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Pediatrician and certified coach Jessie Mahoney discusses her article, “From burnout to balance: a neurosurgeon’s bold career redesign.” She shares the powerful story of a female neurosurgeon who, on the verge of leaving medicine for interior design, instead chose to completely redesign her career. Jessie explains how, through coaching and courage, the surgeon created a non-traditional model of working one week on and one week off, which allowed her to find deep fulfillment in both her personal and professional life. The conversation explores the profound role that shame and cultural conditioning play in keeping physicians, especially women, trapped in unhealthy and misaligned roles. Listeners will learn why feeling stuck is not a personal failure but often a sign that the system wasn’t built for them, and how creativity, support, and questioning long-held assumptions can help any physician forge a more authentic and sustainable path in medicine.

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Transcript

Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast. Today we welcome back Jessie Mahoney, pediatrician and certified coach. Today’s KevinMD article is “From burnout to balance: a neurosurgeon’s bold career redesign.” Jessie, welcome back to the show.

Jessie Mahoney: Thank you so much for having me.

Kevin Pho: Alright, so what’s this latest article about?

Jessie Mahoney: So this article is really about moving beyond this feeling of failure and shame when the traditional systems don’t work, and especially for women who I think really see the option as: if the traditional system doesn’t work, they have to leave medicine. They feel that they have failed if that traditional system and conforming to signing up for a job or working in a specific place that doesn’t work for you is a failure and you haven’t made medicine work. It’s a “you” problem.

Kevin Pho: Alright, so in your article, you talk about a neurosurgeon who wanted to become an interior designer. So tell us about that story.

Jessie Mahoney: That story just blew my mind. So this neurosurgeon came to a women physician retreat that I run; I run them many times a year. And she came actually having redesigned her job, left a job that wasn’t working for her, and redesigned it to a job that was working for her life but was still considering leaving altogether, literally becoming an interior designer. She loved interior design. She was super good at it; it was her passion. And it really felt like that was the only path forward.

And if you look now, a year and a bit later, she’s still doing that same job, actually loving medicine and happy that she’s there, and really figuring out how to move beyond. It wasn’t just that logistical piece of making the change because she had actually already made that change. It was really more of the internal shift of saying it’s actually OK to practice medicine in unique and different ways, and we can bring tremendous good to the world, and in fact, to very underserved areas and places that really need physicians when we think outside the box.

When we can move beyond this blame and shame about not conforming to the system—and I know that I worked through that myself, and I work with so many people who feel like, “Well, if where I am doesn’t work, it’s a me problem, and therefore maybe I have to leave medicine”—and to recognize that when we can look beyond that and be curious, we start to recognize the system needs to have room for lots of different ways of practicing. Medicine wasn’t really built with women in mind. It wasn’t built with people who are having children in mind. It wasn’t really built with two partners working full-time in mind. It wasn’t built for women who are neurosurgeons, for sure. Even ORs aren’t built for women, and our residency training isn’t built for women.

So we get to this point where we’ve just tried to conform and become a chameleon for so long that even when we maybe are brave enough to make the shift, we still sit in this idea of, “Well, maybe I have to leave because maybe this isn’t an acceptable way to be in medicine,” when we’re actually making a huge difference. And so I would really like for people to see that we can make a big difference practicing outside the box and that there’s hope.

Kevin Pho: When you talked to that neurosurgeon who harbored those thoughts to think outside the box, tell us the story about what happened next. Were you able to coach her, or was this more of a group retreat? Tell us the next steps.

Jessie Mahoney: Well, I think two things. It started with the group retreat where the words were literally, “Well, I’m thinking I might just leave and become an interior designer.” So part of it is the connection with other physicians who are supporting you and seeing you and seeing this path and all that you’ve done to try to make it work. I think very often, we can be in a space where other people see better than we do the contribution that we’re making. She’d already made a shift to working—not actually locums, but working in another state and just flying back and forth, which I actually see a lot of physicians doing now.

So it’s partly that acceptance of others and then working on all of these things that we were taught as women and children and in our training about forging your own path and whether that’s OK to do. When we go into medicine, we are pretty much people-pleasers. We want people to like us. And I think particularly for women, during our training, we spend so much time trying to fit the mold that we’ve almost forgotten who we are. So then it’s hard to build back that internal sense of self and strength and authenticity.

