Physician burnout and quitting medicine - Chris Borth
Chris is a urologist, senior partner and Linivan advisory group. He completed his bachelors and M.D. at Queens University and his MBA at Wilfred Laurier. He previously ran clinical trials, has been a practicing urologist for 17 years and routinely advises medical startups. We talk about:
Transcript
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Thanks so much for joining us today, Chris.
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If you could give our audience a bit of an intro as to who you are, your childhood, and
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your paths to where you are today.
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Sure.
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Thank you very much for inviting me.
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It's been something I've been looking forward to.
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Yeah, I was thinking about, you might ask me to introduce myself, and I realized that
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the cliche is that people like talking about themselves, but I actually don't really love
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talking about myself, but I'll do my best.
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So childhood, I was born and raised in Kitchener Waterloo, which I sort of recognize is in
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this global era is not all that exciting a background.
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I'm back in Kitchener Waterloo after some years away, but yeah, I think back on childhood,
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it was a very good time in my life.
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One aspect of my childhood that people ask me that I think stands out for me is my mother's
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family were refugees from Eastern Europe.
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They were ethnic Germans who had to flee Romania.
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They lived in a multi-ethnic community with Germans, Hungarians, Romanians, and Serbs,
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but people knew that the Russians were not fond of ethnic Germans, and so they fled.
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And they spent some years traveling through Europe.
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I believe they lived in Austria and then France, and that went on for years.
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But family legend has it that my grandfather, my mother's father, was very anxious to get
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citizenship, which to be fair is a pretty legitimate concern as we know today with people
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fleeing various regimes.
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And he believed that that would happen or could happen faster in Canada, so they ended
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up in Canada.
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And they came to Kitchener Waterloo because at the time, this would have been in the early
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1950s, it was thought that there were a lot of German-speaking people in Kitchener, which
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there were, although I think they thought it would be kind of like back home where you'd
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go into the store and you could speak German or whatever else, but that wasn't the case.
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In the 1950s, it might have been the case in the early 20th century.
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But anyway, what I'm going with this is that growing up, so first generation Canadian, and
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I actually, my parents both worked, so I lived at my grandparents because there was a duplex.
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I'm actually in that house right now because we bought it from my grandmother as a state
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when she died.
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And at the time it was duplexed, and my parents lived upstairs, my grandparents were downstairs,
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and so when my parents went to work, I spent the entire day with my grandparents, as a
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preschooler.
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And I am told that my first language was German, which I guess this is a very long drawn out
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way of getting to the idea that I grew up feeling a little bit like an outsider.
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There was a fair bit of anti-German sentiment in Canada at the time.
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It was pretty soon after I grew up in the 70s and 80s basically, and there was still a fair
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bit of anti-German sentiment.
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So even though, obviously in the real world, I pass as an Anglophone Canadian, but when
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I brought people home to my house and there's people speaking German, and it was awkward
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at times.
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And I think what that gave me was a little bit of empathy into several things.
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One of them being what it feels like to be a bit of an outsider.
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So that colored my childhood for sure.
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I've enjoyed, like, you know, it's easy now, speaking and understanding German as an asset
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in 2024, but at the time it was a bit awkward.
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That said, I had a good childhood.
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My parents are very thoughtful people.
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They're still very high functioning.
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They're both working actually still.
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And yeah, where do I go from there?
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I went to Queens University, did a biochemistry undergraduate degree.
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I worked a little bit in industry during that.
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Toward the end of that I had a summer job at a chemistry lab, and my supervisor was Swiss,
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and he asked me what I wanted to do when I graduated.
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I said, well, ideally I'd love to go to Europe and work in my field in a German-speaking
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country.
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And a couple months later he basically came to me and said, I have lined up a job for
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you in Switzerland with a friend of mine.
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So I went to Switzerland for a year, worked for Hoffman La Roche again in a lab.
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And then that was a contract.
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So I was done, I came back, and I had a PhD in biochemistry lined up, but then applied
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to medical school and did that instead.
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And so all told, except for the year in Switzerland, I was in Kingston through my undergraduate
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degree in medical school, and then I did a five-year urology residency, and then spent
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an extra year doing a locum year there before eventually coming back to Kitchener Waterloo.
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My parents, again, were here.
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At the time we moved back, my grandmother was still alive, and there's a fair bit of
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extended family around here.
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And yeah, I worked as a urologist for, well, from 2005 until I closed my practice last
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year, 2023, so for that long.
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Yeah, I don't know what else you want to know.
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I guess I should mention that around, I don't know if we're going to talk about medical
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burnout, but around 2016 I started to realize I was experiencing burnout, boredom.
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You realize after a while most medical specialties are highly repetitive and there isn't a whole
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lot new.
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You know, again, if we're going to talk about burnout, I'm happy to dive into that.
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But I started looking for directions I could go that would be more positive than I would
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enjoy more, and I eventually decided that I was interested in business enough to actually
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do a business degree, and I did an MBA.
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I was fortunate enough that here in Kitchener Waterloo there's a part-time MBA program through
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Laurier Lazaridis, School of Economics and Business, and so I did that while still practicing,
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and that actually worked very well.
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It was a wonderful experience.
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People ask, you know, as a physician, did you enjoy doing the MBA?
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What was it like?
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I loved it.
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I loved the subject matter.
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I think it's made me a better person, I hope.
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Maybe my wife, hopefully she agrees, but I really enjoyed it.
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And then since then, I've been trying to forge a, trying to build a second career at the intersection
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between medicine and business.
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And again, fortunate enough that we have this vibrant tech ecosystem that includes a fair
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bit of med tech and health tech here in Kitchener Waterloo.
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So I've worked with a number of startups and an advisory and sort of guidance role.
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Just recently, I'm working with a local AI startup called Primal.
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They're trying to build some healthcare products, and that's been lovely.
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They're wonderful people.
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I've enjoyed that work very much.
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And I should mention before I, I'll stop rambling soon, but I got pulled back into clinical
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medicine.
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I've been doing some locom work north of here, which I've actually enjoyed very much.
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So after over a year of not practicing urology at all, I've been doing that, you know, at
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least, I guess five or six days a month.
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And I've actually surprised me how much I've been enjoying it.
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The working conditions are very different from what led to my burnout in my primary practice.
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But so to be fair, there is that, but, but it's been kind of nice to get a little bit
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of exposure to clinical medicine again.
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Let's go deeper into physician burnout.
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There seems to be a lack of meaning and purpose in work for us.
