Physician Wellness Unfiltered - The FinancialMD Show - Ep 035

noemedagatan
Aug 19
32 min read

Summary:

· Wellness In Times Of Transitions [0:03:04]

· The Struggle In Silence [0:05:33]

· Self-Assessment: Where To Begin [0:08:56]

· Mental Health Toolkit [0:13:50]

· What Comes After The Assessment? [0:17:03]

· The Functional Impact Of Diagnosis [0:19:29

· Psychology Vs Psychiatry [0:22:31]

· The Burnout Spiral: Thoughts, Feelings, Actions [0:27:34]

· Mental Wellness Meets Financial Wellness [0:30:46]

· Know Where You Are, Know Where You’re Going [0:34:12]

· Next Up: Your Financial Game Plan [0:37:28]

Jon Solitro: Money can put a lot of stress on a marriage. It's one of the leading causes of divorce. And so there's a way to go about it that's healthy and respectful.

Dr. Matt Huckabee: Taking the noise out of the system, it's so easy. There are so many voices out there. It's so easy to get overwhelmed when in reality, none of this is that hard or that complicated. Once you really understand a little bit better, it's really not a bad process, but you can just feel a little overwhelmed.

Jon: What are some things that maybe are just quick self-assessment to questions they can ask to say, do you notice this about yourself?

Matt: A hundred percent, right. Irritability, withdrawal from friends, right; the sense of detachment from your work.

Jon: For sure. If you start to see some of these signs that we're mentioning here, so then what?

Matt: And that's the part that's hard, right? That's the part that's hard. Whether we're talking about burnout or we're talking about something like clinically defined, like depression or anxiety, you know, that's where like a counselor comes in, right? Because these kinds of things, yeah, it's not easy to do.

Jon: Welcome to today's episode of The Financial MD Show. We are so excited today because we've got a much-needed topic on physician wellness. We're going to talk about burnout. We're going to talk health, holistically looking at everything, including finances. But we don't want to ignore everything else that is equally important, if not more.

Joining me today, as usual, my co-host, Dr. Matt Huckabee. How are you, Matt?

Matt: Doing great, Jon. I really appreciate you bringing this topic up. You know, I host third-year medical students often. I have one right now, and we talk a lot about this topic, so I'm excited to jump into it.

Jon: Fantastic. Yeah, I'm excited, especially to hear your perspective, through your eyes, the eyes of your specialty. For those of you who don't know, Matt is a practicing psychiatrist, and we get to hear about wellness for people in general and then you get the view of him being a physician. And then us at Financial MD are getting to sit down with residents, sit down with young attendings, the couples talk marriage stuff, talk parenting, kids, self-care, all those other kind of things that go with it. Get to witness the stress and emotional uprising that comes from talking about a tough concept like finances -- and we do all day long. So all sorts of interesting stories we've seen here over the last ten years of just trying to push people to talk about money and make some tough decisions. All that really plays into this. So, Matt, I'll let you kind of start with where do you feel like we need to start when talking about this topic of physician wellness at, especially this phase in the career, deep into training or starting to come out into attending, where do we start with that? What's to think about?

Wellness In Times Of Transitions [0:03:04]

Matt: You know, Jon, it's a space and it's really broad and it's hard to kind of focus in on one particular aspect. You know, obviously, we can talk about physical wellness. We can talk about financial wellness and all these things are really, really important. Now this is a financial show so we're obviously we're going to spend some time focusing on that. But, you know, I think -- we're in July, right? This is a time of transition in medicine. We've got a lot of new med students coming in. We got a lot of new residents and new attendings transitioning. So, this is a big time of transition. So I do a lot of mentorship around this time. And, you know, I have a student right now and he's on his first rotation of third year. And that's when you're first in your clinicals and that can be a really challenging time. You're coming out of the classroom, you're getting into the broader part of your training, and same kind of thing. When you leave residency and you're starting into your jobs and attending, these are big transitions. And, you know, folks need to make sure that they take care of themselves. Number one, because, you know, we use this analogy, or I use this analogy, with my patients. Like, when you're on the airplane and they are doing their little spiel about the exits and the seatbelts, right. And the masks drop-down, they tell you put your own mask on first before assisting others, right? You got to be good to yourself before you can be good to your spouse, your kids, your patients. This stuff trickles down hill. So if you're not taking care of yourself, well, then, it's hard to take care of others.

Jon: Yeah, that's totally true, and we see that affect so many different things. And it's not the kind of thing -- we say this about personal finance as well is that you probably see this in health. It becomes this ostrich effect, almost where they'd rather just kind of stick their head in the sand and say, I'm doing okay, I'll be fine, whatever. I mean, what are some common responses you see to that? What are people's natural reaction when they're so busy with what they have to get done, they're physicians, they're driven as med students or residents. It's just like drive and push through and suck it up. Do you see that a lot?