Kevin Pho: So I’ve been doing this podcast for four to five years now. Of course, I’ve been on KevinMD for 20-plus years, and one of the themes I try to promote is that physicians are more than their degrees. Thinking outside the box and the narrow definition of what a doctor should be should no longer be the case. Now, over the years that you’ve been coaching and counseling, have you seen that mold of a physician become less rigid?

Jessie Mahoney: I would say that probably in the last year, it’s become a lot less rigid. So there’s been a movement over the last couple of years. Is it OK to add in lifestyle medicine? Is it OK to do this? And so these little pivots where people are willing to start shifting have appeared. But this idea that you can truly practice in a very unique and different way, where you can have an extremely fulfilling career where you fly to another state and work for a week and then you’re home for a week—the fact that you can do that, and we don’t consider that less than, and in fact, it could be considered more than—is really powerful. I see a lot of people who have made changes. Other physicians are reaching out now and saying, “How did you do that? How do I do that? I didn’t know that it was possible.” And I think when we actually moved beyond this sort of “one way is better than the other” idea, we really have opened almost Pandora’s box.

I don’t see it as everyone is leaving medicine. I think we’re recreating, redesigning a medicine that’s actually more human-focused for those who are practicing medicine and that will ultimately lead to more people staying in medicine and providing great care. So I see so many really creative ways to practice outside the box, whether it’s having your own sort of private DPC practice or even within hospital medicine. I think that the outpatient side came first. So people started recognizing they could do a concierge practice, they could do private pay, or they could… some people have a more concierge practice, and they have a bit of a dilemma because they also want to provide care to the underserved, but they can also volunteer or they can do mission trips. There are so many different ways to piece it together. That was sort of the first break in the dam. And then the second piece is really people being willing to do hospital work in a different way.

And I think, I’ll say, I think particularly for women, it has been harder because they’ve tried to fit into this mold for so long. And one of the things that’s really cool is once you start to do this, you start to meet lots of other people that do this. And then it becomes clear that, wow, this is actually a way that we can do medicine that works in a much healthier way for everyone. It reminds me of other specialties where people are really… pilots work these shifts and then they’re off for this amount of time, but it is more regimented. In the way that we can have pauses and breaks, our other systems of practicing medicine aren’t built that way.

Kevin Pho: Now we’ve mentioned those physicians who are listening to you on this podcast and say, “You know, why can’t I do that?” But do you also hear from those who cling to the traditional model of medicine who are resistant to this change? What kind of pushback have you heard from these—I’m going to call them—traditionalists?

Jessie Mahoney: I think there is a lot of pushback. One, physicians don’t like change. We’re threatened by change, and we were kind of raised in a culture where if we do it all the same way, then it works, even if that change benefits them.

But I think the other thing is, when someone goes out and does something, it threatens what everyone else has clung to for so long. This isn’t a personal thing; it’s really that most physicians are depleted and have overgiven. And so to see someone out here doing something different, it’s sort of like, “Well, wait a minute. I sacrificed all this, and I am doing it this way. This is the way we’ve always done it.” And I think we use this “the way we’ve always done it” as the right way. And I heard from someone that this idea of shame—when there isn’t really a good reason, we make people feel shame. The culture is shame. And so I think that’s like, “Well, I’ve been doing this. This is the way it’s done.” And I don’t think it’s done mean-spiritedly. I think it’s just what people know. And if we don’t know any different, we can’t know.

I’ve mentioned this before, but we’re practicing medicine in a way that was designed for a different kind of medicine. And so it’s really imperative that we begin to adapt and change and that we be brave enough and courageous enough to do that. I think it’s very isolating. It’s isolating for those who choose to stay and isolating for those who choose to do something different. And honestly, I’m not sure that one is better than the other. I think that a traditional model can work really well for some people. They actually want to be in that model, and they don’t want to be out there doing things in a different way. But can we in medicine make room for all of it? There are so many people needing care that of course we can and should, but is our system going to be willing to offer that? I hope so.

Kevin Pho: And it’s not just physicians or some physicians that cling to the traditional model. It’s, of course, the administrators as well, who generally are going to push back against the flexibility that we’re talking about today. So tell us about some of the arguments that we can make to convince these administrators that sometimes thinking outside the box can keep physicians happy, and happy physicians tend to stay. So what are some arguments that we can make to these skeptical administrators?

