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We sit down with Ben Reinking, a board-certified pediatric cardiologist, medical educator, and certified physician development coach, to explore the challenges and rewards of medical training. We dive into themes of delayed gratification, maintaining work-life balance, and how medical students can navigate the tension between professional identity and personal fulfillment. Ben shares insights on balancing long-term goals with present joy, avoiding burnout, and fostering resilience throughout the journey to becoming a physician.

Ben Reinking is a board-certified pediatric cardiologist, medical educator, and certified physician development coach, as well as the owner of The Developing Doctor.

He discusses the KevinMD article, “The practice of delayed gratification in medical training: a double-edged sword.”

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Transcript

Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast. Today we welcome Ben Reinking. He’s a pediatric cardiologist, medical educator, and certified physician development coach. You could find him at The Developing Doctor. Today’s KevinMD article is “The practice of delayed gratification in medical training: a double-edged sword.” Ben, welcome to the show.

Ben Reinking: Thanks for having me, Kevin. It’s great to be here.

Kevin Pho: So you wear many hats. You’re a pediatric cardiologist, medical educator, certified physician development coach. So in that context, tell us about your story a little bit and how you came to wear all those hats.

Ben Reinking: Yeah, you bet. So I think professionally, just to start with, like you said, I’m a pediatric cardiologist. I’ve been at the same institution for my entire career, so going on almost 25 years at the same place.

And I entered medicine probably like many people thinking that, oh, I’m going to be a clinician, I’m going to take care of patients, and that’s really where my passion lies. And through just the natural evolution of things and through training, I found that I really liked helping others and helping them learn, and wound up in medical education, and have been a fellowship program director and a community director in the College of Medicine.

And then through my own personal experiences with some of the challenges in medicine, stumbled upon coaching, and that fit into the vein of really kind of helping others, and it seemed like a natural progression for my career.

Kevin Pho: All right, today’s KevinMD article focuses on the practice of delayed gratification in medical training, a double-edged sword. Now tell us the events that led you to write this article, and then talk about the article itself for those who didn’t get a chance to read it.

Ben Reinking: Yeah, you bet. So my job’s a little bit unique in that I meet first year medical students in their first week during orientation, and I’ve been in the position long enough that I’ve seen some of them progress through medical school, go through residency, and some of them are even now faculty.

And one thing that I’ve noticed is that every step of the way people say, oh, I can’t wait until I’m done with the preclinical years and then I’m in the clinical years, or I can’t wait till I’m done with medical school and I’m in residency. And part of that process then is sometimes delaying other parts of their lives.

And that works well for short-term things, right? So if you’re on a tough rotation and you have to skip going to the gym for a month, that’s something that works out for people. I think as many of us experience, that short-term cycle that happens during training in medical school ends as soon as you graduate and finish training, and then all of a sudden the horizon’s indefinite. And you also have this realization that it’s not really easier, it’s different, but it’s not really a lot easier. And sometimes there’s a sense of loss along the way, that oh, there are things that I wished I would have done up to this point.

Kevin Pho: And I’ve seen it. As you know, medical training in general is very grueling and rigorous, and it’s always the next short-term goal, right? When you’re premed you have to study for the MCATs and get grades, and then you’re in medical school and it’s always the next shelf exam, and then USMLE, and then internship, residency, and fellowship, and just a series of short-term goals. And then when it all ends, and then like you said there’s that infinite horizon, sometimes it is a little bit jarring for a lot of these young doctors.

Ben Reinking: Yeah, absolutely. And I think what prompted me to write this article was, I think it was mid August, and I ran into a student that I had worked with for four years as a medical student, and he was on his first month of an inpatient rotation, about two weeks in as a family practice resident. And I said, hey, how’s it going? And he had the shell shocked look, and said, you know, I knew it was going to be tough, but I really didn’t think it was going to be this tough. And he happened to have two young kids at home, and was just kind of struggling with some of the things that he was missing out on that he I think didn’t predict was going to happen.

Kevin Pho: So as a medical educator, or medical leader, what kind of things do you do to, I don’t know, I want to say warn, but maybe soften the blow, that maybe the decisions that they’re making, you don’t want them to regret later on? What kind of things do you do as an educator?

Ben Reinking: Yeah, I think there are a couple things that are helpful. So one common theme that I think everyone has when they enter medical school is everyone’s so passionate about helping people. That’s the number one reason that we hear in interviews, and even in the first year students, is I just really got into this to help people. Frequently the other theme is it’s also kind of hard, and people like the challenge that comes with it.