Matt: Now I think that's changing. I mean, we still see that to some degree. I think mental health and wellness are kind of lumped together in this sort of stigmatized world that we live in. That's changing somewhat. I think the younger generation is much more apt to talk about it than others. Now, of course, this may be specialty-dependent, right? I'm a psychiatrist. I talk about wellness and health and, you know, I tell the students, you know, take some time for your mental health in the rotation and things like that. And that may be biased because of me. I don't know if a surgeon is telling their students to do the same kind of thing, but it's changing over time. We're more open to talk about stuff like that than we used to be, but we got a long way to go.

The Struggle In Silence [0:05:33]

As a society, in general, right, and in medicine, I think there was this culture in medicine where we don't really talk about our problems, we don't always reach out for help, and that's often to our detriment. There's a lot of docs out there that struggle in silence as a result of that stigma. And so my hope is that's changing, and whether that's like something as big as, like substance abuse or something like that or even just, hey, you know, I'm burned out or maybe I'm feeling, you know, stressed out about this one case that I had or something like that so.

Jon: Yeah.

Matt: Sometimes it's really important just to reach out to, you know, friends and colleagues in that early phase when you just feel those first things, and I do think that's changing somewhat. But like I said, I think we got a long way to go.

Jon: No, I agree. I would say I have observed from this and some of the same things, more openness to that, getting treatment for different mental things, no matter how big or small; the anxiety, depression, what the mental health field would label adjustment disorder and situational things. And honestly, we see that we help a lot of residents and young attendings get disability insurance, and that comes up in underwriting is mental health. They want to see what medications they are taking. They want to know -- have you seen any mental health professionals? And that's a big deal. So, I think if, number one, we can start to stress that this is important, and if we just look at data, we've seen a lot of disability insurance underwriting situations, outcomes, decisions, and to see how much stress and influence that disability insurance companies put on mental health, like they don't mess around with it. I mean, we have seen residents and young attendings declined for disability insurance, for mental health issues, probably more than anything else, to be honest.

Matt: Not so surely here, yeah.

Jon: Yeah, it kind of shocked me and surprised me. And I think it's because it's, you know, the effects of it can be so broad and, I don't know. What's the medical term for that? Like when something just has so many different possible affecting every other system in your life. You know what I mean?

Matt: It hits in all domains for sure. I mean, occupational can hit it home. I mean, absolutely. You know, when I'm filling out disability paperwork for a patient, they often ask me to assess, right, how does their depression impact X, Y, and Z? It's really hard, right? It's really hard because you're right. There is this like really broad impact and it's just depression, forget anxiety or, you know, bipolar, or something like that, right.

Jon: Yeah.

Matt: So, there is a really, or there can be a really wide ranging impact from some of these diseases that makes it challenging. No, it's totally livable and totally, you know, totally doable. But, yeah, it can be tough to kind of assess what kind of an impact that might have, yeah.

Jon: Yeah. If one of our listeners is not there yet, you know, not a place where they would consider it a, mental health disorder or anything, but just like, yeah, the stress, maybe feeling some of what you call burnout, it's where do we start? What are some of the preventative maintenance things, you know? Where do you, if you're sitting in front of a bunch of med students or you're talking to your third-year med student like, how do you start that process or evaluation or self-assessment, let's say, because everyone listening to this is trying to learn some stuff they can do themselves. Where do you start with that?

Self-Assessment: Where To Begin [0:08:56]

Matt: It's a great question. There's been a lot of research on this field, right, and there's some scales and things that are out there. You know, a hit or miss, right, in your experience. I mean, I think honestly, the big key in these kinds of things is, at least in my experience -- now this is just me in my, my life. But having peers, having friends, having classmates to reach out to, especially if it's work related, right. If we're talking like for focusing in on like medical burnout, stress, that kind of thing; not talking about like at home and stuff like that. You know, having somebody to process that stuff with, it's really important. Now, the ACGME, that's the group that runs all the medical education in the country, they've gotten better about adding modules and trainings and things like that, right. But I don't know about the full spectrum of your listeners, but we get a lot of modules, we get a lot of online trainings and things like that. And so there's a big tendency for these kinds of things to kind of be glossed over. And I hate to say that, but I just…

Jon: Yeah, I can picture that.

