Thanks so much for joining us today, Chris.
If you could give our audience a bit of an intro as to who you are, your childhood, and
your paths to where you are today.
Sure.
Thank you very much for inviting me.
It's been something I've been looking forward to.
Yeah, I was thinking about, you might ask me to introduce myself, and I realized that
the cliche is that people like talking about themselves, but I actually don't really love
talking about myself, but I'll do my best.
So childhood, I was born and raised in Kitchener Waterloo, which I sort of recognize is in
this global era is not all that exciting a background.
I'm back in Kitchener Waterloo after some years away, but yeah, I think back on childhood,
it was a very good time in my life.
One aspect of my childhood that people ask me that I think stands out for me is my mother's
family were refugees from Eastern Europe.
They were ethnic Germans who had to flee Romania.
They lived in a multi-ethnic community with Germans, Hungarians, Romanians, and Serbs,
but people knew that the Russians were not fond of ethnic Germans, and so they fled.
And they spent some years traveling through Europe.
I believe they lived in Austria and then France, and that went on for years.
But family legend has it that my grandfather, my mother's father, was very anxious to get
citizenship, which to be fair is a pretty legitimate concern as we know today with people
fleeing various regimes.
And he believed that that would happen or could happen faster in Canada, so they ended
up in Canada.
And they came to Kitchener Waterloo because at the time, this would have been in the early
1950s, it was thought that there were a lot of German-speaking people in Kitchener, which
there were, although I think they thought it would be kind of like back home where you'd
go into the store and you could speak German or whatever else, but that wasn't the case.
In the 1950s, it might have been the case in the early 20th century.
But anyway, what I'm going with this is that growing up, so first generation Canadian, and
I actually, my parents both worked, so I lived at my grandparents because there was a duplex.
I'm actually in that house right now because we bought it from my grandmother as a state
when she died.
And at the time it was duplexed, and my parents lived upstairs, my grandparents were downstairs,
and so when my parents went to work, I spent the entire day with my grandparents, as a
preschooler.
And I am told that my first language was German, which I guess this is a very long drawn out
way of getting to the idea that I grew up feeling a little bit like an outsider.
There was a fair bit of anti-German sentiment in Canada at the time.
It was pretty soon after I grew up in the 70s and 80s basically, and there was still a fair
bit of anti-German sentiment.
So even though, obviously in the real world, I pass as an Anglophone Canadian, but when
I brought people home to my house and there's people speaking German, and it was awkward
at times.
And I think what that gave me was a little bit of empathy into several things.
One of them being what it feels like to be a bit of an outsider.
So that colored my childhood for sure.
I've enjoyed, like, you know, it's easy now, speaking and understanding German as an asset
in 2024, but at the time it was a bit awkward.
That said, I had a good childhood.
My parents are very thoughtful people.
They're still very high functioning.
They're both working actually still.
And yeah, where do I go from there?
I went to Queens University, did a biochemistry undergraduate degree.
I worked a little bit in industry during that.
Toward the end of that I had a summer job at a chemistry lab, and my supervisor was Swiss,
and he asked me what I wanted to do when I graduated.
I said, well, ideally I'd love to go to Europe and work in my field in a German-speaking
country.
And a couple months later he basically came to me and said, I have lined up a job for
you in Switzerland with a friend of mine.
So I went to Switzerland for a year, worked for Hoffman La Roche again in a lab.
And then that was a contract.
So I was done, I came back, and I had a PhD in biochemistry lined up, but then applied
to medical school and did that instead.
And so all told, except for the year in Switzerland, I was in Kingston through my undergraduate
degree in medical school, and then I did a five-year urology residency, and then spent
an extra year doing a locum year there before eventually coming back to Kitchener Waterloo.
My parents, again, were here.
At the time we moved back, my grandmother was still alive, and there's a fair bit of
extended family around here.
And yeah, I worked as a urologist for, well, from 2005 until I closed my practice last
year, 2023, so for that long.
Yeah, I don't know what else you want to know.
I guess I should mention that around, I don't know if we're going to talk about medical
burnout, but around 2016 I started to realize I was experiencing burnout, boredom.
You realize after a while most medical specialties are highly repetitive and there isn't a whole
lot new.
You know, again, if we're going to talk about burnout, I'm happy to dive into that.