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It's something I've been feeling a lot of my colleagues have commented on it.
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I'm one of my favorite books as man search for meaning by Victor Frankel.
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He's a psychiatrist in the concentration camp.
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And then for those listening who don't know about it, essentially, he talks about the
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people who give up in concentration camps during the Holocaust and then people who don't.
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And the difference is they have meaning and purpose usually driven by someone they love.
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So the question I have for you is how do we get meaning and purpose back into medicine?
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And why do you think medicine has lost its purpose and meaning for physicians?
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Right.
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Yeah, that's a great question.
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A lot to unpack.
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Yeah, I guess, I mean, I would back up a little bit and say, I think my experience of burnout
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and I think when you go through it, you do spend a lot of time thinking about it and
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analyzing it and wondering, like, you know, where could I've gone differently and might
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have made a difference.
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And I often quote a friend of mine who said, who says that medical burnout is not caused
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by a single variable.
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She calls it death by a thousand cuts.
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And I think a lot of those factors are systemic.
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We have entities like the Ministry of Health, the college, whose interests are very siloed,
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even though they intersect in the life of a physician.
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And so, you know, oftentimes you'll see situations where the college will essentially implicitly
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say, well, we're agnostic about that.
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That's between you and the Ministry or that's between you and the OMA.
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And likewise, those other siloed entities will do the same thing.
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And I think that that, like, to the point about, you know, meaning in clinical medicine,
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I think that does become very disillusioning, right?
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You think, well, I've approached this in good faith and I put a lot into it and I try to
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be my best every day and give meaning to this job.
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But these other interests are behaving in ways that take away that meaning.
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And I mean, I don't know if I've directly answered your question, but I think the answer
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is it's really hard, like, because those are monolithic forces that we don't really have
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a lot of power over, right?
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I think I'm sure you're familiar with Jillian Horton, who speaks very articulately about
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burnout.
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She's, I believe, a family physician and she lectures on medical burnout.
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And I think she's, and there's other people too, but she does a very good job of framing,
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you know, so the cliche, of course, is that institutions, like, say, a hospital that has
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been a major factor driving your burnout will pay lip service to burnout mitigation and
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say, well, you know, you should do yoga, you should meditate, be more resilient, Rashaan,
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right?
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And that doesn't help at all.
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And so Jillian Horton talks about the fact that until those systemic work environment
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factors are mitigated, we will never see the end of burnout.
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And I believe that very strongly.
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Because, you know, you could look at it too as like intrinsic versus extrinsic motivation
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or factors like that.
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And the reality is you can't intrinsically, you know, meaning your way out of those systemic
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problems.
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Again, I don't know if I've really answered your question, but.
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Yeah.
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Let's go back to when you were a biochemistry major.
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I majored in epidemiology and I kind of struggled with this question of whether I should pursue
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that as a master's in PhD and going to public health.
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As opposed to medicine, as opposed to if I'm being frank with you engineering, which was
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what I wanted to do.
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But we can get into that later.
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We'll prompt the decision to go to med school as opposed to pursuing a more, for lack of
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a better word, scientific or more true science.
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Yeah.
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And that's something I've thought a lot about because like you, I had an affinity for engineering
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as well.
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I never really, you know, pursued it seriously, but my father's an engineer.
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And it's just, you know, there is the appeal of that hybrid, you know, space between theory
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and practice that engineers, they solve problems with a whole lot of information.
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My path to biochemistry, I don't know if it's interesting to anyone else.
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I find it interesting.
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So I was, I had been interested to some extent in a medical career, even in high school.
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And I was never, you know, I knew people who were just so driven from an early age to be
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a physician.
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I actually knew a guy, we were in the same class of medical school who had known he wanted
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to be a pediatric emergency room physician since he was like 12 years old.
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And that's in fact what he actually did, which to me is ridiculous.
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Like I was like, well, do I want to do that?
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Or do I want to pursue a scientific career?
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And so where I was going with this is in high school, I told a guidance counselor that I
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might be interested in, in a medical career.
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He said, well, and you got it, you got to apply to life sciences.
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So I did that.
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And I was in the Queens life science program for exactly one year and I hated it because
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almost everyone else in the program wanted to go to medical school.
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And I wasn't actually 100% sure that I wanted to do that.
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And so you're in these classes with these people that are incredibly competitive and
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driven, but they're not, they're not actually all that interested in the underlying subject
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matter that they're studying at the time.
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It's all about a pathway.
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And I found that to be a significant turnoff.
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So large classes, people are only there as a, you know, a stepping stone.
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So I ended up looking around at adjacent programs and discovered that the biochemistry
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program at Queens was very good and also very small.
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And so I switched into that.
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And by, by third year, my classes were down to like a lot of them were just with the other
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biochemistry students in my year, which was literally like 15 people.
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And it was awesome.
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I loved those classes.
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The professors were speaking to a small lecture hall full of people that were actually interested
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in biochemistry, right?
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A couple of us ended up going to medical school in the end, but at the time it wasn't about
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a pathway.
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It was about, you know, in the moment, I want to know about biochemistry.
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But then, yeah, I, you know, I spent enough time in labs and around disillusioned, pure
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scientists and, and I, and I guess I thought as well that, you know, we should talk about
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this too.
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I don't think a lot of people who are interested in a medical career actually know what the
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reality looks like before they end up practicing, right?
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So I didn't, I assumed that medicine existed at this sort of sweet spot between science
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and art, which, okay, it kind of does, but in, in clinical practice, it doesn't feel
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like that most days, right?
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And I definitely come from a fairly humanistic background and upbringing.
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So that, that resonated with me in ways that pure science or say engineering didn't.
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And that's, that was sort of how I ended up applying and eventually doing it.
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Talk to me about the decision to go back to clinical medicine.
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Just in the last few months, you mean?
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Yeah.
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So, I will admit that there was an extremely practical mundane reason and it was that in
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the spring when my CPSO license turned over, I was very conflicted about, you know, what
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I would do about that.
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Because as you know, it's very costly to, to renew it.
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I wasn't practicing at all and I hadn't been practicing for a year, but it, you know, it
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struck me that it would be foolish to give it up entirely and then potentially want it
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back, which is not that easy to get back.
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So I contacted them and basically discovered that not only do I have to pay the CPSO renewal
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fee, but also you have to have CMP coverage, which I didn't.
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I had stopped it because I wasn't practicing, which in my opinion is completely irrational.
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But anyway, it's a rule.