And sometimes it takes a little bit of reminding of that. So remember why you got into this, and what values were you honoring when you got into medicine. And it is going to be hard, you’re absolutely right, but when you get to the point where you’re struggling and the hard piece takes over and you forget why you got into medicine, it’s really about reconnecting with what’s important. And sometimes that’s life outside of medicine. And then when you recognize that, it’s about making a choice intentionally to choose something outside of medicine when you have the option to.

Kevin Pho: So what would be an example of that, or story or case study that you’ve seen, where a medical student or resident may be confronted with that choice? And you’re right, it has to be somewhat intentional. What would be an example of that?

Ben Reinking: Yeah, I think a simple everyday thing is many of us, and this includes students and residents, is eat lunch in front of our computers, right? You don’t step away from the office. For me, I don’t step out of the echo reading room some days, and I just eat my salad in front of the screen. And it’s intentionally making a choice to change something small in your day, right? And sometimes that’s all that it takes.

There are other times when it’s something big, right, where there’s a family event or maybe you have a date night, and you have the option of, do I stay late and get this chart done and I know tomorrow is going to be easier, or do I stick with this other commitment and choose something outside of the hospital? And it’s recognizing that you have the power to choose and choosing what’s important.

Kevin Pho: So this concept of delayed gratification, I guess the culture of delayed gratification, do you think that contributes to the burnout and the dissatisfaction that we see in many attending physicians today?

Ben Reinking: It absolutely does, right? I mean, there’s always this sense that I need to put the patient first, and this obligation for self-sacrifice, which is honorable and definitely part of the job. But then you get to a point where you realize that, wow, I don’t even remember who I am anymore. And some of those things that you gave up and that delayed gratification, I think catches up with you, and then people aren’t happy that they made some of the choices that they made.

Kevin Pho: How difficult is it for medical students, residents, young physicians sometimes to choose personal fulfillment over professional duty? Because like you said, they want to go in because they want to help patients, and sometimes they don’t want to be seen as selfish, and they don’t want to do that self-care that is so necessary but maybe perceived as putting themselves ahead of the patients. How difficult do you see it is for these young medical trainees?

Ben Reinking: Yeah, it’s very different for trainees than it is for people outside, because they’re constantly being judged, right? So they feel like they’re being graded and being assessed. And so although we talk about having a growth mindset and focusing on learning, you can’t help but focus on your performance and how people perceive you. So I think it’s really difficult for them to do so.

And training is relatively rigid, right? I mean, they have times when they can take vacation and times when they can’t. And so although I’m sitting here saying try to make choices that you can, I also recognize that there are confines related to the program that limit the choices that they can make.

Kevin Pho: So over the years or decades that you’ve been involved in medical education, have you seen an evolution of these programs that can perhaps be more sensitive to the concerns we’re talking about today?

Ben Reinking: Absolutely. I think a simple change that I’ve seen in the clerkships just at our institution is they now have flex days, right, where there are a couple days on every rotation where if they need to go to a doctor’s appointment, or if they have a wedding they need to go to, they actually have the option of saying, hey, I can’t be here this day. Which when I was in training was unheard of, right? And so the culture has definitely shifted in a way that hopefully is encouraging people to take care of themselves.

Kevin Pho: And in terms of changing that medical culture, right, so as I think I’ve talked about before with other guests, and I’m sure you’re familiar, the status quo is very powerful in medical culture, right? So sometimes there’s that perception of heroism in medicine that you never want to look vulnerable or weak. So how difficult is it to change that medical culture where we can make some of these adjustments to prevent how delayed gratification can affect physicians in the future?

Ben Reinking: Yeah, I think you touched on something important, is that it is really hard to change. And I think some of the changes we’ve seen have actually resulted from the organizations that oversee us, right? So the LCME for medical school, the ACGME for training programs. And although people frequently look at institutions that oversee physicians in training as the enemy, in this case I think they’ve been very beneficial in terms of advocating for wellness of our learners, trainees, and physicians.

But getting people to change on the individual level, you know, and it’s always, I walked to school both ways uphill in six feet of snow kind of, we all remember how hard it was. And so it also takes a little bit of a generational shift, I think.