But I started looking for directions I could go that would be more positive than I would
enjoy more, and I eventually decided that I was interested in business enough to actually
do a business degree, and I did an MBA.
I was fortunate enough that here in Kitchener Waterloo there's a part-time MBA program through
Laurier Lazaridis, School of Economics and Business, and so I did that while still practicing,
and that actually worked very well.
It was a wonderful experience.
People ask, you know, as a physician, did you enjoy doing the MBA?
What was it like?
I loved it.
I loved the subject matter.
I think it's made me a better person, I hope.
Maybe my wife, hopefully she agrees, but I really enjoyed it.
And then since then, I've been trying to forge a, trying to build a second career at the intersection
between medicine and business.
And again, fortunate enough that we have this vibrant tech ecosystem that includes a fair
bit of med tech and health tech here in Kitchener Waterloo.
So I've worked with a number of startups and an advisory and sort of guidance role.
Just recently, I'm working with a local AI startup called Primal.
They're trying to build some healthcare products, and that's been lovely.
They're wonderful people.
I've enjoyed that work very much.
And I should mention before I, I'll stop rambling soon, but I got pulled back into clinical
medicine.
I've been doing some locom work north of here, which I've actually enjoyed very much.
So after over a year of not practicing urology at all, I've been doing that, you know, at
least, I guess five or six days a month.
And I've actually surprised me how much I've been enjoying it.
The working conditions are very different from what led to my burnout in my primary practice.
But so to be fair, there is that, but, but it's been kind of nice to get a little bit
of exposure to clinical medicine again.
Let's go deeper into physician burnout.
There seems to be a lack of meaning and purpose in work for us.
It's something I've been feeling a lot of my colleagues have commented on it.
I'm one of my favorite books as man search for meaning by Victor Frankel.
He's a psychiatrist in the concentration camp.
And then for those listening who don't know about it, essentially, he talks about the
people who give up in concentration camps during the Holocaust and then people who don't.
And the difference is they have meaning and purpose usually driven by someone they love.
So the question I have for you is how do we get meaning and purpose back into medicine?
And why do you think medicine has lost its purpose and meaning for physicians?
Right.
Yeah, that's a great question.
A lot to unpack.
Yeah, I guess, I mean, I would back up a little bit and say, I think my experience of burnout
and I think when you go through it, you do spend a lot of time thinking about it and
analyzing it and wondering, like, you know, where could I've gone differently and might
have made a difference.
And I often quote a friend of mine who said, who says that medical burnout is not caused
by a single variable.
She calls it death by a thousand cuts.
And I think a lot of those factors are systemic.
We have entities like the Ministry of Health, the college, whose interests are very siloed,
even though they intersect in the life of a physician.
And so, you know, oftentimes you'll see situations where the college will essentially implicitly
say, well, we're agnostic about that.
That's between you and the Ministry or that's between you and the OMA.
And likewise, those other siloed entities will do the same thing.
And I think that that, like, to the point about, you know, meaning in clinical medicine,
I think that does become very disillusioning, right?
You think, well, I've approached this in good faith and I put a lot into it and I try to
be my best every day and give meaning to this job.
But these other interests are behaving in ways that take away that meaning.
And I mean, I don't know if I've directly answered your question, but I think the answer
is it's really hard, like, because those are monolithic forces that we don't really have
a lot of power over, right?
I think I'm sure you're familiar with Jillian Horton, who speaks very articulately about
burnout.
She's, I believe, a family physician and she lectures on medical burnout.
And I think she's, and there's other people too, but she does a very good job of framing,
you know, so the cliche, of course, is that institutions, like, say, a hospital that has
been a major factor driving your burnout will pay lip service to burnout mitigation and
say, well, you know, you should do yoga, you should meditate, be more resilient, Rashaan,
right?
And that doesn't help at all.
And so Jillian Horton talks about the fact that until those systemic work environment
factors are mitigated, we will never see the end of burnout.
And I believe that very strongly.
Because, you know, you could look at it too as like intrinsic versus extrinsic motivation
or factors like that.
And the reality is you can't intrinsically, you know, meaning your way out of those systemic
problems.
Again, I don't know if I've really answered your question, but.
Yeah.
Let's go back to when you were a biochemistry major.