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So, so then I thought, well, if I'm going to spend this money on renewing my license
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and paying for malpractice insurance in a context where I have literally zero clinical revenue,
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that's a little bit hard to justify.
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So I reached out to a friend.
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I had been doing some local work.
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It's an O1 sound where I've been helping out again and I had been doing that in the late
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2000s, but I stopped during the pandemic because my kids were young and I couldn't really travel
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up there.
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And so I reached out to my friend and colleague there and said, I suspect that the ship has
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sailed on that and you probably don't need me, but this is my situation.
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Is there any way I could help out?
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Because I'm looking for ways to justify the cost of starting up my, you know, whatever
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my license and my CMPA.
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And he said, in fact, we would be thrilled if he came up because I'm super behind on
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follow-ups.
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I have nowhere to put people.
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My secretary would be thrilled if you come, you know, even just once in a while.
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And so that's how it started.
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And I was a bit apprehensive, as you can imagine.
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I had envisioned potentially never practicing again.
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I wouldn't say I decided firmly that I never would, but at least on a moving forward basis,
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I had no specific intention of going back to clinical medicine.
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So I didn't know what to expect, like what I like it, what I hated.
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I was certainly not enjoying clinical urology in its previous iteration, but I've actually
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quite enjoyed it.
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And part of that is that the cultural context there is much more positive and team-oriented.
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And I've recognized that I really value that.
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I don't enjoy being a lone wolf, which is what most hospital-based specialists are.
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You know, you did some hospitalist works, you know what it's like.
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You're on your own, more or less.
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You might get some support from, say, a consultant that you involve in a patient's care, but
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for the most part.
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And what I tell a lot of people, too, is that you're not only, it's not strictly true that
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you're on your own.
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In many cases, the systemic, the many systemic factors line up in a way that they're actively
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opposing you.
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And in fact, in some cases, they're trying their hardest to throw you under the bus at
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all times, right?
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So that becomes very, very exhausting.
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And where I'm going with this is that the work environment in own sound is very different
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from that in my experience.
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It's very, there is much more of a collective dynamic, you know, we're kind of in this together.
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People are nicer.
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So, yeah, I've been pleasantly surprised how much I've been enjoying it.
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Yeah, I've seen a shift in increase in accountability almost for patient outcomes thrown on to physicians,
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but that goes along with a decrease in control.
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And I think that the sense of a lack of autonomy is likely contributing to a burnout as well.
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Absolutely.
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But yeah, I mean, as a surgeon, again, I would say that so, you know, take one individual
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example, you have a patient who urgently needs an operation.
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A lot of the time getting that done for them, you know, you would think that, I mean, there's
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an operating room that's there and it's for elective cases, but it's also for emergency
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cases.
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So the system should be set up to do this stuff.
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But in reality, at every turn, people are trying to stop you, you know, we have no beds,
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you can't you can't bring that patient from the other hospital.
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But that patient, you know, needs an urgent operation or they'll die.
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Well, we have no beds and you didn't fill out this form properly.
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So you'll have to fill it out again.
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You can't do it from home.
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You'll have to come in in person, you know, all these things that, you know, are put
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in their roadblocks to getting patients looked after.
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That becomes exhausting.
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I think this is a wider trend in Canada in which all the golf leaves and people usually
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say these are banks and are telecommunication companies, but I would sort of put hospitals
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in that in that category as they really aren't accountable for their decisions to anyone.
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Right.
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Apart from maybe the Ministry of Health, but that doesn't even seem to matter as much.
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There are a lot of physicians listening who would have loved to be in your shoes six months
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ago where you were not practicing clinical medicine at all.
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The biggest barrier for them is finances.
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Talk to me about your financial path on how you were able to set yourself up so you could
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leave medicine.
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Yeah.
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Well, I always tell people quite upfront that I was not even close to being financially
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independent and ready to retire.
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So my patients were saying, oh, I heard you're retiring and I'd say, nope, I am not retiring.
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I am not financially able to do that.
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I'm quitting.
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I did have a buffer, although I viewed that buffer as essentially, well, it is retirement
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savings.
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So for the last year and a half, I've certainly chewed through some of that, but I don't know.
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I think you have to take risks in life and you have to accept that.
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So my financial plan 10 years ago was what it was and I've had to deviate somewhat from
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that.
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But I do a lot of this.
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I wouldn't say it's a bit absurd to say I do this for my children.
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I guess on some level I do, but I definitely have been guided by, I was aware that they
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were listening to my wife and I complain incessantly about the realities of working in clinical
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medicine and I don't think that's particularly good for them to say, well, he complains about
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it all the time, but he's not actually doing anything about it.
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So I went back to school.
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No, definitely multiple reasons I did that, but on one level it was to set an example
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for my kids, say, well, you didn't like it, so he changed it.
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But again, there is risk and financial risk is definitely one of those risks.
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My fingers are crossed that this is going to eventually pay off and I believe that it
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will, but I think you have to definitely prepare yourself for a lean period when you're changing
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careers.
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Yeah, I think most people I talk to, including myself, my income, if I were to transition
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and I have not been brave enough to take that leap yet, would be about a fifth to a half
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of my clinical income.
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And yeah, I'm nowhere near financial freedom.
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How do you, is this, how do you decrease your anxiety on the lack of income in terms of,
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are you saying, okay, I'm going to give this a shot for one year, two year, three years,
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or is it, no, this is what I'm doing for the rest of my life.
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And I'm going to figure out a way to make enough income so I'm comfortable and my kids
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are comfortable.
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It may not be my clinical income, but it will be enough.
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How do you decide what that number should be?
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Should it be 75% of your clinical income?
350
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And then, yeah, I didn't really approach it that way.
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And maybe I should have, like, I think, for sure, a more prudent way to approach this
352
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would be to, you know, you could continue practicing medicine and just try to, you know,
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restrict your hours enough to gradually increase whatever alternate, alternate career you're
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trying to build.
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And I didn't do that.
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I was pretty burnt out.
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And I really did not enjoy the work environment in Kitchena Waterloo.
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But yeah, I don't know if I would view it as sort of, like, sure, I could tell you what,
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ideally, I would like to be earning, and I'm not, but for me, it was basically a necessity.
360
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My former career was not only not working for me, it was harming me.
361
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And I needed to do something different.
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And on multiple levels, you know, there was the PTSD, the burnout, also the boredom, the
363
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lack of intellectual stimulation.