Matt: That’s just the truth, yeah. And so, you know, my advice first is especially if you're in training, especially if you're in training, if you're a medical student or a resident, then you need to reach out to either a trusted resident or a trusted faculty member to start. That is absolutely the first place to start because particularly in residency, there are lots of mechanisms in place to make sure that that stuff gets handled. That's the first step, is making sure. Now, of course, every residency is going to be different and I'm well aware that there is a full spectrum of acceptance of that kind of thing within residencies, right? I mean, some surgical residencies, for example, aren't going to be as tolerant of that kind of thing. Unfortunately, that's just kind of the medical culture that's, you know, evolved for a long time. But, you know, I do think these are things that breed and they kind of compound on each other. So if you're even feeling like, hey, maybe this is something that I should think about or I should start talking to somebody about, I'd encourage you to do that because it often doesn't get better by itself.

Jon: Yeah, I know that's good. You mentioned there's so much that the ACGME has started to put out and recognizes with that, but I think it becomes this problem. And we see this in the financial world as well, is there's too much information so they don't do anything. It's out there. Like you said, research has been done. There's modules that are put out. You can find YouTube videos. There's training. There's just so much stuff. There's no lack of resources. You know, we're probably drowning in information, but we're starving for execution. And I see that with everything, this is no exception, that there is so much help out there and resources available, but what's that point where somebody sits down and says, okay, it's affecting me enough that I have to do something and learn about it. And unfortunately, a lot of times that's I wouldn't say too late, but definitely later than it needs to be.

Matt: It’s hard to say. I think it would probably be different for every person, to be honest with you, you know. I don't necessarily know if there's one sort of line in the sand that you could say is like, hey, this is where we need to, you know, have an intervention or whatever. But I think it's kind of different for everyone. And I think, you know, to your point about this massive amount of information and so many resources, I think you're right. And what I often tell folks is medical school and residency is an extremely busy time. You know, obviously, some rotations are going to be more busy than others, but I tell my patients this to start somewhere, right? Start with one small thing and go from there. So even if it's, you know, a 20-minute jog, whatever it is, you can find time even on those busy rotations to do something for yourself. You know, some people it's music, some people it's cooking, some people it's whatever. But you got to start somewhere. And then that being said too, not one tool is going to be good for any… for every specific situation, right? And so I often tell people, I tell patients, right, load yourself up with three or four. You know, when Batman's got his belt, he doesn't have just one tool, right? It's not always the boomerang or the grappling hook or whatever, right. There's a specific tool for a specific circumstance. So, I think having a few different de-stressing techniques or whatever they are, whether that's meditation; whether that's, you know, having a beer with a buddy that, you know. One of those may not be the best for each situation, so having a few different ways you can de-stress and start somewhere because, if you keep it bottled up, that's when there's troubles.

Jon: Okay. So that's the question. So let's say, we're at the very early stage and somebody says, I don't, as I think, I have a problem, or I'm at that point, but I am interested enough to figure it out. Is there some tools to that point or self-assessment where they can start to kind of just get a quick measurement to a questionnaire to say…?

Matt: Yeah. I apologize. I don't have the exact scale off of the top of my head, but there are validated screening tools for burnout that you can find for free on the internet, and I'm blanking on the acronym right now.

Jon: No, we'll do… we'll post some stuff in the show notes. We'll do some research.

Mental Health Toolkit [0:13:50]

Matt: Absolutely. I can get you those. And that could just even be, you know… For those in sort of the mental health world, right, we have the GAD-7 that is a screener for anxiety. We have the PHQ-9, which is a screener for depression. It's the same kind of thing, right? A series of questions that, you know, that have been validated for burnout and it's really helpful. And so, you know, folks can use that to sort of, at least, start the process like, hey, is this something ranking high and this is something that I need to really pursue? Or is this kind of just in the early phases?

Jon: Yup, that's good. What are some signs? And let's say they don't do the assessment or they do, whatever. What are some things that maybe are just quick self-assessment to questions they can ask to say, do you notice this about yourself? You know, what are some things that you feel like people notice they should?

Matt: Oh, 100 percent, right. Irritability; withdraw from friends, right. And these are -- and to be fair, these are nebulous in terms of, say, maybe looking a little bit like depression or anxiety or things like that, but certainly, a lack of empathy -- a lack of empathy for your work, a sense of detachment from your work; certainly, social withdrawal, irritability. You know, that sense of, hey, I'd rather be anywhere than work; the Sunday scaries. I know it doesn't apply necessarily to medicine, but, you know, those are all things to be watchful for, right? I mean, we got into this job because of passion. When you don't give up as much as you give up to get into medicine without having at least some degree of passion for the work. But then you get into it. You're in medical school. You're in residency, right? And it's a grind. And so everybody understands that. And so, it can wear on in anybody so. So that sense of detachment ebbs and flows, right, but certainly, that in concert with some of those other things, you know, needing a drink, needing an alcoholic beverage to unwind after every single shift, all kinds of things. But those are certain sort of the yellow flags that I would say be kind of mindful for.