I majored in epidemiology and I kind of struggled with this question of whether I should pursue
that as a master's in PhD and going to public health.
As opposed to medicine, as opposed to if I'm being frank with you engineering, which was
what I wanted to do.
But we can get into that later.
We'll prompt the decision to go to med school as opposed to pursuing a more, for lack of
a better word, scientific or more true science.
Yeah.
And that's something I've thought a lot about because like you, I had an affinity for engineering
as well.
I never really, you know, pursued it seriously, but my father's an engineer.
And it's just, you know, there is the appeal of that hybrid, you know, space between theory
and practice that engineers, they solve problems with a whole lot of information.
My path to biochemistry, I don't know if it's interesting to anyone else.
I find it interesting.
So I was, I had been interested to some extent in a medical career, even in high school.
And I was never, you know, I knew people who were just so driven from an early age to be
a physician.
I actually knew a guy, we were in the same class of medical school who had known he wanted
to be a pediatric emergency room physician since he was like 12 years old.
And that's in fact what he actually did, which to me is ridiculous.
Like I was like, well, do I want to do that?
Or do I want to pursue a scientific career?
And so where I was going with this is in high school, I told a guidance counselor that I
might be interested in, in a medical career.
He said, well, and you got it, you got to apply to life sciences.
So I did that.
And I was in the Queens life science program for exactly one year and I hated it because
almost everyone else in the program wanted to go to medical school.
And I wasn't actually 100% sure that I wanted to do that.
And so you're in these classes with these people that are incredibly competitive and
driven, but they're not, they're not actually all that interested in the underlying subject
matter that they're studying at the time.
It's all about a pathway.
And I found that to be a significant turnoff.
So large classes, people are only there as a, you know, a stepping stone.
So I ended up looking around at adjacent programs and discovered that the biochemistry
program at Queens was very good and also very small.
And so I switched into that.
And by, by third year, my classes were down to like a lot of them were just with the other
biochemistry students in my year, which was literally like 15 people.
And it was awesome.
I loved those classes.
The professors were speaking to a small lecture hall full of people that were actually interested
in biochemistry, right?
A couple of us ended up going to medical school in the end, but at the time it wasn't about
a pathway.
It was about, you know, in the moment, I want to know about biochemistry.
But then, yeah, I, you know, I spent enough time in labs and around disillusioned, pure
scientists and, and I, and I guess I thought as well that, you know, we should talk about
this too.
I don't think a lot of people who are interested in a medical career actually know what the
reality looks like before they end up practicing, right?
So I didn't, I assumed that medicine existed at this sort of sweet spot between science
and art, which, okay, it kind of does, but in, in clinical practice, it doesn't feel
like that most days, right?
And I definitely come from a fairly humanistic background and upbringing.
So that, that resonated with me in ways that pure science or say engineering didn't.
And that's, that was sort of how I ended up applying and eventually doing it.
Talk to me about the decision to go back to clinical medicine.
Just in the last few months, you mean?
Yeah.
So, I will admit that there was an extremely practical mundane reason and it was that in
the spring when my CPSO license turned over, I was very conflicted about, you know, what
I would do about that.
Because as you know, it's very costly to, to renew it.
I wasn't practicing at all and I hadn't been practicing for a year, but it, you know, it
struck me that it would be foolish to give it up entirely and then potentially want it
back, which is not that easy to get back.
So I contacted them and basically discovered that not only do I have to pay the CPSO renewal
fee, but also you have to have CMP coverage, which I didn't.
I had stopped it because I wasn't practicing, which in my opinion is completely irrational.
But anyway, it's a rule.
So, so then I thought, well, if I'm going to spend this money on renewing my license
and paying for malpractice insurance in a context where I have literally zero clinical revenue,
that's a little bit hard to justify.
So I reached out to a friend.
I had been doing some local work.
It's an O1 sound where I've been helping out again and I had been doing that in the late
2000s, but I stopped during the pandemic because my kids were young and I couldn't really travel
up there.
And so I reached out to my friend and colleague there and said, I suspect that the ship has
sailed on that and you probably don't need me, but this is my situation.
Is there any way I could help out?
Because I'm looking for ways to justify the cost of starting up my, you know, whatever
my license and my CMPA.
And he said, in fact, we would be thrilled if he came up because I'm super behind on
follow-ups.