364
00:25:54,200 --> 00:25:58,480
And that's, I think, for a lot of physicians, that has to be a huge disappointment to think,
365
00:25:58,480 --> 00:26:03,320
well, you know, the public thinks that this is super interesting and challenging, and
366
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you're making up creative solutions to people's medical problems.
367
00:26:06,400 --> 00:26:10,480
One of the realities, you're not doing that 99% of the time, you're just following guidelines,
368
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right?
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It's boring a lot of the time.
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And then when you, that's compounded by the fact that a lot of patients aren't actually
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all that, well, they're not grateful at all, right?
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They take you for granted.
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Do you think it's always been boring, Chris, or is that a new phenomena?
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And if it's a new phenomena, are people different now?
375
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Because that is, I hear that a lot, and I experience that as well.
376
00:26:32,200 --> 00:26:37,400
But I do wonder why older physicians don't seem to say it's boring, or it's not intellectually
377
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stimulating.
378
00:26:38,400 --> 00:26:42,080
Yeah, I think that's an excellent question, and I thought a lot about that.
379
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But I think that to some extent it has become more boring, because, I mean, guidelines are
380
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a good thing, obviously, right?
381
00:26:47,920 --> 00:26:51,880
Like having somebody make something up, and, you know, while this works for me, so I'm
382
00:26:51,880 --> 00:26:53,480
going to do it to all my patients.
383
00:26:53,480 --> 00:26:55,160
That's nonsense, right?
384
00:26:55,160 --> 00:26:59,800
But for sure, the reality, the flip side of guidelines is that it makes everything a recipe.
385
00:26:59,800 --> 00:27:03,000
And it's the same recipe almost every time, right?
386
00:27:03,000 --> 00:27:05,120
So that's, I think that's somewhat different.
387
00:27:05,120 --> 00:27:09,800
That wasn't, you know, guidelines really only started being part of the fabric, what, like
388
00:27:09,800 --> 00:27:13,320
10 or 20 years ago, maybe a little bit more.
389
00:27:13,320 --> 00:27:16,840
But I think that that piece that I mentioned that I think, you know, if you go back far
390
00:27:16,840 --> 00:27:19,600
enough, maybe you have to go back to the 80s or 90s.
391
00:27:19,600 --> 00:27:25,840
But I think that patients were much more grateful, you know, they put a value on it.
392
00:27:25,840 --> 00:27:31,560
I think for me, a pet peeve of mine is that when healthcare is quote unquote free, the
393
00:27:31,560 --> 00:27:34,320
implicit assumption is that it has no value, right?
394
00:27:34,320 --> 00:27:38,320
So then people, and I guess, you know, it's always been like that in our lifetime.
395
00:27:38,320 --> 00:27:39,920
So why is it different now?
396
00:27:39,920 --> 00:27:44,600
Well, I don't know, I guess there's been enough propaganda around that or something, but people
397
00:27:44,600 --> 00:27:47,080
don't seem particularly grateful for the care.
398
00:27:47,080 --> 00:27:51,200
There are exceptions, as you know, like some people are enormously grateful, and that's
399
00:27:51,200 --> 00:27:52,200
very gratifying.
400
00:27:52,200 --> 00:27:58,120
But yeah, I, and then you were so, when did it change?
401
00:27:58,120 --> 00:28:04,000
I think you asked, is that, so I think it's been changing very gradually, but it definitely
402
00:28:04,000 --> 00:28:05,880
is much more noticeable.
403
00:28:05,880 --> 00:28:09,680
You know, it was no, it was more noticeable toward the end of my practice in kitchen water
404
00:28:09,680 --> 00:28:11,120
earlier than it was at the beginning.
405
00:28:11,120 --> 00:28:15,080
So I think it is an inexorable change over time.
406
00:28:15,080 --> 00:28:19,600
With the rise of guidelines in algorithmic medicine, do you think we're over trained?
407
00:28:19,600 --> 00:28:25,240
This is another way of asking, do you think NPs and PAs should replace us?
408
00:28:25,240 --> 00:28:30,760
And then in the future, should AI replace us and can it?
409
00:28:30,760 --> 00:28:33,880
My take is, and I don't claim to know the answer to that.
410
00:28:33,880 --> 00:28:38,040
I think it's a very challenging question that we will have to witness how it plays out and
411
00:28:38,040 --> 00:28:43,000
see, but my sense is, maybe it's a bit overly optimistic, but I think that those sorts of
412
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changes are just going to push us to a different place in the value chain of delivering healthcare.
413
00:28:48,080 --> 00:28:53,680
And in an ideal world, it'll put us in a position, the value chain that's more interesting and
414
00:28:53,680 --> 00:28:55,160
less burnout driving.
415
00:28:55,160 --> 00:29:01,440
That may not be the way it plays out, but I think that AI and, you know, alternative
416
00:29:01,440 --> 00:29:07,200
healthcare providers have the potential to make being a physician a much more interesting
417
00:29:07,200 --> 00:29:10,080
and gratifying job.
418
00:29:10,080 --> 00:29:12,520
I think in terms of being over trained, I don't know.
419
00:29:12,520 --> 00:29:20,680
I do believe that, like I can recall specific examples where I made a significant difference
420
00:29:20,680 --> 00:29:24,520
in someone's care because of something I remembered from training.
421
00:29:24,520 --> 00:29:27,640
You know, there wasn't any guideline.
422
00:29:27,640 --> 00:29:32,200
And everyone else involved in the care of the patient was like, oh, we would have done
423
00:29:32,200 --> 00:29:33,880
this and that would have been really bad.
424
00:29:33,880 --> 00:29:39,320
And I only knew that because I was well trained.
425
00:29:39,320 --> 00:29:43,760
So I don't think that that, I think you're right that to some extent that's what happens
426
00:29:43,760 --> 00:29:48,600
with guidelines, but there are scenarios that guidelines don't cover or scenarios where
427
00:29:48,600 --> 00:29:54,080
you have to say, look, the guideline is great for this, but if you apply it to this, then
428
00:29:54,080 --> 00:29:55,640
that's not going to work out very well.
429
00:29:55,640 --> 00:30:00,160
And it takes insight and experience and knowledge to know, you know, which of those scenarios
430
00:30:00,160 --> 00:30:01,160
applies.
431
00:30:01,160 --> 00:30:05,640
Yeah, there's a couple of themes that come to mind there.
432
00:30:05,640 --> 00:30:11,520
One is we're happy to pay for things that we want, but we're not happy to pay for things
433
00:30:11,520 --> 00:30:12,760
that we need.