Jon: Okay, got you. So, if somebody noticed that they just weren't that interested in their work anymore on a regular basis, that would be a sign that, maybe take a deeper look at some of their emotional well-being, mental health, that kind of thing?

Matt: Mm-hmm.

Jon: Okay. Withdrawing from friends, family, just kind of would you say just a general kind of just don't seem to be interested in anything, you know, type of dysthymic thing?

Matt: Yeah, certainly not socializing with friends, that kind of thing. So I apologize. I'm just googling it as we speak. It's the Oldenburg Burnout Inventory (OLBI). It's a 16-item scale, right, and there are eight items related to exhaustion, physical fatigue, cognitive fatigue, that kind of thing, and then there are eight items related to sort of disengagement, sort of your sense of degree of distance from your work, negative attitudes towards the work, that sort of thing.

Jon: Yeah. Great, okay. So we'll put this in the show notes as well so people can link directly to it. So we start with trying to figure out, hey, if you're interested at all and take this assessment, for sure, if you start to see some of these signs that we're mentioning here. So, then what? So you take this assessment. It helps you to figure out that, yeah, you might be looking at some burnout and some things that you might need to look at. Then what? What do you do next?

What Comes After The Assessment? [0:17:03]

Matt: Well, it's tough, you know. The easy answer, right, is to get some time off, right? But now we all know that that's not the easiest thing to come by in medical school.

Jon: Yeah.

Matt: So, that might even just be, you know, something as taking yourself when you are off work, taking yourself completely away from the work, take and get away time. But that's the hard part about this, right, is because we're talking about a period of time when people are really in a pipeline of medical training and so taking time off or taking breaks is often a big challenge. And so that's I think where some of these, you know, the tendency to engage with these modules and, you know, wellness and exercise and all these kinds of things, and those are all good. But it's a really tough thing to solve. And some people do, to be fair. When I was in residency, we had a resident take a month off. And so it's dependent on the residency, but these kinds of things are doable. I think, you know, the logic behind it would be sort of we'd rather have you take time off and extend your time than hurt somebody or something.

Jon: Yeah, something or then completely walk away from medicine.

Matt: Of course, right. Of course, yeah, but these are often hard things to solve and so, you know, it kind of depends on the degree of it. You know, early stages, as I said, it can be something as much as finding those positive coping skills and, you know, kind of like the old timey balances, right? You know, you need to -- you have a lot weighing down on the sort of stress side so we need to add some more positive things to balance that out. Whether that's time with friends, time away from work that's completely detached from work, those kinds of things; exercise routine, better diet, those kinds of things. Versus like a little bit higher, on the burnout scale, you know, that's professional counseling and potentially psychiatric intervention. You know, all of that is part of that spectrum.

Jon: Do you find often just that first step of time off, time away, really helps and can make a difference there?

Matt: It varies. To be honest with you, it does vary. It's person to person. It kind of depends how early we catch it.

Jon: Yeah.

Matt: You know, in later stages or further career, like when I'm talking about later attendings and things like that, that's harder; that's a little bit harder to sort of recover back from. So not always, to be fair.

Jon: So you've taken time off. It helps or it doesn't. You then try to find some competent help through counselor, psychologist, psychiatrist, whatever you got access to. And everybody has this question on their mind: do you find that medication is important or necessary here? Sometimes helpful. How would you describe that?

The Functional Impact Of Diagnosis [0:19:29]

Matt: You know, in my personal practice, I'll tell you my general approach when I'm when I'm looking at whatever diagnosis it is, is what is the functional impact. And so there'll be times when I might be doing an intake assessment on someone and they might meet X number of criteria for, say, PTSD, for example, they don't make quite enough to make the diagnosis stamped in stone, right. But, I'm pretty sure that this is the diagnosis. They're meeting most of the criteria. You know what, but they can't go to work because of their anxiety, or they can't go to the grocery store because of their anxiety. So am I held back by the fact that I can't stamp and stone that diagnosis? No. We're going to treat it because there's a dysfunction, right? So the sense is, is kind of what's the long… like how long are the symptoms been around and how are they impacting the patient's life. And, you know, medicine is not forever. If you're on medicine for a little bit, you take some of these other steps we've been talking about. You can come off of it, absolutely, but you know, if there's a high degree of symptom burden or lifestyle burden, then I think, you know, medication is certainly something to be considered.