I have nowhere to put people.
My secretary would be thrilled if you come, you know, even just once in a while.
And so that's how it started.
And I was a bit apprehensive, as you can imagine.
I had envisioned potentially never practicing again.
I wouldn't say I decided firmly that I never would, but at least on a moving forward basis,
I had no specific intention of going back to clinical medicine.
So I didn't know what to expect, like what I like it, what I hated.
I was certainly not enjoying clinical urology in its previous iteration, but I've actually
quite enjoyed it.
And part of that is that the cultural context there is much more positive and team-oriented.
And I've recognized that I really value that.
I don't enjoy being a lone wolf, which is what most hospital-based specialists are.
You know, you did some hospitalist works, you know what it's like.
You're on your own, more or less.
You might get some support from, say, a consultant that you involve in a patient's care, but
for the most part.
And what I tell a lot of people, too, is that you're not only, it's not strictly true that
you're on your own.
In many cases, the systemic, the many systemic factors line up in a way that they're actively
opposing you.
And in fact, in some cases, they're trying their hardest to throw you under the bus at
all times, right?
So that becomes very, very exhausting.
And where I'm going with this is that the work environment in own sound is very different
from that in my experience.
It's very, there is much more of a collective dynamic, you know, we're kind of in this together.
People are nicer.
So, yeah, I've been pleasantly surprised how much I've been enjoying it.
Yeah, I've seen a shift in increase in accountability almost for patient outcomes thrown on to physicians,
but that goes along with a decrease in control.
And I think that the sense of a lack of autonomy is likely contributing to a burnout as well.
Absolutely.
But yeah, I mean, as a surgeon, again, I would say that so, you know, take one individual
example, you have a patient who urgently needs an operation.
A lot of the time getting that done for them, you know, you would think that, I mean, there's
an operating room that's there and it's for elective cases, but it's also for emergency
cases.
So the system should be set up to do this stuff.
But in reality, at every turn, people are trying to stop you, you know, we have no beds,
you can't you can't bring that patient from the other hospital.
But that patient, you know, needs an urgent operation or they'll die.
Well, we have no beds and you didn't fill out this form properly.
So you'll have to fill it out again.
You can't do it from home.
You'll have to come in in person, you know, all these things that, you know, are put
in their roadblocks to getting patients looked after.
That becomes exhausting.
I think this is a wider trend in Canada in which all the golf leaves and people usually
say these are banks and are telecommunication companies, but I would sort of put hospitals
in that in that category as they really aren't accountable for their decisions to anyone.
Right.
Apart from maybe the Ministry of Health, but that doesn't even seem to matter as much.
There are a lot of physicians listening who would have loved to be in your shoes six months
ago where you were not practicing clinical medicine at all.
The biggest barrier for them is finances.
Talk to me about your financial path on how you were able to set yourself up so you could
leave medicine.
Yeah.
Well, I always tell people quite upfront that I was not even close to being financially
independent and ready to retire.
So my patients were saying, oh, I heard you're retiring and I'd say, nope, I am not retiring.
I am not financially able to do that.
I'm quitting.
I did have a buffer, although I viewed that buffer as essentially, well, it is retirement
savings.
So for the last year and a half, I've certainly chewed through some of that, but I don't know.
I think you have to take risks in life and you have to accept that.
So my financial plan 10 years ago was what it was and I've had to deviate somewhat from
that.
But I do a lot of this.
I wouldn't say it's a bit absurd to say I do this for my children.
I guess on some level I do, but I definitely have been guided by, I was aware that they
were listening to my wife and I complain incessantly about the realities of working in clinical
medicine and I don't think that's particularly good for them to say, well, he complains about
it all the time, but he's not actually doing anything about it.
So I went back to school.
No, definitely multiple reasons I did that, but on one level it was to set an example
for my kids, say, well, you didn't like it, so he changed it.
But again, there is risk and financial risk is definitely one of those risks.
My fingers are crossed that this is going to eventually pay off and I believe that it
will, but I think you have to definitely prepare yourself for a lean period when you're changing
careers.
Yeah, I think most people I talk to, including myself, my income, if I were to transition
and I have not been brave enough to take that leap yet, would be about a fifth to a half
of my clinical income.
And yeah, I'm nowhere near financial freedom.