434
00:30:12,760 --> 00:30:18,240
We think certain things should be nonprofit, whereas we're okay with certain things being
435
00:30:18,240 --> 00:30:19,240
for profit.
436
00:30:19,240 --> 00:30:22,520
And it's never made sense to me why that distinction exists.
437
00:30:22,520 --> 00:30:31,560
But you know, we think if something is a human right, then we should be nonprofit, which
438
00:30:31,560 --> 00:30:35,920
the downstream effect of that is people aren't paid as well, you know, attract the best and
439
00:30:35,920 --> 00:30:37,280
brightest.
440
00:30:37,280 --> 00:30:44,120
And there seems to be somewhat of a contradiction there.
441
00:30:44,120 --> 00:30:45,880
What are your thoughts there?
442
00:30:45,880 --> 00:30:52,480
Yeah, I think, I mean, to me, recent examples of exactly what you're talking about are the
443
00:30:52,480 --> 00:30:59,120
shifts within dentistry in Canada where the Canadian government is saying, well, and you
444
00:30:59,120 --> 00:31:02,200
know, I think your point is well taken, like those are fundamental rights.
445
00:31:02,200 --> 00:31:07,080
Like why should you lose your teeth because you don't have dental care?
446
00:31:07,080 --> 00:31:11,360
It's absurd because of course that's a huge hit to your health, right?
447
00:31:11,360 --> 00:31:16,040
So on one level, I think it's great, but on another level, like I tell my dentist, like
448
00:31:16,040 --> 00:31:17,040
you guys are screwed.
449
00:31:17,040 --> 00:31:20,800
It's going to be just like medicine, they're going to pay you some absurd fee that doesn't
450
00:31:20,800 --> 00:31:23,000
actually cover your overhead for that procedure.
451
00:31:23,000 --> 00:31:25,960
And they'll just be like, well, that's the way it is now.
452
00:31:25,960 --> 00:31:28,520
Or another one is subsidized daycare.
453
00:31:28,520 --> 00:31:30,440
That's a fundamental public good.
454
00:31:30,440 --> 00:31:31,440
It's fantastic.
455
00:31:31,440 --> 00:31:35,360
But you know, you can see where the economics go.
456
00:31:35,360 --> 00:31:39,200
You know, daycares would be like, well, we can't afford to look after children for those
457
00:31:39,200 --> 00:31:40,200
rates.
458
00:31:40,200 --> 00:31:44,520
And then, you know, that's what happens with publicly provided services.
459
00:31:44,520 --> 00:31:48,640
Yeah, I think this is going to sound very privileged.
460
00:31:48,640 --> 00:31:52,480
And I am very privileged in a lot of ways.
461
00:31:52,480 --> 00:32:00,040
But it seems like there is a percent of society we can economically support.
462
00:32:00,040 --> 00:32:07,200
So say if 10% of people spend all their money on iPhones and to take it further drugs and
463
00:32:07,200 --> 00:32:10,080
gambling, then that's okay.
464
00:32:10,080 --> 00:32:15,000
But if 50% of people spend all their money on what their wants are and don't save any
465
00:32:15,000 --> 00:32:19,280
money for their needs, then the economic model starts to crumble.
466
00:32:19,280 --> 00:32:20,280
Yeah.
467
00:32:20,280 --> 00:32:25,680
So I think that's something we kind of, I don't know, we need someone smarter than me
468
00:32:25,680 --> 00:32:27,280
to figure that number out.
469
00:32:27,280 --> 00:32:28,280
Yeah.
470
00:32:28,280 --> 00:32:31,720
I mean, that kind of economic problem is incredibly complex.
471
00:32:31,720 --> 00:32:38,160
And there's a huge risk, I think, of what they call the wicked problem where you do
472
00:32:38,160 --> 00:32:41,600
something that you think is going to help, but in fact, you make it worse.
473
00:32:41,600 --> 00:32:47,040
But yeah, I think, you know, so we say, well, we are economically a collective and we have
474
00:32:47,040 --> 00:32:51,320
to look out for the, you know, people that can't afford, again, dental care.
475
00:32:51,320 --> 00:32:52,480
Well, I agree with that.
476
00:32:52,480 --> 00:32:54,520
But I think your point is correct.
477
00:32:54,520 --> 00:32:59,840
Like, you know, there comes a certain percentage of the population, if they're not able to
478
00:32:59,840 --> 00:33:03,400
contribute in that way, then eventually it isn't affordable.
479
00:33:03,400 --> 00:33:06,160
And I guess, yeah, you guys see where you're going with this, that our publicly funded
480
00:33:06,160 --> 00:33:09,280
healthcare is headed toward that outcome potentially.
481
00:33:09,280 --> 00:33:11,080
We just won't be able to afford it.
482
00:33:11,080 --> 00:33:14,760
Yeah, let's talk about AI a bit more.
483
00:33:14,760 --> 00:33:22,960
We seem to be very comfortable when AI makes mistakes we would make rarely.
484
00:33:22,960 --> 00:33:26,640
But we're not comfortable in the AI makes mistakes we wouldn't make.
485
00:33:26,640 --> 00:33:32,280
So when you think about regulating AI, say AI misses a PE, a very obvious PE, someone
486
00:33:32,280 --> 00:33:36,040
who has cancer, comes in and attack a car here, shortness of breath, and AI is like
487
00:33:36,040 --> 00:33:38,800
whatever this is, is a UTI.
488
00:33:38,800 --> 00:33:42,480
Anything just complete nonsense to us, right?
489
00:33:42,480 --> 00:33:49,520
But it catches more PE's in people who come in with, because my right pinky is tingling,
490
00:33:49,520 --> 00:33:52,000
something that doesn't make sense to us.
491
00:33:52,000 --> 00:33:53,920
How should we regulate that AI?
492
00:33:53,920 --> 00:33:59,800
Should we just look at it as a whole and say, okay, if you're doing a net positive, then
493
00:33:59,800 --> 00:34:01,360
you're good to go.
494
00:34:01,360 --> 00:34:04,200
Or is that you cannot make these mistakes?
495
00:34:04,200 --> 00:34:09,040
Because one of the problems with AI is it drifts, which is from what I understand, I'm
496
00:34:09,040 --> 00:34:13,920
not an engineer, but what people have explained to me is it goes wonky.
497
00:34:13,920 --> 00:34:18,640
It's like it goes drunk, or it's on drugs for like a second and it just completely loses
498
00:34:18,640 --> 00:34:20,720
its mind.
