Toughness is not defined by a dollar amount [PODCAST]

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“It has now been almost four years since I transitioned to academia. I see fewer patients per day and take fewer call. I also have more time with each patient, more time to recharge, more time for other academic pursuits, and more time for creative outlets. My compensation has decreased, but I have never felt tougher.”

Jayson Greenberg is an otolaryngologist.

He shares his story and discusses his KevinMD article, “Toughness is not infinite and is not defined by a dollar amount.”

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Transcript

Kevin Pho: Hi, and 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/podcast. Today on the show we have Jayson Greenberg. He’s an otolaryngologist, and his KevinMD article is titled “Toughness is not infinite and is not defined by a dollar amount.” Jayson, welcome to the show.

Jayson Greenberg: Thank you very much, Kevin. Thank you for publishing my article and taking the time here today.

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

Jayson Greenberg: I’m an otolaryngologist, a general otolaryngologist. I’ve been in practice for 20 years now. I was born and raised in Michigan, went to undergrad and med school here, and then did my training in Houston, Texas, and then moved back. I’ve been in private practice for 16 years, and in academics now for four.

My story is an interesting one. I know you said you’d get to my article, but there’s lots of buildup to that. About four years ago, I had a quintuple bypass and was burned out and whatnot. I feel lucky to be here, and I’ve learned a lot along the way and want to share with others.

Kevin Pho: All right, so we could actually go straight into your story. Like I said, it’s titled “Toughness is not infinite and is not defined by a dollar amount.” So tell me about the events that led up to the story in your article, and then you could talk about that article to those who didn’t get a chance to read it.

Jayson Greenberg: Sure. After I switched jobs. I was burned out and unhappy, working very hard in a small town where we couldn’t find another physician to help us, and I saw an ad for a position at the local academic center. I knew the salary would be less. We all know there are differences in salaries between academics and private practice, but I felt that was what I needed to do.

Kevin Pho: Now, before you get into academics: When you said that you were burned out in private practice in a small town and you were having trouble recruiting another physician, just paint a picture. Give us a sense of what that was like.

Jayson Greenberg: We were three doctors in a small town, and after five years there, we dropped to two. Someone left, and it’s tough to recruit people to work in small-town America, especially in the subspecialty world. There just aren’t that many subspecialists or specialists out there, and most of them are looking to go to metropolitan areas. So what happened is the weight of the practice just kept on growing. It was like a weight on my shoulders. Every year the patient load got a little bit bigger, and it took its toll to the point where you dread coming to work some days, you feel lucky you made it out at the end of the day, and you’re exhausted when you come home.

Kevin Pho: And at what point did you decide, “This may not be the right situation for me,” and you wanted to maybe look at an academic center? How long did it take you to process that decision before you took that next step?

Jayson Greenberg: This is going to tie into my article a little bit. I looked around, and I did pursue another offer, but it was a pay cut, and I wasn’t ready to do it. There were other issues there, but the main thing was money, and it just didn’t seem like the right fit. So I soldiered on.

As I tell my story, I was looking through our Academy Bulletin, and I call it a miracle: I saw an ad for a general otolaryngologist in our Academy Bulletin at the local academic center. They’re usually looking for quaternary subspecialists, and I thought it was an ad that they had to do and that the position had already been filled. I waited a month, I saw it again, and I applied. I went through the process, and I tell people this job saved my life.

Kevin Pho: So when you were considering that job, you mentioned that it was less pay. What was your mentality going into that? Because one of the things you wrote in your article is that no job is too tough if they pay you enough. That was what you were told. So tell me about your mindset as you were considering this transition.

Jayson Greenberg: You know, that’s certainly what I heard. At least in private practice, not in all private practices, but sometimes the only metric that you follow is money. That was the only metric that was followed, and it’s tough to jump off that train. When I sat down with my wife and family and looked at it: Look, we’re physicians. We’re always going to do well. I’m always going to put food on the table. And what’s the point if you don’t have the time and energy to enjoy some of that money?

It wasn’t an unreasonable jump. I felt like we could make it, and fortunately, I’ve always lived within my means. The “tough enough” quandary did jump through my mind, but I think this really shows your toughness, when you’re willing to make a change like that for things that are more important than the dollar amount, and I’m grateful that I did.

Kevin Pho: Now, you mentioned that you did have the insight to realize that success is measured by more than a dollar amount. Is that a common train of thought, a common thought process, among the private practice colleagues that you’ve encountered?

Jayson Greenberg: Not really, at first. When you get out and you’re applying for jobs and you’re on a resident salary, you’re excited to make a bigger salary, and that’s a lot of the way you compare some of these offers. It’s certainly why I took the first job offer I did; one of the main reasons was that it was a higher salary. And then you get on that train, and that’s what people talk about. Certainly you want to deliver quality care and get better at your craft, but it seems like money takes a high precedence.

Kevin Pho: So tell us the next step in your story. You took this academic position. Tell us what happened.

Jayson Greenberg: I took the academic position, and I guess I can’t tell my story without talking about my heart issues, because that’s a big part of it, and it’s a big part of what I’m passionate about. So I switched jobs, and I started to be a little short of breath at times and to have some, to be quite frank, stinging in my chest with exercise. I exercise regularly, and I thought it was just the anxiety from the new job. A change is hard, especially after 16 years in a practice environment. I was lucky enough to listen and talk to my primary care physician. I saw a cardiologist, and I failed my stress test.