Jessie Mahoney: Well, I would say one, primarily the retention issue. They need doctors, and if you want doctors to stay, you have to find a way to make medicine palatable, doable, and reasonable in a healthy way. But I also think that administrators like the old system because it works for them. It has worked for a while, but it’s actually breaking for them as well. And so to me, it’s: if you want to be able to continue to have a sustainable system, you need to actually allow this because doctors are brilliant, smart, creative, determined people. And once we can see beyond this idea that we have to do it this way, they’re all going to be able to go do this. So I think that administrators who aren’t willing to hear it are going to get left behind. And I think we’re seeing that in a lot of medical spaces.

So, I think trying hard to figure out how we can create options and flexibility… I think if you see a few people do things outside the box and stay, and then actually they bring more and more to organizations, that’s the value. I think it’s tricky to convince people because they don’t want to change, but we also know that we’re almost to the point that if you don’t change, things will break. I remember in my old organization, we were actually encouraged to change by this idea that we didn’t want to become Blockbuster or Kodak. And I remember thinking, “Oh, well, that’s a little bit of a scarcity mindset,” and now I’m thinking, “Well, it actually is also the same.” We can sort of put that back on them: that if the systems don’t want to become that…

So that was used to get us to do emails. If we didn’t do emails, we would be sort of totally old, like the paper film that we used to have in the dark rooms. And so this is kind of the same idea, that we can’t keep practicing the way that we’ve always practiced because medicine is different. I think, though, if as physicians we don’t acknowledge that and we don’t support one another and we don’t have each other’s back, then it isn’t going to work either. And so it’s really this thinking outside the box for all of us and recognizing that—there’s that quote—doing the same thing and expecting a different result is insanity. And so I do think that that’s probably the most helpful way to speak to the administrators. It also reminds me of the idea of just speaking the same language: how will it benefit them? And of course it can. It’s going to take creativity and change, but if we don’t adapt and keep up, I don’t know how we can make things work in the future. We know that when we haven’t, things are falling apart.

Kevin Pho: Now for those physicians who are listening to you and may feel stuck in their job for any number of reasons, whether it’s the traditional mindset or whether it’s overwhelming loans that they have to pay back, what’s the first step that you would recommend to think outside the box and redefine what success should be as a physician?

Jessie Mahoney: I think the first step is really to not catastrophize because I think most people think that they can’t change because it won’t work. And they can’t change because they might fail. And I would say, “Well, you might not fail.” I think many people are like, “Well, I can’t take that risk because of X, Y, or Z.” And my thought might be: you might find something that allows you to pay off your loans a lot faster, for example. But we are really caught in this “I can’t take a risk” mindset. And so, really, you’re worth the risk, and your career is worth the risk.

The question that has really helped me and many people is thinking ahead to some future self, whether it’s your 40-year-old self or your 60-year-old self. What will they wish you had done now? Because rarely will they wish you had stayed somewhere where you feel stuck. The other thing is, I love this vision of a car stuck in the mud. You don’t accelerate and shoot out; you rock back and forth. You have to start nudging yourself loose, and it takes time. As physicians, we want a checkbox and to figure out the answer, but you don’t know how you’re going to get out of the mud until you start wiggling and thinking.

And then I think the other thing that allows us to think more flexibly is back to mindfulness, a healthy nervous system, and being replete, because nobody can make a big change from just a place of complete depletion and fight-or-flight stress and terror, which many of us feel working in the current system. So whether you need to take a pause, which is very often what people need, or to look out there and see all the other people. So many people are beginning to make change and speak up for themselves, and the more we speak up for ourselves, there’s precedent. And so I think if you don’t see it in your smaller setting or people are telling you it can’t be done, look farther afield and see how it is being done. I think we often say, “Look for clues.”

Kevin Pho: We’re talking to Jessie Mahoney, pediatrician and certified coach. Today’s KevinMD article is “From burnout to balance: a neurosurgeon’s bold career redesign.” Jessie, let’s have some take-home messages you want to leave with the KevinMD audience.

Jessie Mahoney: I think when the system isn’t working for you, recognize that it’s not you that’s broken; it’s our system that is not functioning well. It wasn’t built with you in mind, it wasn’t built for women, and it wasn’t built for the current care system that we’re offering. And so it doesn’t mean there isn’t a path for you. So believe and trust, and recognize that most people’s path does require some non-conformity and stepping outside of the paved path.

I think the other thing is it, of course, takes moving through fear. It, of course, takes courage. It, of course, takes creativity and support. I think many of us think we should just know how to do it and be brave enough, and that it won’t be scary, but it always is.

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

Jessie Mahoney: My pleasure.