499
00:34:20,720 --> 00:34:23,400
And there's no way to control for it.
500
00:34:23,400 --> 00:34:25,960
There is a way to control for hallucinations, which is different.
501
00:34:25,960 --> 00:34:29,720
You can put parameters, but this drift phenomena you can't control for.
502
00:34:29,720 --> 00:34:33,440
So how do you think about regulating AI and its mistakes?
503
00:34:33,440 --> 00:34:37,160
Yeah, I mean, that's again, that's a very challenging question.
504
00:34:37,160 --> 00:34:38,920
Good for you for asking it.
505
00:34:38,920 --> 00:34:44,400
I guess the first thing I thought of when trying to think of how I would answer that
506
00:34:44,400 --> 00:34:52,240
is that, so I'm a big believer that I think the terms that are used are AI co-pilots versus
507
00:34:52,240 --> 00:34:54,200
AI agents.
508
00:34:54,200 --> 00:35:01,560
And I think to some extent, what I would respond to the scenario you posed is that I don't think
509
00:35:01,560 --> 00:35:05,000
we're anywhere near relying on AI agents.
510
00:35:05,000 --> 00:35:10,280
So completely putting control over processes into AI.
511
00:35:10,280 --> 00:35:13,280
I think that having an AI co-pilot makes a whole lot of sense.
512
00:35:13,280 --> 00:35:17,720
So in theory, the specific example you mentioned, there would be a human radiologist who would
513
00:35:17,720 --> 00:35:21,040
also be looking at this and saying, well, that doesn't make sense.
514
00:35:21,040 --> 00:35:24,520
There's clearly a PE here or vice versa.
515
00:35:24,520 --> 00:35:30,320
So I think that to me, that's the reality is, and I get a lot of the fears around AI are
516
00:35:30,320 --> 00:35:36,080
really fears about AI agents rather than AI co-pilots.
517
00:35:36,080 --> 00:35:41,320
Three years ago, I was working in urgent care and I felt uneasy.
518
00:35:41,320 --> 00:35:47,600
I went to check my heart rate and I was 126.
519
00:35:47,600 --> 00:35:51,360
That was how I recognized I was burnt out.
520
00:35:51,360 --> 00:35:53,880
And I was working full time in clinical medicine.
521
00:35:53,880 --> 00:35:56,960
I had a startup, I had a young baby at home.
522
00:35:56,960 --> 00:35:57,960
I went home.
523
00:35:57,960 --> 00:35:58,960
I rested.
524
00:35:58,960 --> 00:36:02,800
I did not go to the doctor when I should have.
525
00:36:02,800 --> 00:36:06,800
But that was the beginning of my burnout journey.
526
00:36:06,800 --> 00:36:11,000
Talk to me about how you've recognized you were burnt out.
527
00:36:11,000 --> 00:36:16,160
How long did that journey take and what made the decision to say, okay, I've had enough.
528
00:36:16,160 --> 00:36:18,040
I need to leave this setting.
529
00:36:18,040 --> 00:36:19,040
Yeah.
530
00:36:19,040 --> 00:36:28,400
I mean, I think that I'm also inclined to answer that with reference to anecdotes because
531
00:36:28,400 --> 00:36:30,120
the reality is it is a continuum.
532
00:36:30,120 --> 00:36:37,040
I will say I've thought a fair bit about the fact that I used to use the term PTSD quite
533
00:36:37,040 --> 00:36:42,560
liberally when I think a lot of the time what I was really talking about was burnout.
534
00:36:42,560 --> 00:36:49,080
But that said, I mean, I do recall instances that are pretty classic like PTSD.
535
00:36:49,080 --> 00:36:56,560
And it's funny too because I think for surgeons, there's legit PTSD around body horror and
536
00:36:56,560 --> 00:36:57,560
stuff.
537
00:36:57,560 --> 00:37:02,000
And I remember in my intensive care rotation as a surgery resident, there was a guy who
538
00:37:02,000 --> 00:37:06,480
had necrotizing pancreatitis and they used to bring the general surgery team would wheel
539
00:37:06,480 --> 00:37:07,480
him out of the O.R.
540
00:37:07,480 --> 00:37:09,680
every day or wheel him out of the ICU to the O.R.
541
00:37:09,680 --> 00:37:14,160
every day, wash out his retroperitoneum and then bring him back.
542
00:37:14,160 --> 00:37:19,840
And eventually they installed somebody actually literally went to Canadian Tire and bought
543
00:37:19,840 --> 00:37:23,240
a zipper, which they then so they wouldn't have to open and close it.
544
00:37:23,240 --> 00:37:25,200
They just used a zipper on his abdomen.
545
00:37:25,200 --> 00:37:26,200
And that's horrifying.
546
00:37:26,200 --> 00:37:31,200
You know, this poor guy was there for probably the entire entirety of my ICU rotation.
547
00:37:31,200 --> 00:37:35,080
It's like, how can this possibly happen to somebody?
548
00:37:35,080 --> 00:37:41,440
So there's I think there's legit PTSD and not just a surgery, but in medicine more generally.
549
00:37:41,440 --> 00:37:47,120
And I remember where I was going with this is I remember doing a circumcision in the
550
00:37:47,120 --> 00:37:49,760
operating room and the tissue was garbage.
551
00:37:49,760 --> 00:37:56,680
Like this guy had like awful chronic fibrosis and chronic inflammation.
552
00:37:56,680 --> 00:38:01,080
And I was thinking like, you know, this is one of the most trivial operations in urology.
553
00:38:01,080 --> 00:38:05,000
I, you know, sorry to interrupt Chris, just for our audience, when you said the tissue
554
00:38:05,000 --> 00:38:07,200
is garbage, what does that mean?
555
00:38:07,200 --> 00:38:09,720
And what does that mean in terms of, you know, operation?
556
00:38:09,720 --> 00:38:13,080
That sounds derogatory to a layperson because it isn't meant to be.
557
00:38:13,080 --> 00:38:21,000
But basically, you know, if you can imagine normal skin is supple and healthy and pink
558
00:38:21,000 --> 00:38:25,760
or, you know, beige or whatever.
559
00:38:25,760 --> 00:38:31,560
In some instances, human skin, when it's diseased is not that it becomes, you know, it has the
560
00:38:31,560 --> 00:38:38,840
consistency of styrofoam, I guess, hard to come up with with examples.