How do you, is this, how do you decrease your anxiety on the lack of income in terms of,
are you saying, okay, I'm going to give this a shot for one year, two year, three years,
or is it, no, this is what I'm doing for the rest of my life.
And I'm going to figure out a way to make enough income so I'm comfortable and my kids
are comfortable.
It may not be my clinical income, but it will be enough.
How do you decide what that number should be?
Should it be 75% of your clinical income?
And then, yeah, I didn't really approach it that way.
And maybe I should have, like, I think, for sure, a more prudent way to approach this
would be to, you know, you could continue practicing medicine and just try to, you know,
restrict your hours enough to gradually increase whatever alternate, alternate career you're
trying to build.
And I didn't do that.
I was pretty burnt out.
And I really did not enjoy the work environment in Kitchena Waterloo.
But yeah, I don't know if I would view it as sort of, like, sure, I could tell you what,
ideally, I would like to be earning, and I'm not, but for me, it was basically a necessity.
My former career was not only not working for me, it was harming me.
And I needed to do something different.
And on multiple levels, you know, there was the PTSD, the burnout, also the boredom, the
lack of intellectual stimulation.
And that's, I think, for a lot of physicians, that has to be a huge disappointment to think,
well, you know, the public thinks that this is super interesting and challenging, and
you're making up creative solutions to people's medical problems.
One of the realities, you're not doing that 99% of the time, you're just following guidelines,
right?
It's boring a lot of the time.
And then when you, that's compounded by the fact that a lot of patients aren't actually
all that, well, they're not grateful at all, right?
They take you for granted.
Do you think it's always been boring, Chris, or is that a new phenomena?
And if it's a new phenomena, are people different now?
Because that is, I hear that a lot, and I experience that as well.
But I do wonder why older physicians don't seem to say it's boring, or it's not intellectually
stimulating.
Yeah, I think that's an excellent question, and I thought a lot about that.
But I think that to some extent it has become more boring, because, I mean, guidelines are
a good thing, obviously, right?
Like having somebody make something up, and, you know, while this works for me, so I'm
going to do it to all my patients.
That's nonsense, right?
But for sure, the reality, the flip side of guidelines is that it makes everything a recipe.
And it's the same recipe almost every time, right?
So that's, I think that's somewhat different.
That wasn't, you know, guidelines really only started being part of the fabric, what, like
10 or 20 years ago, maybe a little bit more.
But I think that that piece that I mentioned that I think, you know, if you go back far
enough, maybe you have to go back to the 80s or 90s.
But I think that patients were much more grateful, you know, they put a value on it.
I think for me, a pet peeve of mine is that when healthcare is quote unquote free, the
implicit assumption is that it has no value, right?
So then people, and I guess, you know, it's always been like that in our lifetime.
So why is it different now?
Well, I don't know, I guess there's been enough propaganda around that or something, but people
don't seem particularly grateful for the care.
There are exceptions, as you know, like some people are enormously grateful, and that's
very gratifying.
But yeah, I, and then you were so, when did it change?
I think you asked, is that, so I think it's been changing very gradually, but it definitely
is much more noticeable.
You know, it was no, it was more noticeable toward the end of my practice in kitchen water
earlier than it was at the beginning.
So I think it is an inexorable change over time.
With the rise of guidelines in algorithmic medicine, do you think we're over trained?
This is another way of asking, do you think NPs and PAs should replace us?
And then in the future, should AI replace us and can it?
My take is, and I don't claim to know the answer to that.
I think it's a very challenging question that we will have to witness how it plays out and
see, but my sense is, maybe it's a bit overly optimistic, but I think that those sorts of
changes are just going to push us to a different place in the value chain of delivering healthcare.
And in an ideal world, it'll put us in a position, the value chain that's more interesting and
less burnout driving.
That may not be the way it plays out, but I think that AI and, you know, alternative
healthcare providers have the potential to make being a physician a much more interesting
and gratifying job.
I think in terms of being over trained, I don't know.
I do believe that, like I can recall specific examples where I made a significant difference
in someone's care because of something I remembered from training.
You know, there wasn't any guideline.
And everyone else involved in the care of the patient was like, oh, we would have done
this and that would have been really bad.
And I only knew that because I was well trained.