Jon: Sure. And we see that, and again, we help residents through the disability insurance application process so we see this in terms of we get… the insurance company comes back to us and says, hey, we noticed on their prescription record, it said -- who knows; I don't know what's a common anxiety medication -- and they'll say, what was this for? And we got to pass that on to the resident and they'll say, oh, I just took it for 18 months during residency, I was going to this really stressful time, blah, blah, blah. I don't take it anymore. But, you know, that is so common. But, you know, to your point, it's like they took it for a time and they truly… it's been two or three years since they took it. They don't it need anymore. There was just a time when they needed a little bit of a boost and assistance. And, great. But that's, so to maybe destigmatize it a little, that's pretty common. And, obviously, you see that in your practice. We see that in terms of the health and underwriting medical records history. It's pretty common. And isn't a deal killer in terms of if somebody has to get their disability insurance, for example, that if they explain it well and just say, hey, I took this for a time because it was just a stressful residency, underwriters usually get it and not a big deal.

Matt: That's good to hear for sure.

Jon: Yeah. Man, it's… gosh. How many stories of just seriously, like, I try to sit down and ask some preliminary questions before residents fill out a disability insurance application like, are you're taking any medication in the last two years; if you get any seen a, you know, psychologist, therapist, anything. This is a common one that maybe gets asked whether physician or not. But if somebody asks you like, okay, I can see a counselor and I’ll be see… I can see a psychologist or a psychiatrist like most people. The layperson is like, what's the different, you know. I don't know. Like, what do you- how do you differentiate that from people and give them direction on where to go?

Psychology Vs Psychiatry [0:22:31]

Matt: Yeah, great question. The first sort of fork in the road is psychology versus psychiatry. So psychiatry is a medical subspecialty. Psychiatrists go to medical school obviously and I do a residency in psychiatry. Now in part of your residency, you're trained in some psychotherapies in order to prescribe psychiatric medication. Some states are trying to change that with PhD level psychologists or pharmacists or things but neither here or there. For the most part, right, psychiatrists, medical school psychologists, that can either be like a PhD psychologist, or any other people in the field, for example, social workers, etcetera, like you mentioned that solely do psychotherapy. And so for the most part, in the way things work these days, those folks are doing most of the like, say, week to week psychotherapy-type sessions and the psychiatrists are doing the medicine management-type stuff. Most of my clients now that's anxiety, depression, bipolar, what have you, they're be in both, right.

Jon: Okay.

Matt: For the burden of the folks that we're kind of talking about, you know, I would say that the lion's share not going to rise to the level of needing a psychiatrist or needing a specialist in mental health. For the most part, a. if they do need medicines, the primary care physician is usually adept at using the SSRI, number one, and number two, they may just not need medications. And so, which is a good thing, right, because most of them can do just fine with psychotherapy or talk therapy, whether that's like a counselor or a social worker or what have you, there's also a lot more access, right, through this part.

Jon: What comes to mind for me -- and this is, you know, my background there at a time I was in LPC, I have a master's in counseling so I know some of the stuff -- cognitive behavioral therapy. Do you find that's a common resource for this type of management with when it comes to seeing a therapist and that kind of thing?

Matt: Yeah, definitely. I mean, I think, I might step on toes by saying this, but I would venture to say that most therapists in the country nowadays are doing CBT, which is cognitive behavioral therapy, or variants of it. You know, we don't have a lot of psychodynamic stuff going on anymore. There's certain places, of course, but, you know, for the most part for the lion's share of complaints, we're doing some variants of CBT. So, absolutely. This kind of stuff is super helpful. Of course, there's a range of implementation of that. But, you know.

Jon: Yeah. And we get, you know, let's say if someone wants a little more lay explanation of CBT, I explain cognitive behavioral therapy like training you in skills that you may not know how in terms of reframing thoughts, just managing the thoughts and feelings inside to just learning skills.

Matt: I tell people, and particularly when I talk about DBT, which is dialectical behavioral therapy, I mean that's different. But that is an emotional regulation skill teaching tool, basically, at its core, and it's phenomenal for lots of different things. If you Google it, of course you're going to get the borderline thing right up front. But I tell folks, you know, from an emotional regulation standpoint, it really builds a lot of good skills. Now, CBT, the way I teach it, I tell folks, right, we all have our thoughts, right? We all have our thoughts that occur in our brain and we all have our feelings. And sometimes the way that our thoughts influence our feelings can be kind of automatic.

Jon: Yeah.

Matt: Over time, thoughts reoccur and reoccur and reoccur. And so they influence and so you hear this phrase automating thoughts. That's what it's talking about, right. It's a well-worn path that our brain does that influences so that thoughts can influence the feelings. I think that I'm worthless and then I feel sad, for example, right. Well, the other sort of -- if you picture a triangle, the other sort of point on the triangle is actions, right? And so what we found, right, is that there's a reciprocal relationship between how we think, how we act, and how we feel.