561
00:38:38,840 --> 00:38:44,640
But there are scenarios where, you know, the routine performance of an operation is almost
562
00:38:44,640 --> 00:38:48,960
completely impossible because the tissue quality is so poor that it just doesn't do what tissue
563
00:38:48,960 --> 00:38:49,960
is supposed to do.
564
00:38:49,960 --> 00:38:52,200
You can't, you know, put it back together again.
565
00:38:52,200 --> 00:38:53,560
And that's what I was faced with.
566
00:38:53,560 --> 00:38:57,680
You know, on one level, I would say a circumcision is a pretty mundane operation.
567
00:38:57,680 --> 00:39:00,600
But on another level, I literally had a panic attack in the oar.
568
00:39:00,600 --> 00:39:02,840
I doubt anyone else perceived it.
569
00:39:02,840 --> 00:39:05,600
But I bet you my heart rate was 120 and I felt faint.
570
00:39:05,600 --> 00:39:09,400
And I'm like, you know, the other thing with a lot of this stuff is you're on your own,
571
00:39:09,400 --> 00:39:10,400
right?
572
00:39:10,400 --> 00:39:14,560
If I was at a teaching program, I would have a resident and then you're just talking about
573
00:39:14,560 --> 00:39:17,000
it and saying, wow, this is going to be really hard.
574
00:39:17,000 --> 00:39:18,920
But there's nobody there that appreciates it.
575
00:39:18,920 --> 00:39:21,560
They're just like, they're looking at the clock thinking, when is he going to get done
576
00:39:21,560 --> 00:39:22,560
this operation?
577
00:39:22,560 --> 00:39:30,320
Anyway, so an instance of not the only instance of like a legit, you know, PTSD response.
578
00:39:30,320 --> 00:39:34,960
But I think the, I can't remember what your original question was, but the, how did I,
579
00:39:34,960 --> 00:39:39,000
what did my burnout pathway look like?
580
00:39:39,000 --> 00:39:44,800
I just got, you know, I was historically a very empathetic physician, I think, like
581
00:39:44,800 --> 00:39:45,800
unusually so.
582
00:39:45,800 --> 00:39:48,840
And I would, you know, we could talk a lot about maybe being more empathetic puts you
583
00:39:48,840 --> 00:39:52,320
at a higher risk of burnout because I think that's actually true.
584
00:39:52,320 --> 00:39:56,440
But I found myself thinking, wow, I wasn't really all that nice to that guy.
585
00:39:56,440 --> 00:40:01,200
And to be fair, that guy wasn't nice at all to me, but I lost my patience, you know, and
586
00:40:01,200 --> 00:40:02,480
I was sharp with them.
587
00:40:02,480 --> 00:40:04,240
I said, you know, whatever.
588
00:40:04,240 --> 00:40:08,800
So I started noticing instances like that more frequently.
589
00:40:08,800 --> 00:40:13,880
And just, you know, again, the boredom, like coming home and thinking, why, why am I doing
590
00:40:13,880 --> 00:40:14,880
this?
591
00:40:14,880 --> 00:40:15,880
I hated, you know, that sort of thing.
592
00:40:15,880 --> 00:40:23,880
It just became, I guess, putting it another way, the positive experiences diminished
593
00:40:23,880 --> 00:40:30,480
in frequency and intensity and the negative experiences increased, you know, in the opposite
594
00:40:30,480 --> 00:40:31,720
way.
595
00:40:31,720 --> 00:40:34,840
And then at a certain point, I'm like, I really can't do this anymore.
596
00:40:34,840 --> 00:40:39,160
And I struggled through because, you know, the MBA I did took three years and I was still
597
00:40:39,160 --> 00:40:41,320
working through it and beyond it.
598
00:40:41,320 --> 00:40:45,360
And sometimes you just do what you got to do, right?
599
00:40:45,360 --> 00:40:49,400
There's lots of people out there who are working through burnout because they at least financially
600
00:40:49,400 --> 00:40:51,240
have to, right?
601
00:40:51,240 --> 00:40:52,240
So I did that.
602
00:40:52,240 --> 00:40:56,840
But yeah, that's, that's, I don't know, you talk all day about burnout, but that's sort
603
00:40:56,840 --> 00:41:00,720
of one way of framing what my experience was.
604
00:41:00,720 --> 00:41:08,880
If you could talk to 20 year old Chris, biochemistry major, hasn't written the MCAT yet, has not
605
00:41:08,880 --> 00:41:11,200
applied for med school.
606
00:41:11,200 --> 00:41:13,840
What would you tell him in general life advice?
607
00:41:13,840 --> 00:41:17,800
And would you advise him to not pursue medicine?
608
00:41:17,800 --> 00:41:19,840
Yeah, that's tough.
609
00:41:19,840 --> 00:41:26,200
I mean, my kids would probably say, yeah, never a million years based on what they,
610
00:41:26,200 --> 00:41:30,200
you know, what they witness us saying at home and also what we actually say directly to
611
00:41:30,200 --> 00:41:31,800
them, like, don't do this.
612
00:41:31,800 --> 00:41:36,520
But I don't know.
613
00:41:36,520 --> 00:41:40,720
There have been enough upsides to my career choices that I don't think I would tell 20
614
00:41:40,720 --> 00:41:43,240
year old me not to go to medical school.
615
00:41:43,240 --> 00:41:48,120
But I think I might have, like one thing that I really look back, this wouldn't be 20 year
616
00:41:48,120 --> 00:41:52,120
old me be more like, you know, almost 30 year old me.
617
00:41:52,120 --> 00:41:58,320
But I think, again, I think I mentioned earlier about enjoying the team dynamic.
618
00:41:58,320 --> 00:42:01,760
And the other the other piece that I would say is missing and was missing through most
619
00:42:01,760 --> 00:42:03,400
of my career was the teaching part.
620
00:42:03,400 --> 00:42:04,600
I really enjoyed teaching.
621
00:42:04,600 --> 00:42:05,600
I was good at it.
622
00:42:05,600 --> 00:42:09,480
I actually won a clinical teaching award when I was there in Kingston.
623
00:42:09,480 --> 00:42:17,360
So I would say to myself, you should seriously consider a career path that allows you to
624
00:42:17,360 --> 00:42:22,520
be part of a team and to teach because you you're good at that and you enjoy it.
625
00:42:22,520 --> 00:42:23,520
So that would be one thing.
626
00:42:23,520 --> 00:42:25,020
But yeah, it's tough.