So I don't think that that, I think you're right that to some extent that's what happens
with guidelines, but there are scenarios that guidelines don't cover or scenarios where
you have to say, look, the guideline is great for this, but if you apply it to this, then
that's not going to work out very well.
And it takes insight and experience and knowledge to know, you know, which of those scenarios
applies.
Yeah, there's a couple of themes that come to mind there.
One is we're happy to pay for things that we want, but we're not happy to pay for things
that we need.
We think certain things should be nonprofit, whereas we're okay with certain things being
for profit.
And it's never made sense to me why that distinction exists.
But you know, we think if something is a human right, then we should be nonprofit, which
the downstream effect of that is people aren't paid as well, you know, attract the best and
brightest.
And there seems to be somewhat of a contradiction there.
What are your thoughts there?
Yeah, I think, I mean, to me, recent examples of exactly what you're talking about are the
shifts within dentistry in Canada where the Canadian government is saying, well, and you
know, I think your point is well taken, like those are fundamental rights.
Like why should you lose your teeth because you don't have dental care?
It's absurd because of course that's a huge hit to your health, right?
So on one level, I think it's great, but on another level, like I tell my dentist, like
you guys are screwed.
It's going to be just like medicine, they're going to pay you some absurd fee that doesn't
actually cover your overhead for that procedure.
And they'll just be like, well, that's the way it is now.
Or another one is subsidized daycare.
That's a fundamental public good.
It's fantastic.
But you know, you can see where the economics go.
You know, daycares would be like, well, we can't afford to look after children for those
rates.
And then, you know, that's what happens with publicly provided services.
Yeah, I think this is going to sound very privileged.
And I am very privileged in a lot of ways.
But it seems like there is a percent of society we can economically support.
So say if 10% of people spend all their money on iPhones and to take it further drugs and
gambling, then that's okay.
But if 50% of people spend all their money on what their wants are and don't save any
money for their needs, then the economic model starts to crumble.
Yeah.
So I think that's something we kind of, I don't know, we need someone smarter than me
to figure that number out.
Yeah.
I mean, that kind of economic problem is incredibly complex.
And there's a huge risk, I think, of what they call the wicked problem where you do
something that you think is going to help, but in fact, you make it worse.
But yeah, I think, you know, so we say, well, we are economically a collective and we have
to look out for the, you know, people that can't afford, again, dental care.
Well, I agree with that.
But I think your point is correct.
Like, you know, there comes a certain percentage of the population, if they're not able to
contribute in that way, then eventually it isn't affordable.
And I guess, yeah, you guys see where you're going with this, that our publicly funded
healthcare is headed toward that outcome potentially.
We just won't be able to afford it.
Yeah, let's talk about AI a bit more.
We seem to be very comfortable when AI makes mistakes we would make rarely.
But we're not comfortable in the AI makes mistakes we wouldn't make.
So when you think about regulating AI, say AI misses a PE, a very obvious PE, someone
who has cancer, comes in and attack a car here, shortness of breath, and AI is like
whatever this is, is a UTI.
Anything just complete nonsense to us, right?
But it catches more PE's in people who come in with, because my right pinky is tingling,
something that doesn't make sense to us.
How should we regulate that AI?
Should we just look at it as a whole and say, okay, if you're doing a net positive, then
you're good to go.
Or is that you cannot make these mistakes?
Because one of the problems with AI is it drifts, which is from what I understand, I'm
not an engineer, but what people have explained to me is it goes wonky.
It's like it goes drunk, or it's on drugs for like a second and it just completely loses
its mind.
And there's no way to control for it.
There is a way to control for hallucinations, which is different.
You can put parameters, but this drift phenomena you can't control for.
So how do you think about regulating AI and its mistakes?
Yeah, I mean, that's again, that's a very challenging question.
Good for you for asking it.
I guess the first thing I thought of when trying to think of how I would answer that
is that, so I'm a big believer that I think the terms that are used are AI co-pilots versus
AI agents.
And I think to some extent, what I would respond to the scenario you posed is that I don't think
we're anywhere near relying on AI agents.
So completely putting control over processes into AI.
I think that having an AI co-pilot makes a whole lot of sense.
So in theory, the specific example you mentioned, there would be a human radiologist who would
also be looking at this and saying, well, that doesn't make sense.