Kevin Pho: Now we talked about new attendings, because after they finish residency or fellowship and they’re in an attending job, sometimes they ask themselves, this is it, this is the end of the road, there’s no more short-term hoops to go through. And then they kind of find themselves wondering what’s next, right? Do you ever see that in the trainees and the young attendings that you supervise?

Ben Reinking: Yeah, absolutely. You get out of training and you are used to this culture where you’re on to the next thing and on to the next achievement. And although it’s true that there’s a lot of growth in your medical knowledge and clinical care skills, I imagine it’s especially true in private practice where you’re focused just on clinical care, that it can be hard to seek out opportunities for personal professional growth.

And so in academics I think I was lucky that I had opportunities to shift to other things and found coaching as a way to grow. And so I think it’s a matter of encouraging new faculty members to find their thing and find something that they’re passionate about and fiercely protect that, and advocate for time where you can hang on to that. And I think that helps solidify their career and their well-being.

Kevin Pho: Yeah, so speaking of coaching, you’re a certified physician development coach. Tell us about some of the common questions that you get asked, and what is the role for coaching for these physicians who run into these roadblocks?

Ben Reinking: Yeah, I think that’s a great question, and it’s something that everyone struggles with a little bit, I think, because one, asking for help is hard. And then two, coaching is a little bit of a nebulous concept I think for people, and sometimes it’s perceived as almost disciplinary, like I was sent to a coach because I did something wrong.

But I think the biggest benefit that I’ve seen in myself and in my clients is that medical training teaches us how to think and act like physicians in terms of how we can care for patients, and our clinical skills and talking to patients. But there’s a little bit of a gap in the things that we’re taught. We don’t really learn leadership skills the way that we should, communication skills, emotional intelligence. And you don’t recognize that gap until you’re out of training and you’re practicing on your own, and you’re like, I really don’t know how to deal with this situation and I’ve never been exposed to it before. And I think that’s where coaching is really beneficial.

Kevin Pho: So give us the before and after. It doesn’t have to be a specific client that you’ve had, but perhaps an amalgamation or hypothetical case where a young physician came to you and perhaps you’ve coached them. Give us a before and after picture in terms of the changes they made and what it looked like after coaching.

Ben Reinking: Yeah, actually I have a great example of something that was just a really simple mindset shift. So I was working with a young physician. He was a couple years out of emergency medicine training, and during his training and immediately after training he really focused on paying off student debt. And he took extra shifts, he was working hard, and his goal and what he really valued was paying off his debt and that financial security.

During that time he got married and he had twins actually, and so he had a family at home, but his behavior didn’t change. And he kept taking those extra shifts even though he’d already paid off his debt. But it was such a habit for him to do that, and it was so ingrained in him that he wanted this financial security, that he just didn’t take the minute to sit back and reflect and say, hey, this really isn’t that important to me right now. And really what he valued was time with his family.

And all that he needed was someone to listen to him and point out, like, there’s a little discrepancy here. And it was just such a simple thing in retrospect, but in the moment it was really powerful and completely changed how he viewed his home life and his work life, just by eliminating those extra shifts that he was taking.

Kevin Pho: Now for those medical students and trainees who may not have the benefit of listening to this podcast or coaching, what are some of the ways they can fill in those gaps of knowledge beyond patient care? How can they learn about these skills?

Ben Reinking: Yeah, there are threads of it in the curriculum, and I think sometimes they’re the threads that students tend to think are less important because sometimes they’re not tested. And so maybe taking advantage of those lectures that maybe don’t show up on the test but focus on some of the softer skills in terms of team building.

I think the other thing that’s really beneficial is just watch how people around you work. And so you’re going to see people that are really effective at their jobs, that can communicate with people well, and kind of steal what they do and take from those experiences and add their tools to your tool kit. And that’ll help you in the long run.

Kevin Pho: We’re talking to Ben Reinking. He’s a pediatric cardiologist, medical educator, and certified physician development coach. Find him at The Developing Doctor. Ben, we’ll end with some of your take-home messages to the KevinMD audience.

Ben Reinking: Yeah, I just have one simple message to the KevinMD audience, and that is just to recognize the power of the daily choices that you make. If you’re struggling with something at work or at home, sit back and think about one little thing that you do during the day that maybe you could do differently. And sometimes, like I said earlier, it’s as simple as not eating lunch in front of your computer, and that little change changes your whole day.

Kevin Pho: Ben, thank you so much for sharing your perspective and insight, and thanks again for coming on the show.

Ben Reinking: You bet. Thanks so much.