627
00:42:25,020 --> 00:42:29,440
I mean, you know, I made a good living for a few years as a physician.
628
00:42:29,440 --> 00:42:34,440
I definitely found as my burnout got worse, my ability to, you know, actually generate
629
00:42:34,440 --> 00:42:38,720
enough revenue to to exceed my overhead got harder and harder to do.
630
00:42:38,720 --> 00:42:43,440
But but it's pretty, you know, people think what physicians make is obviously much more
631
00:42:43,440 --> 00:42:44,600
than what they actually make.
632
00:42:44,600 --> 00:42:46,760
But the reality is it is a pretty well paying job.
633
00:42:46,760 --> 00:42:52,120
And so it's kind of hard to say, oh, yeah, I would probably still do it.
634
00:42:52,120 --> 00:42:56,480
But I think I would have, I know stuff now that would have altered my pathway in important
635
00:42:56,480 --> 00:43:02,840
ways might have mitigated my or slowed down my burnout.
636
00:43:02,840 --> 00:43:09,800
What advice do you have for physicians looking to break into the startup ecosystem as advisors?
637
00:43:09,800 --> 00:43:12,680
Right.
638
00:43:12,680 --> 00:43:18,720
I guess depending on the context, like for geographic reasons, I've mostly been focused
639
00:43:18,720 --> 00:43:22,320
on the Kitchener Waterloo tech ecosystem.
640
00:43:22,320 --> 00:43:29,120
And the reality is that it is normal not to have to pay for advisory services.
641
00:43:29,120 --> 00:43:34,320
So so prepare yourself to not make any money for a while.
642
00:43:34,320 --> 00:43:39,480
I actually had a really lovely conversation with a physician earlier today who asked me
643
00:43:39,480 --> 00:43:41,120
exactly exactly that question.
644
00:43:41,120 --> 00:43:47,360
I said, well, what I would probably do now and that I frankly didn't really do over the
645
00:43:47,360 --> 00:43:54,800
last year is say to any startup that wants to talk to me, I will I will offer you, I
646
00:43:54,800 --> 00:43:58,720
will I will be your chief medical officer and I'll do it for free.
647
00:43:58,720 --> 00:44:02,840
And if I think if you did that enough times, you eventually generate a certain level of
648
00:44:02,840 --> 00:44:06,720
credibility and people would be then coming to you and then eventually it would become
649
00:44:06,720 --> 00:44:08,880
remunerative.
650
00:44:08,880 --> 00:44:11,400
So that would be one thing.
651
00:44:11,400 --> 00:44:22,480
I think the other thing is learning about some of the business type frame framing to
652
00:44:22,480 --> 00:44:26,280
these situations because it's one thing for a startup to come to you and say, well, so
653
00:44:26,280 --> 00:44:27,280
you're a radiologist.
654
00:44:27,280 --> 00:44:29,240
I've got this radiology startup idea.
655
00:44:29,240 --> 00:44:30,520
What do you think?
656
00:44:30,520 --> 00:44:33,680
And in general, the answer is, yeah, that sounds interesting.
657
00:44:33,680 --> 00:44:35,360
You should pursue that.
658
00:44:35,360 --> 00:44:40,680
But I think it helps a lot to say to be able to say, well, okay, but you're going to face
659
00:44:40,680 --> 00:44:46,400
this problem and this problem and the pathway you've chosen is probably not going to work.
660
00:44:46,400 --> 00:44:49,800
So or or if you're going to do that, you're going to have to do this, this, this and this
661
00:44:49,800 --> 00:44:51,800
and you're going to have to be financed for that.
662
00:44:51,800 --> 00:44:53,360
And a lot of you know what I mean?
663
00:44:53,360 --> 00:44:57,880
So that sort of advice is takes a level of knowledge that I think a lot of physician
664
00:44:57,880 --> 00:45:02,280
advisors need to acquire and don't have from the get go.
665
00:45:02,280 --> 00:45:07,320
So how would they acquire that knowledge?
666
00:45:07,320 --> 00:45:12,600
I think the MBA is the easy answer there, but if they can't afford or don't have time
667
00:45:12,600 --> 00:45:15,120
for an MBA.
668
00:45:15,120 --> 00:45:23,000
I think, you know, so one of the most surprisingly good courses that I took at Laurier was their
669
00:45:23,000 --> 00:45:24,640
entrepreneurship class.
670
00:45:24,640 --> 00:45:27,960
I thought it was going to be fluff, but it was actually excellent.
671
00:45:27,960 --> 00:45:32,200
And every week, the professor would bring in a guest lecturer for even for like half
672
00:45:32,200 --> 00:45:36,800
an hour, an actual entrepreneur and like anything, some of them were better than others.
673
00:45:36,800 --> 00:45:40,320
But there was one guy, well, a number of them were excellent, but the one guy in particular
674
00:45:40,320 --> 00:45:45,440
that I recall in this context is he was asked, you know, a similar question.
675
00:45:45,440 --> 00:45:50,880
This wasn't physicians, but you know, what, what, what's your best advice for someone,
676
00:45:50,880 --> 00:45:52,280
you know, who wants to be an entrepreneur?
677
00:45:52,280 --> 00:45:55,280
And he said, read, read everything you can.
678
00:45:55,280 --> 00:46:01,120
And I think nowadays with the transparency of information on almost any topic, you can
679
00:46:01,120 --> 00:46:03,760
train yourself very, very effectively.
680
00:46:03,760 --> 00:46:07,120
It's not going to be the same as doing an MBA, obviously, but you know, you can come
681
00:46:07,120 --> 00:46:09,880
pretty close and depending on how committed you are.
682
00:46:09,880 --> 00:46:15,000
So reading voraciously, falling into rabbit holes and, you know, thinking, man, I just
683
00:46:15,000 --> 00:46:18,560
spent two hours reading about this obscure topic.
684
00:46:18,560 --> 00:46:22,280
That's I think a reasonable way to approach it as well.
685
00:46:22,280 --> 00:46:28,120
Well, we didn't cover, I think, about 70% of the questions I have here.
686
00:46:28,120 --> 00:46:30,120
Well, I'm sorry.
687
00:46:30,120 --> 00:46:33,080
No, this is amazing.
688
00:46:33,080 --> 00:46:34,080
Let's do a part two soon.
689
00:46:34,080 --> 00:46:35,080
Oh, sure.
690
00:46:35,080 --> 00:46:36,080
I'd love to.
691
00:46:36,080 --> 00:47:05,080
It's a pleasure.