There's clearly a PE here or vice versa.
So I think that to me, that's the reality is, and I get a lot of the fears around AI are
really fears about AI agents rather than AI co-pilots.
Three years ago, I was working in urgent care and I felt uneasy.
I went to check my heart rate and I was 126.
That was how I recognized I was burnt out.
And I was working full time in clinical medicine.
I had a startup, I had a young baby at home.
I went home.
I rested.
I did not go to the doctor when I should have.
But that was the beginning of my burnout journey.
Talk to me about how you've recognized you were burnt out.
How long did that journey take and what made the decision to say, okay, I've had enough.
I need to leave this setting.
Yeah.
I mean, I think that I'm also inclined to answer that with reference to anecdotes because
the reality is it is a continuum.
I will say I've thought a fair bit about the fact that I used to use the term PTSD quite
liberally when I think a lot of the time what I was really talking about was burnout.
But that said, I mean, I do recall instances that are pretty classic like PTSD.
And it's funny too because I think for surgeons, there's legit PTSD around body horror and
stuff.
And I remember in my intensive care rotation as a surgery resident, there was a guy who
had necrotizing pancreatitis and they used to bring the general surgery team would wheel
him out of the O.R.
every day or wheel him out of the ICU to the O.R.
every day, wash out his retroperitoneum and then bring him back.
And eventually they installed somebody actually literally went to Canadian Tire and bought
a zipper, which they then so they wouldn't have to open and close it.
They just used a zipper on his abdomen.
And that's horrifying.
You know, this poor guy was there for probably the entire entirety of my ICU rotation.
It's like, how can this possibly happen to somebody?
So there's I think there's legit PTSD and not just a surgery, but in medicine more generally.
And I remember where I was going with this is I remember doing a circumcision in the
operating room and the tissue was garbage.
Like this guy had like awful chronic fibrosis and chronic inflammation.
And I was thinking like, you know, this is one of the most trivial operations in urology.
I, you know, sorry to interrupt Chris, just for our audience, when you said the tissue
is garbage, what does that mean?
And what does that mean in terms of, you know, operation?
That sounds derogatory to a layperson because it isn't meant to be.
But basically, you know, if you can imagine normal skin is supple and healthy and pink
or, you know, beige or whatever.
In some instances, human skin, when it's diseased is not that it becomes, you know, it has the
consistency of styrofoam, I guess, hard to come up with with examples.
But there are scenarios where, you know, the routine performance of an operation is almost
completely impossible because the tissue quality is so poor that it just doesn't do what tissue
is supposed to do.
You can't, you know, put it back together again.
And that's what I was faced with.
You know, on one level, I would say a circumcision is a pretty mundane operation.
But on another level, I literally had a panic attack in the oar.
I doubt anyone else perceived it.
But I bet you my heart rate was 120 and I felt faint.
And I'm like, you know, the other thing with a lot of this stuff is you're on your own,
right?
If I was at a teaching program, I would have a resident and then you're just talking about
it and saying, wow, this is going to be really hard.
But there's nobody there that appreciates it.
They're just like, they're looking at the clock thinking, when is he going to get done
this operation?
Anyway, so an instance of not the only instance of like a legit, you know, PTSD response.
But I think the, I can't remember what your original question was, but the, how did I,
what did my burnout pathway look like?
I just got, you know, I was historically a very empathetic physician, I think, like
unusually so.
And I would, you know, we could talk a lot about maybe being more empathetic puts you
at a higher risk of burnout because I think that's actually true.
But I found myself thinking, wow, I wasn't really all that nice to that guy.
And to be fair, that guy wasn't nice at all to me, but I lost my patience, you know, and
I was sharp with them.
I said, you know, whatever.
So I started noticing instances like that more frequently.
And just, you know, again, the boredom, like coming home and thinking, why, why am I doing
this?
I hated, you know, that sort of thing.
It just became, I guess, putting it another way, the positive experiences diminished
in frequency and intensity and the negative experiences increased, you know, in the opposite
way.
And then at a certain point, I'm like, I really can't do this anymore.
And I struggled through because, you know, the MBA I did took three years and I was still
working through it and beyond it.
And sometimes you just do what you got to do, right?
There's lots of people out there who are working through burnout because they at least financially
have to, right?
So I did that.
