A neurosurgeon puts down the knife [PODCAST]

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“MRI studies of these patients determined that it was not only the circuitry that was affected by the burnout but also the size of the brain structures. Compared with the controls, patients suffering from burnout showed volume loss in the prefrontal cortex. Burnout patients appeared to also have shrinking in their dorsal striatum (caudate and putamen nuclei (areas that modify movement) and hippocampus (an area involved in emotion and memory), but an increased volume of tissue in the amygdalae.

So, put down the knife. Keep a work-life balance. Don’t burn out. Working too hard is bad for your brain.”

Resources:
Buddhism Without Beliefs: A Contemporary Guide to Awakening
Azazel’s Public House

Marc Arginteanu is a neurosurgeon.

He shares his story and discusses his KevinMD article, “Put down the knife: A neurosurgeon explains the importance of a work-life balance.”

This episode is sponsored by the Stanford Physician Leadership Certificate Program.

For the aspiring physician leader, leadership skills are one of the most important and influential traits that will elevate your overall success. 
 
Leadership impacts nearly every aspect of your career in a complex and diverse health care system. Including how you effectively communicate and influence those around you, how you respond to conflict and make important key decisions, how you develop your team, and even how you navigate social dynamics in your workplace. 
 
Stanford Medicine recognizes the need to foster physician leaders in health care. That is why they developed the physician leadership certificate program. This 6-month cohort-based program includes live virtual sessions, self-paced learning modules, professional coaching, a capstone project, and much more: Providing C-suite education for the non-C-suite physician leader.
 
They encourage all early career and aspiring physician leaders to apply. To find out more about the program or apply, visit physicianleadership.stanford.edu.

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Hosted by Kevin Pho, MD, The Podcast by KevinMD shares the stories of the many who intersect with our health care system but are rarely heard from.

Transcript

Kevin Pho: Hi, welcome to the show, where we share the stories of the many who intersect with our health care system but are rarely heard from. My name is Kevin Pho, founder and editor of KevinMD. Rate and review the show at KevinMD.com/rate. Subscribe at KevinMD.com/follow. Today on the show, we have Marc Arginteanu. He is a neurosurgeon. His KevinMD article is titled “Put down the knife: A neurosurgeon explains the importance of a work-life balance.” Marc, welcome to the show.

Marc Arginteanu: Thanks, and thanks for having me, Kevin.

Kevin Pho: We’ll get into the article in a little bit. First off, briefly share your story and journey to where you are today.

Marc Arginteanu: As you had mentioned, I’m a neurosurgeon. I went to school at the University of Pennsylvania, did my neurosurgery training at Mount Sinai in Manhattan, and then a spinal surgery fellowship there, after which I maintained a private practice in the New York metro area, and I rose to the rank of clinical assistant professor at Mount Sinai.

My personal journey is that I have thankfully been blessed with three wonderful kids and a wonderful wife and family. When my youngest daughter left for college, I said to myself, “I think I’m young enough now still, and I have enough energy to pursue Marc 2.0.” Marc Arginteanu, Marc 2.0. And so what I did is I stepped away from clinical practice. I taught a class in clinical psychology down at Florida International University and began to pursue writing more seriously, both in the realm of fiction and nonfiction.

Kevin Pho: All right, so tell me about that transition from Marc 1.0 to Marc 2.0. What were some of the motivations for you to make that transition in the first place?

Marc Arginteanu: That’s a really great question, and that’s why I wanted to talk about that article, “Put down the knife,” which I’ll summarize soon, or whenever you’d like me to. But just to take a quote from that article, when I started to think about the transition, it’s a quote from a Stephen Batchelor book. It’s called Buddhism Without Beliefs. I’ll have that in the show notes.

Kevin Pho: Oh, that’d be great.

Marc Arginteanu: Because I think it really helped me, and I think it might help other clinicians that might be watching. So the quote from that book, and I’m going to paraphrase because I don’t remember it exactly, is that there are two things that we all know to be true. One is that we’re going to die. Two is we don’t know when we’re going to die. It could be tomorrow, hit by a truck, or it could be 50 years from now, 70 years from now for the younger people. And knowing that those two things are undeniably true, the question becomes: Are you doing what you want to be doing right now? So that was what began my transition to Marc 2.0.

I loved clinical neurosurgery. I love taking care of patients. But it’s not the kind of thing you can dial back to do part-time. I’m sure the other doctors on the show will know, and especially surgical doctors will understand: You go to bed with these patients in your mind, you wake up with these patients in your mind, and you have to do the absolute best job that you can. Doing neurosurgery two days a month or one day a week, you’ll lose those clinical skills, the technical skills, really. And then if you try to go back and do it in that part-time way, you might feel, or I might feel, as if I’m not able to provide that kind of utmost excellent service to the community. Other people might be different. They might be able to do that.

