 2 (25:33):
You just have to know that you can look for it.
You have to then at the sametime know how to ask for it and
then kind of follow through.
Speaker 1 (25:42):
Yeah.
Speaker 2 (25:42):
And I think that's one thing that it took me a
while to realize.
Well, I didn't know I wasmoving in that direction.
I kind of was moving in thatdirection without really
thinking about it, when the onlyjobs that I was looking at were
level twos.
Me.
I like working with residents,but it just so happened that
most of the places that I was athad PAs.
(26:03):
I love working with residents.
Speaker 1 (26:05):
Me too.
Speaker 2 (26:07):
But the places that I'm at it's few and far between,
so I think that it's super andfar between.
So you know, I think that it'ssuper important for the folks
who are listening right now.
If you are in residency andyou're looking for a gig is you
know?
Just know that you know verythere's a lot of things that
you're going to take fromresidency, that you're going to
(26:28):
apply right the knowledge wise.
But in terms of the environmentthat doesn't necessarily have to
go with you, particularly ifthe environment that you are
working in is something that youdon't like you don't
necessarily have to replicate itjust because you know, you did
it in residency.
You can actually avoid thatstuff.
You can say well, I was in abig academic center, I like my
(26:50):
first job to be at a communitybased.
Or I don't want to work withresidents, or I don't want to
work with you know.
Whoever Right or I am, you know, I don't want to have to take
call.
Speaker 1 (27:02):
Right.
Speaker 2 (27:02):
There's some surgeons and procedural places that are
like I don't want to have totake calls, or family meds
internal meds Don't take call.
Speaker 1 (27:10):
I mean, I think it's really important to just know
what it is.
Yeah, I want to doing what it isthat you actually like to do,
by saying, oh well, but you knowwhat?
(27:30):
If you don't ever do X, y and Z, again it's like, well, I don't
like doing it, so what's thebig deal?
You know, if I don't like doingsomething, then I should have
the right not to do that thing,right, because there is value in
doing other things that youlike.
One in the main value.
I don't know about you, but themain value is you become very
(27:53):
good at the things that youactually like to do, right, you
become kind of the master of one, right, and so I think that
there's something to be said forthat If you're pushing yourself
to do something.
I think attending should bepushing to be said for that.
Speaker 2 (28:05):
If you're pushing yourself to do something that
you— I think attending should bepushing that more.
Speaker 1 (28:09):
Yeah, exactly, do what it is that you love.
Speaker 2 (28:11):
I know you're going to leave this residency, but
just know that there's ways thatyou can be really super good at
just a couple of things and bevery successful.
We're not going to look at youany other way and stuff.
Speaker 1 (28:22):
Right exactly.
Speaker 2 (28:23):
I think that comes with maturity.
I think that comes withmaturity.
Yeah, I think that comes withthe school of hard knocks and
you just realize the BS that youwant to put up with Exactly.
You may just say I'm going toput up with this, but I'm
getting rid of all this otherstuff.
Yep, we see that in trauma,actually, like any place that
wants to start a trauma center,you'll see that there's a
significant amount of people ata hospital that are usually
resisting the transition from ahospital becoming a trauma
(28:45):
hospital.
And they'll tell you bro, Icame here to avoid this stuff.
I don't want to deal with levelone stuff I don't want to deal
with level two stuff.
I just want to take care ofpeople.
I don't want to have to have tomake like like, for example,
like a lot of you know, withtrauma in critical care you have
to like the amount ofechocardiograms that get ordered
like, exponentially increase.
So now the people who read itare cardiologists, right.
(29:06):
So now they are having to readechoes in the middle of the
night or during the daytime andthey're like look, man, like the
way how it was before you guysgot here was you know, an echo
was only ordered by my serviceand we only ordered maybe five
echoes a week.
Now, all of a sudden we're upto like 30 echoes.
Some of them are stat, some ofthem need to be read, like at
two o'clock in the morning andguess what you know.
(29:28):
So it's just one thing toconsider.
Is guys like money ain'teverything.
Speaker 1 (29:33):
Yeah.
Speaker 2 (29:34):
A lot of times this is a really good question A lot
of times, your workingenvironment, how you get up, and
how you move.
Speaker 1 (29:39):
Look at the money last.
I'm telling you it's not andthat when I say look at the
money last, I don't mean thatmoney is not important.
Right, Just put.
Just because you put somethinglast doesn't mean that it's not
important.
But I say put the money lastbecause a lot of times when you
put the money first, you makethat so important to you that
you forget to look at all thoseother things.
Speaker 2 (30:01):
Or you put up with stuff, Right.