But yeah, that's, that's, I don't know, you talk all day about burnout, but that's sort
of one way of framing what my experience was.
If you could talk to 20 year old Chris, biochemistry major, hasn't written the MCAT yet, has not
applied for med school.
What would you tell him in general life advice?
And would you advise him to not pursue medicine?
Yeah, that's tough.
I mean, my kids would probably say, yeah, never a million years based on what they,
you know, what they witness us saying at home and also what we actually say directly to
them, like, don't do this.
But I don't know.
There have been enough upsides to my career choices that I don't think I would tell 20
year old me not to go to medical school.
But I think I might have, like one thing that I really look back, this wouldn't be 20 year
old me be more like, you know, almost 30 year old me.
But I think, again, I think I mentioned earlier about enjoying the team dynamic.
And the other the other piece that I would say is missing and was missing through most
of my career was the teaching part.
I really enjoyed teaching.
I was good at it.
I actually won a clinical teaching award when I was there in Kingston.
So I would say to myself, you should seriously consider a career path that allows you to
be part of a team and to teach because you you're good at that and you enjoy it.
So that would be one thing.
But yeah, it's tough.
I mean, you know, I made a good living for a few years as a physician.
I definitely found as my burnout got worse, my ability to, you know, actually generate
enough revenue to to exceed my overhead got harder and harder to do.
But but it's pretty, you know, people think what physicians make is obviously much more
than what they actually make.
But the reality is it is a pretty well paying job.
And so it's kind of hard to say, oh, yeah, I would probably still do it.
But I think I would have, I know stuff now that would have altered my pathway in important
ways might have mitigated my or slowed down my burnout.
What advice do you have for physicians looking to break into the startup ecosystem as advisors?
Right.
I guess depending on the context, like for geographic reasons, I've mostly been focused
on the Kitchener Waterloo tech ecosystem.
And the reality is that it is normal not to have to pay for advisory services.
So so prepare yourself to not make any money for a while.
I actually had a really lovely conversation with a physician earlier today who asked me
exactly exactly that question.
I said, well, what I would probably do now and that I frankly didn't really do over the
last year is say to any startup that wants to talk to me, I will I will offer you, I
will I will be your chief medical officer and I'll do it for free.
And if I think if you did that enough times, you eventually generate a certain level of
credibility and people would be then coming to you and then eventually it would become
remunerative.
So that would be one thing.
I think the other thing is learning about some of the business type frame framing to
these situations because it's one thing for a startup to come to you and say, well, so
you're a radiologist.
I've got this radiology startup idea.
What do you think?
And in general, the answer is, yeah, that sounds interesting.
You should pursue that.
But I think it helps a lot to say to be able to say, well, okay, but you're going to face
this problem and this problem and the pathway you've chosen is probably not going to work.
So or or if you're going to do that, you're going to have to do this, this, this and this
and you're going to have to be financed for that.
And a lot of you know what I mean?
So that sort of advice is takes a level of knowledge that I think a lot of physician
advisors need to acquire and don't have from the get go.
So how would they acquire that knowledge?
I think the MBA is the easy answer there, but if they can't afford or don't have time
for an MBA.
I think, you know, so one of the most surprisingly good courses that I took at Laurier was their
entrepreneurship class.
I thought it was going to be fluff, but it was actually excellent.
And every week, the professor would bring in a guest lecturer for even for like half
an hour, an actual entrepreneur and like anything, some of them were better than others.
But there was one guy, well, a number of them were excellent, but the one guy in particular
that I recall in this context is he was asked, you know, a similar question.
This wasn't physicians, but you know, what, what, what's your best advice for someone,
you know, who wants to be an entrepreneur?
And he said, read, read everything you can.
And I think nowadays with the transparency of information on almost any topic, you can
train yourself very, very effectively.
It's not going to be the same as doing an MBA, obviously, but you know, you can come
pretty close and depending on how committed you are.
So reading voraciously, falling into rabbit holes and, you know, thinking, man, I just
spent two hours reading about this obscure topic.
That's I think a reasonable way to approach it as well.
Well, we didn't cover, I think, about 70% of the questions I have here.
Well, I'm sorry.
No, this is amazing.
Let's do a part two soon.
Oh, sure.
I'd love to.
It's a pleasure.