Jon: Absolutely. Love that.

Matt: And so all three of those are reciprocally integrated. And so if you think a certain way, you will feel and act a certain way. If you opt a certain way, you will think and you will feel a certain way, etcetera, right? So, the way I tell folks is, is if you think about cognitive behavioral -- cognitive being thoughts, behavioral being actions, right -- that's kind of where the name comes from. And so when we're making an intervention, what we're doing is we're intervening on one of those axes, right. And so there's a variant called behavioral therapy which is just focused on the actions, but cognitive behavioral therapy really focuses on all three. And when you talk about reframing, that's, of course, reframing some of the way that we think and undoing that automatic thought process that develops. So again, high-level stuff, very top level of the explanation of CBT, but that's how I teach it to patients and we're kind of undoing those automatic relationships that happened between the triangle so.

Jon: Okay. So what's a common thought, action, feeling that may come when it comes to burnout or physician wellness? Like somebody is feeling that burnout effects, like, what are some common thoughts and feelings associated with that type of situation?

The Burnout Spiral: Thoughts, Feelings, Actions [0:27:34]

Matt: We'll, just off the top of my head, right? Like, I think I did a bad job with that patient.

Jon: Okay, yeah.

Matt: Right. So then I might feel like -- and this is a little bit of thought-feeling gray zone, right -- but I think I did a bad job with that patient, so I feel bad about it. So I act differently for the next patient.

Jon: Yeah.

Matt: Right. It's very simple explanation, but you could argue like if we're talking about depression, right? I think I'm worthless so I feel sad so I'm going to sit on the couch… whatever, right. You could see how, and then of course, if I'm sitting on the couch more or if I'm changing my behavior with that patient, right, then that might reinforce the thought that I had, right? The thought that I did a bad job, right? Oh, I changed how I manage the next patient and something went bad and so therefore I am thinking more that I'm a bad resident and therefore… So you can see easily how, over time, this path gets reinforced and you get this downward, downward spiral, right.

Jon: The action part of it like is what you talked about before the retreating from friends; just, you know, lack of desire and motivation, like not doing anything. That's like the action side of stuff, right? That's how it comes out and manifest, action-wise. But even if we take that action piece out and we keep the thoughts and feelings and just say, even if we're just focusing on thoughts and feelings, that can be a problem. There could be a point where, “I just don't like feeling this way all the time and I need to change my thoughts so I don't feel this way.”

Matt: Yeah, and that's the part that's hard, right? That's the part that's hard. Whether we're talking about burnout or we're talking about something like clinically defined, like depression or anxiety, you know, that's where like a counselor comes in, right? Because these kinds of things, it's not easy to do.

Jon: Yeah, we're not born knowing how to do this.

Matt: Right. This is changing and developing enough an outside perspective on that process that's happening subconsciously with inside you is really hard, right? And so that's where having an outside perspective that you see on a regular basis to kind of probe the depths of that relationship is really important because oftentimes we can't see it ourselves.

Jon: Yup. No, and I think that's good where the assessment tool comes in and just say, “Yeah, something doesn't feel right or doesn't seem right. I need something to help me assess where I'm at and then…”

Matt: Definitely. And, you know, to shift, we're talking a lot about burnout to shift towards wellness, right, sort of the antithesis of burnout, right, being wellness is focusing on a lot of these things. And to get to like think about the topic of the podcast and like financial wellness, you know, you talked about like mentoring couples and new attendings and things like that, you know, financial disagreements or financial mismanagement in a couple is like a huge indicator for divorce, right? And it's one of the main reasons people get divorced in this country. So not to say way too hard, but I think it's all kind of interrelated, right? Because again, you got to take care of yourself and then all the things that come along with it, because obviously we try to, you know, separating work and home, right, but like you're a person and you exist in all of these places and so your home life is super important for your work life and vice versa. Because if you're burned out, you're going to take that home. If you're struggling with the money and relationships at home, you're going to take that to work. And so it's all interrelated.

Mental Wellness Meets Financial Wellness [0:30:46]