So the money if they're willingto pay you a million dollars
for something that the averageis like $500,000.
Speaker 1 (30:08):
You're going to have to earn it.
Speaker 2 (30:10):
You're going to have to earn it, but you're going to
be willing to put up with a lotof stuff.
Yeah earn it To justify gettingthat million dollars.
Speaker 1 (30:16):
Exactly earn it.
Speaker 2 (30:17):
And you're going to be like well, this is what comes
, along with the $1 million.
And you're going to be like butI looked at that $1 million
first, so now it's hard to gobackwards.
Exactly, but if you look atthis and be like.
You want me to work 30 days,for how Like I ain't doing none?
Of that I ain't doing that.
Speaker 1 (30:39):
I ain't doing it, then they.
I think about it, though youwould think about it, but you
would think about not gettingthat million dollars because,
listen, you can't get your timeback.
You can always make money inother ways.
Speaker 2 (30:48):
Yeah, there's studies , but you can't get time back.
There's a study that I thinkI've got to look it up.
Maybe chat, gpt or someone canwrite in and let us know.
But there's a study that showslike once you make a certain
amount of money, you make right.
Like I think it's like 75k orsomething like that.
Like most people are likeextremely happy at 75k, right,
(31:09):
but this must have been like 20years ago because yo the way the
price of the eggs tariffs.
But once you get past that pointright, once you start going
into 100k, 200k, 300k and wellinto you know where we're
talking about seven figures likethe level of the, the amount of
activity that people have likedramatically decreases because,
(31:31):
yeah, they have all that money,gotta earn it.
But you gotta earn it and a lotof times that may involve
giving up weekends.
Um, giving it giving upsomething that you may want to
do with your family going to avacation.
Earn it um, whatever it may be,you know, earn it and that's
when you're going to do withyour family going to a vacation,
earn it, whatever it may be.
You know earn it.
And that's when you're going tobe at work all the time, and
then that's when you will haveto have a work husband or a work
(31:52):
wife.
Speaker 1 (31:53):
Earn it.
Speaker 2 (31:54):
Earn it, earn it, earn it.
I got to look up that study.
But if anybody knows it, writeit in and we'll go from there.
Speaker 1 (32:03):
But nobody giving you a million dollars or whatever a
huge salary to sit on your ass.
Let's just put it out there.
Yeah, so you're going to haveto earn it.
Speaker 2 (32:13):
Well in clinical medicine.
Speaker 1 (32:16):
Well, that's what we're talking about, right,
that's what we're talking aboutNow, if you're the.
Ceo, that's a different story.
Okay, they literally paying youa whole six-figure salary to
sit on your ass in the black carthat they sent to you.
Speaker 2 (32:30):
Oh, you're going to get the show canceled.
You're going to get the showcanceled.
Speaker 1 (32:32):
Listen, listen.
Speaker 2 (32:34):
If I'm lying, then they can cancel me For all the
people who listen to this show,who are new yo shout out to
y'all we appreciate y'all onYouTube.
Sorry, sorry, but we're nottalking about anybody in
particular.
Everything, alfred, please.
On the bottom, just put likewhat is it?
Speaker 1 (32:49):
Description of fiction.
Disclaimer Description.
Speaker 2 (32:51):
Everything in these things are fictional, Fictional
Gang gang.
What do you call it?
Gang gang?
A lot of this shit isdramatized, but this shit ain't
Shout out to the person whowrote to us about the first
question, Dr Muna, Shout out toyou, and Surf Al, who wrote that
question on Reddit.
They didn't write it to us, butI just took it from Reddit.
But listen, guys, you know howto get in touch with us.
I'm going to read this againbecause I just want to read
(33:15):
again.
Guys, listen, I got a differentone right here.
Chat, GPT, help me fromphysicians who are breaking the
mold and redefining what itmeans to be a doctor today.
Whether you're a pre-med,knee-deep in residency,
knee-deep in running your ownpractice, Docs Outside the Box
is here to give you the toolsand confidence to take control
(33:35):
of your career and your life.
Got a question about studentloans, locums, non-clinical
careers or anything in between?
We want to hear from you.
Damn it.
Shoot us your questions, big orsmall, and we just might answer
it right here on the show.
Email us at we ain't got noemail or DM us on Instagram at
(33:58):
and this is your chance to getthe answers you need from people
who've been there.
No fluff, no filter, juststraight talk from doctors doing
things differently.
Speaker 1 (34:06):
Music swells.
Go ahead, Alfred.
Speaker 2 (34:14):
Peace y'all.
Catch you guys on the nextepisode.
Speaker 1 (34:16):
Go out and vote.
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