My other public service announcement is to get a coronary calcium scan. I believe you’re an internist. My score was absurdly high. I was cathed a week later and on the table two or three weeks after that. I had diffuse disease and had a quintuple bypass. So that’s why I say this job saved my life.

And aside from the care I received, the pace is dramatically different. I work less, and I make less, and I’m fine with that. I see fewer patients, but I think I’m a better clinician. I have more time to talk to people, and I have a bunch of talented colleagues I can tap into whenever I need them. So it’s been a great change for me.

Kevin Pho: Now, if you were to relive this all over again, maybe not the heart issues, but in terms of the professional pathway that you took, is there anything that you would have done differently?

Jayson Greenberg: That’s a great question. I like to think that everything happens for a reason, so I don’t know if I would have this job. Although it was tough, I wish I had paid more attention to culture when I started. But you know, there are many factors in the job decision formula. We wanted to live in Ann Arbor. We love it. It’s been a great place to raise a family, and this was the only position available to live where we wanted to live. The trade-off that I made was that it was a high-stress environment. So I don’t think I would have done anything different from that standpoint. I pursued other offers earlier; that might have been something where I might have made a change sooner. But I think this was meant to be my path, and I’m happy with what I’ve accomplished and the path that I’m on.

Kevin Pho: Do you think you would have been happier had you gone straight to an academic setting after fellowship training, or did you need to have that private practice experience first so you could have this contrast?

Jayson Greenberg: That’s a great question. I think whatever specialty you do, it’s good to work in different environments and have that contrast. I think in academics I would have had more mentorship, which I think is important, and there’s a lot more talk about that now. In private practice, depending on the private practice you’re in, a lot of it is everyone for themselves. When you finish, you think you know everything, but you don’t know everything, and you learn some things the hard way. It would have been nice to have a little more support, which I think you get, especially now, in an academic environment.

But to be quite candid, there are differences in salary. We all get those flyers every week: This job has very high dollar values on there. And it factors in, especially when you’re young and you haven’t been out there yet and you’re considering job offers. The situation may be different now.

Kevin Pho: Did you have any guidance, any career counseling, to give you a heads-up: “Hey, the dollar amount may be higher, but it comes with these downsides”? Did you have any of that?

Jayson Greenberg: Not from that standpoint. I do have an inner circle who I discuss things with. I think everyone should have an inner circle that they discuss decisions with. But if you’re young and you’re healthy, sure, there’s more call and it’s busier, but that’s good. You’ll grow your practice. You’re in the growth phase then, and you’re eager to work and get started. So I didn’t really anticipate the downstream effects. I didn’t think it would be that detrimental down the road.

Kevin Pho: We’re talking to Jayson Greenberg. He’s an otolaryngologist. We’re talking about his KevinMD article titled “Toughness is not infinite and is not defined by a dollar amount.” So Jayson, take us into that conversation you had with your family. What specifically was it about that conversation that made you realize that success is more about the money, that there is more to being a physician than the dollar amount and the RVU?

Jayson Greenberg: There’s something that I often quote. My kids say this is annoying when I do it, and I can’t give you the origin, but my kids will say, “Oh, is that person rich?” And I’ll say, and it’s something from Judaic texts, “Who is rich? He who is happy with what he has.” It’s not about the dollar amount.

And I wasn’t happy when I was on call. I was a different person. When that pager went off, my heart would be through my chest, and I wanted to throw it through the window. My kids appreciate how much happier I am now and how much more present I am now. But we haven’t really had to change our lifestyle. I was fortunate. I worked hard and did well, and we lived within our means and made sound financial decisions. But I think overall, my family’s been ecstatic. I’m a different person than what I was back then.

Kevin Pho: And for those other surgical residents or fellows just encountering the attending job market who are considering various offers, what kind of advice do you have for them?

Jayson Greenberg: You know, the money is important, but it’s not the only thing. The culture is important. There’s a lot more wellness and well-being and burnout, and you have to take those factors into effect. You’re always going to be able to put food on the table, and you’ll always take care of your family. You have to make sound financial decisions, but money shouldn’t be the only factor. Quality is important. It’s a tough job. You’re going to work hard, and you’re going to learn a lot, but there’s more to it than the dollar sign.

Kevin Pho: So when you say culture is important and wellness is important, during a typical job interview, what kind of questions should they be asking to assess the culture?

Jayson Greenberg: That’s a great question. Has there been turnover, or retention? I think that’s a great subtle sign of culture. Are people leaving? I know when I was looking at jobs, there were certain types of practices where there had been constant turnover of junior partners, and those were places I wanted to know about.

And you can also ask that not just of the faculty; find out what the staff are saying. That’s also a sign of good culture. And how often do the other faculty members or colleagues get together and meet? Not that you’re necessarily looking for a new set of friends, but how collegial are they outside of the work environment? I think that is another important one.

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

Jayson Greenberg: I would say to be self-aware, to take care of yourself, and there are times you have to put yourself first. See or die. I’m also passionate, besides wellness, about preventative care. See your physician. Doctors take better care of patients. And lastly, I would say get a coronary calcium scan, or talk to your primary care physician about that.

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

Jayson Greenberg: Thanks, Kevin.

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