Jon: Yeah. No, definitely. And I would say if we were to pick out some key tactics or action items for, let's say, just finances, I think the first feeling that we tend to get when we sit down with the resident and they want to talk finances, and that's really all that has to start. So we'll do a lecture, dinner, whatever, and then they want to schedule consultation and talk about finances. It often starts with, “I'm overwhelmed. I know I need to do something. I don't know what, or I don't know that I can or have the time or capacity or wherewithal to do it. I just feel this pressure like I need to do something.” And we say, okay, let's just -- we always start with this: “Tell me what you're doing well.” And I know it sounds scripted, but it truly helps to say, “Focus on the positive. Everybody's doing something well.” As weird or innocuous or hard to find as it might be, everybody's doing something well. And so then we tend to focus on, “Okay, let's clear out what we can't control and just focus on what we can control.” Just that alone can help to alleviate some of the overwhelming feeling and say, “Okay, what are some of the biggest hurdles or stressors for you?” “I just feel disorganized.” “Okay, let's start instituting some actions, baby steps, to help you get organized. And the beauty of where we are today in history is that there's so much technology and automation and apps to help you get organized.” You know, we look at… Mint’s not around anymore, but, You Need A Budget is an app, Monarch's a good one, Rocket Money. You know, we've got links for these all over the place and we'll put some more in the show notes. But just to say, okay, start with this, link your accounts to get an idea. Okay, first where's your money going? And that can be a great place to start. Just that alone will help you feel like, okay, I'm getting on the path to being more organized. That action then creates a thought that says, hey, I'm starting to improve. That creates a feeling of positive feelings of some kind of, you know, self-improvement, feeling good about yourself, etcetera. So, just those steps alone can help a ton. And to your point of what about a couple that's never really even talked about finances because I can't tell you how many times we sit down and ask some of our list of questions or go through our values staircase and just start asking questions. When I ask one of a couple, hey, what's important to you about money? And they think, no one's ever asked me that before. And then they start to answer things and the spouse looks at them and goes, “Really? I didn't know that was important to you.” Or so many times I get the phrase, “Well, I've never really shared this,” or “We've never really discussed this before,” that, honestly, that's the part that I love about what we do and when we bring up the concept of finances and personal finance of, okay, this stuff. Does it need to be talked about? I mean, at some point. But the earlier we talk about it, the better of helping a couple to figure out, okay, are we on the same page with some stuff, different page with other things. You don't have to be on the same page with everything. You just have to start with being aware of where each other is and how you operate and how you tick. We talk about some people are naturally spenders. Some people are naturally savers. I'm guessing Matt Huckabee is more naturally a saver, born to…

Know Where You Are, Know Where You’re Going [0:34:12]

Matt: As a matter of fact, a reformed saver in later years, but yeah. And I think you're absolutely right, you know, and I think it's kind of like the old Alice in Wonderland. Well, which way do I go? Where do you want to go? Well, I don't know. Then, it doesn't matter, right. So you need to know where you are. You need to know where you are. Then you need to know where you're going, and then you can make a plan to get there, right? It's like any kind of… it's kind -- nobody operates… I mean, with some exceptions, right? Nobody operates without a plan, right? You know, you kind of know what you want to fix and then you make the plan and, you know. So I think the same thing is true for our money, right? So to your point, there's this tendency to like, freak out -- I have to invest. Well, what about investing? What about it? It’s like take a break. Like let's just get a stable, you know. Look at where your accounts are right now. Where's your money going? That kind of thing. Okay, you want to do this in the future? Okay. Well, then here's how we get there. The line we draw between two points, right? So, yeah, the first step is often, you know, taking the noise out of the system. It's so easy. There's so many voices out there. It's so easy to get overwhelmed, when in reality, none of this is that hard or that complicated. Once you really understand a little bit better, it's really not a bad process, but it can just feel a little overwhelming. But, so did medicine, right? Like if you're a resident or you're an attending… you know, when you were a med student, you didn't know your way around anything, and you, you know, it's a little bit like learning a different language, kind of like medicine is, but it's something that you work at and you can do too.

Jon: No, that's good. And that's, I think that gives our listeners some action items, whether it's action items in terms of burnout, action items in terms of their finances. We want to make sure with every one of these episodes that we're giving you some actionable things, things you can assess in yourself and start to take action on. And maybe that first thing is you sit down with your spouse and say, hey, let's just talk about goals for a minute. Like, where do you see us financially 30, 40, 50 years? How long do you really want to work? What does financial independence mean to you? You know, like asking some of these questions, and we can help with that. Our consultations always free if you want to just, hey, I want a third party to sit down with me and my spouse and just ask some of these questions. No problem. You don’t have to use our services. Just happy to have that conversation with you and ask some of those key questions that, frankly, as Matt talked about money can put a lot of stress on a marriage. It's one of the leading causes of divorce. And so there's a way to go about it that's healthy and respectful. When we have our lectures and talk about this topic, we always say, “Hey, when you sit down for the first time to talk finances, your number one goal should be respect and love.” And I say both of those things. And if you can handle a conversation with love and respect, then the conversation will go fine and you'll feel better because of it. You'll start to feel like you're making some headway in your finances, and that alone can be a huge first step that most couples don't take. So just that alone will put you ahead of, I'm sure, 50 percent more of the population.