Kevin Pho: All right, and let’s talk more about that transition and your continuing journey. Your KevinMD article is titled “Put down the knife: A neurosurgeon explains the importance of a work-life balance.” Now, for those who get a chance to read the article, continue your story. Talk more about that article.

Marc Arginteanu: Yeah, absolutely. So one of the things that happened, and I think you look younger than me, but I don’t want to presume your age: When I started, the people who were my mentors and my senior people were so engrossed in their career. Their career was their life, and their life was their career. And again, especially on the surgical side, you’d see some of these guys who were in their 70s and 80s and long past the ability to operate, either staying in the operating room to the detriment of their patients, or on the other hand, staying out of the operating room but just hanging around at these conferences and clinics.

If you talked to them for a little bit, you’d realize it’s not because they loved medicine that much, although some of them did, so I don’t want to paint everyone with the same brush. But in a lot of cases, it was because they’d never developed any other thing, any other passion, any other joy in their life. So their own sort of 1.0 journey reached its peak and started to decline, as it will for all of us. We all lose technical skills. We all lose intellectual skills, whether we’d like to admit it or not, and as a neurosurgeon who knows the brain, I know that to be true.

So you have to start to think about something that doesn’t depend as much on your fluid intelligence but more on your crystallized intelligence and your experience and your accrued wisdom. So to do something, or to have something, that you either love because it’s just a joy, or to have a second passion that you can pursue as a second career, is a lot of what that article is about. And besides the Stephen Batchelor quote, I even went back to the Bible and took a quote from King Solomon: “He who works with the stone ultimately will be killed by the stone.” And that’s what happens to people that don’t find a way to get that work-life balance going.

And to put meat on the bones a little bit, so it’s not just a touchy-feely thing, I actually wrote another article for your site, which took into account what had happened during the coronavirus pandemic. There were two separate things. The burnout rate in doctors and nurses went berserk. There was some Lancet article that described a significant percentage of doctors and nurses who had even contemplated suicide. And secondly, burnout is bad for your brain. There was a study in the British literature that showed that for people who spent too much time working and not doing anything else, if you did an MRI at the beginning of their career and at the end of their career, as a longitudinal study, and it wasn’t just doctors, it was anyone who overworks, there was more atrophy in the people who worked beyond a certain percentage of time.

So based on all those things, again, when I saw the opportunity in my life, knowing that my kids were at their next stage, all in college, and I didn’t have to be home for dinner every single night, I said, “All right, let me try teaching a course at a college. Let me explore writing. Let me do these things that, to me, give me a feeling of timelessness.” I’m suddenly not saying, “Oh, man, I’m in the office looking out the window, wondering when I can leave,” or worrying about blank.

Kevin Pho: So as a neurosurgeon, you’ve obviously spent a good part of your career in training, doing these very long procedures, and you’ve invested so much of your life into being a neurosurgeon. How difficult was it for you to let go of that identity?

Marc Arginteanu: That’s actually a super awesome question, and I really love that question. I’m going to answer with two separate things. So one is the sunk cost fallacy. As I said, I loved what I did as a neurosurgeon, but imagine I didn’t. Imagine I had gone through all that training and realized on day one of my practice that I didn’t love it. The sunk cost fallacy, just in case anyone doesn’t understand it, would say, “I’ve already put in this much time. I’d better keep going.” And they continue to do something even though they’re miserable with it. So just the fact that you put in a long time to do something and to achieve something doesn’t mean you should keep doing it if you don’t like it.

Now, that wasn’t the case for me. As I said, I loved it. I love taking care of patients. I love my patients. Many of them became friends and so forth, and some of them have become mentors in my Marc 2.0 journey. Even the ones who were business savvy and had also retired early, I turned to them for advice: “What are you doing? How does it work?”

I loved what I did, so for me, it was more like thinking about a baseball career. I love baseball. I love the Yankees. I love Derek Jeter. I don’t know whether one knows him or not, but he was a quintessential Yankee player, the captain of the Yankees. When he retired, he probably could have squeezed the lemon for another few years, got a lot more money, and just rested on his laurels. But he decided, “You know what? Enough’s enough. I did the baseball thing. I love the baseball thing. I’m ready to move on.” And I took that as a lesson.

I graduated medical school in ’93, so by the time I stepped away, it was 2020, 2021. That’s a lot of time. So it wasn’t as if, “Wow, you put in that time, and it’s wasted.” I definitely got what, if I were a fireman or a policeman, would have been a full career, easily.