Matt: And it's a great idea, yeah. And I don't know if you want me to speak about kind of what our plan is for maybe the next few episodes.

Jon: Yeah, let's do it.

Next Up: Your Financial Game Plan [0:37:28]

Matt: Just so for our listeners, you know, this is something that we're pretty excited about and I think one of the key things to hit home with this message is it doesn't matter where you are in your training. You could be out in attendinghood or you could be a brand new, incoming first-year medical student or anywhere in between. One of our really big points is that at any point in here, you can make changes and you can set things on a path that are going to set you up, you know, for greatness in the future. There's this tendency among med students or among residents like, oh, you know, these numbers aren't there. I’m in debt. I've got all these things going on. But there are steps you can take, and that can put you on a really awesome path. And that's one of our goals. And so, over the next few episodes, Jon and I are going to be introducing sort of a series of steps.

Jon: Yeah. And that's the idea to help you not feel overwhelmed, but just have you take one bite at a time.

Matt: The idea of how it is, is that when your money comes in, we want to be able to sort of say, hey, this is, you know, first, second, third, fourth, fifth, sixth things you want to think about. So we're going to kind of present an outline over the next few episodes and kind of delve into each of those steps in a little bit of more detail. And the hopes as being is kind of give you a roadmap, right? A first few steps that you can take at any phase in your career. You know, these are the kinds of things you should be thinking about. Some may apply to you, some may you've already mastered, and that's great. But our hope is, is to kind of give you that roadmap that, you know, one foot in front of the other type of thing and puts you on a better path.

Jon: Awesome. Yeah, so you'll be hearing about that. If you want to hear as soon as that comes out, then you'll want to make sure you obviously follow this show on any of your podcast platforms. Follow us on Instagram, TikTok, Facebook, and YouTube. Those will be the places where we will send out these announcements and then, of course, go to FinancialMD.com. Join the email list because in addition to that announcement, any of the resources, our articles, timely things will be sent out there as well. So, there's no shortage of places to know. Lastly, remember that there is the Financial MD Community. It's our Facebook group for physicians only, by physicians, to talk about all things personal finance with doctors and we're posting a lot of these things and resources there as well. So, no shortage of places to go. We'll get this out to you in the next couple of weeks. We're excited to start giving you some actionable things and just in bite-sized pieces. You know, my dad used to always say, “How do you eat an elephant?” One bite at a time. It's the same thing with you. How do you get on track financially? One bite at a time, and we'll help you do that. So, stay tuned here to the Financial MD Show. We will get you what you need to know and nothing more. Maybe a little bit more just from our bantering and stories, but you'll definitely get what you need to know. And until next time, this is Jon and Matt, signing off on the Financial MD Show. We will see you next time.

Thanks for joining us for another Financial MD Show. Be sure to head over to financialmd.com to get more in-depth resources on financial tips for physicians and don’t forget to join the Financial MD community group on Facebook, where physicians at all stages of their career gather to share tips and get ideas on achieving true financial success. We’ll see you next time.

The Financial MD Show is for informational purposes only and is not an offer to invest. It is not financial, tax, or legal advice. Be sure to seek financial, legal, or tax professionals when making any financial decisions. Before investing, you should make sure that any investment strategy or investment meets your individual investment needs, goals, and objectives. Financial MD makes no claims or guarantees to individual investment performance. All investing involves the risk of loss as well as the potential for gain.

Resources and Links:

· ACGME: Accreditation Council for Graduate Medical Education -- https://www.acgme.org/

· GAD-7 Anxiety Scale -- https://adaa.org/sites/default/files/GAD-7_Anxiety-updated_0.pdf

· The Patient Health Questionnaire (PHQ-9) -- Overview -- https://www.drugsandalcohol.ie/26814/1/Patient%20Health%20Questionnaire.pdf

· Oldenburg Burnout Inventory (OLBI) -- https://novopsych.com/assessments/well-being/oldenburg-burnout-inventory-olbi/

· Differences Between Psychology & Psychiatry -- https://www.psychology.org/resources/differences-between-psychology-and-psychiatry/

· What is Cognitive Behavioral Therapy -- https://www.apa.org/ptsd-guideline/patients-and-families/cognitive-behavioral

· Dialectical Behavior Therapy (DBT): What It Is & Purpose -- https://my.clevelandclinic.org/health/treatments/22838-dialectical-behavior-therapy-dbt

· Financial MD Email Address – info@financialmd.com

· Financial MD Website – https://www.financialmd.co/

· Financial MD YouTube page – https://www.youtube.com/channel/UC6qEAQxK8L8JM7joy3wvdkA

· Financial MD Facebook community – https://www.facebook.com/FinancialMD/