Kevin Pho: We’re talking to Marc Arginteanu. He is a neurosurgeon. His KevinMD article is titled “Put down the knife: A neurosurgeon explains the importance of a work-life balance.” Marc, you said earlier that a lot of people who are steeped in clinical medicine hang around clinical medicine until the latter part of their lives. So when you decided to step away and pursue this secondary career as a writer, what were some of the reactions of your colleagues and people that you knew well?

Marc Arginteanu: Yeah, that’s also a great question. So basically, many of them were supportive, and really, to a person, they were supportive. Luckily enough, I was in a private practice. I surrounded myself with the best, the wonderful partners one could ask for, or they surrounded me, whatever way you want to look at it. And even at the academic medical center at Mount Sinai, the people who were higher up on the academic chain, the vice chairman and the chairman, were nothing but lovely and supportive, and still welcomed me back if I wanted to give a guest lecture or a grand rounds or something of that nature.

So there was support, and there was also a lot of, in a way, not bad jealousy, good jealousy, like, “Oh, I wish I could do it. I wish this. I wish that.” And I do think it’s an important thing, and it touches on something else. I think it’s an important thing early on, for people who are listening and for people who have sort of means, like they’re in a practice that’s lucrative: Start thinking very early on about setting aside stuff that’s going to give you a passive income as you get older, and also get rid of as much of your debt as you can, because debt, in my opinion, is slavery.

So once you have your debts paid off and you have enough passive income coming in, as long as you can manage your lifestyle appropriately, then you at least have the freedom to say, “Well, I’m going to pursue Marc 2.0,” or John 2.0, whatever it may be. So there has to be a lot of planning going in, because you don’t want to, obviously, do things like this irresponsibly.

Kevin Pho: So we have a lot of clinicians who listen to this show, and a lot of them are going to be at a mid-career crossroads. So for those clinicians, what kind of advice do you have? What kind of questions should they be asking themselves about whether to continue on that 1.0 journey or make that pivot into a 2.0 journey like you did?

Marc Arginteanu: So there’s the practical part that I touched upon, meaning: Do I have the resources to maintain the lifestyle that I want? And if I don’t have those resources, what does 2.0 look like? Does it look like something that would provide me with the same or more resources? Some people who would pivot (doctors are so smart in general) could pivot to something like finance or venture capital, and they could leverage the skills that they’ve accrued for that second career if they need to have a lucrative career.

But if you’re going to transition a little more to something like I did, which is something that won’t necessarily be lucrative, such as teaching a college course or writing some books, you’re swinging for the fences. If whatever you do is super successful, great. But many more people, even super talented people, pursue something in the arts, writing, singing, playing an instrument, and they’re so spectacularly good, but it’s not something that could support their lifestyle.

So the other thing I would say is that pursuing your passion blindly is not really something that I would advise, and I don’t think it’s something that resonates with a lot of doctors. A lot of us, and I don’t know about you, but myself included, went into medicine because we have a certain level of risk aversion. I’m a risk-averse individual. I definitely wanted to know my mortgage could be paid, my kids’ college tuition could be paid, and my nice vacations, wherever I want to go, I won’t have to be staying in the youth hostels, things of that nature.

Kevin Pho: And my final question: What are some of your take-home messages that you want to leave with the KevinMD audience?

Marc Arginteanu: Oh, yeah. So I think the take-home message is to have some level of introspection, to know where you’re at in your life journey, and to prepare for the inevitable changes around you. I’m still in my 50s, but if I were to stick around in surgery till my 60s or 70s, there’s a technical decline. If you’re not a surgeon, if you’re a medical person, there’s a time where you’re so far out of your training that many of the medicines that are around weren’t even invented when you were in school.

Kevin Pho: And so for those who are interested in pursuing Marc 2.0 and your writing career, how can they find out more about you?

Marc Arginteanu: Oh, yeah, I really appreciate it. So the book that I was fortunate to have published was Azazel’s Public House. It’s a fiction book, and the storyline is this: I grew up in Staten Island in the 1980s. At that time, Staten Island had the largest garbage dump in the world. You could see it from space. And the idea is, Azazel’s Public House is a dive bar in Staten Island, and the manager happens to also be a demon who’s able to ride on the stench that rises from the garbage dump and torment the good people of Staten Island. He’s wreaking havoc, and the only thing really standing in his way is a skinny teenage misfit named Gina. And I won’t give much more than that.

It’s fun. It’s a fun, enjoyable book. People who’ve read it so far have given excellent feedback, luckily enough, on Amazon, and it just came out a couple of weeks ago. So it’s really propitious that you were kind enough to have me on at this time, when I’m still in the super excited phase about it.

Kevin Pho: Marc, thank you so much for sharing your story, time, and insight, and thanks again for being on the show.

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