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Cardiologist Stanley Liu discusses his article “The business lesson new doctors must unlearn.” Stanley explains why the habits of being a “good soldier” during residency—such as accepting excessive workloads, never questioning compensation, and suppressing dissatisfaction—can harm physicians as they transition into attending roles. He discusses the importance of reframing one’s professional identity from soldier to CEO, emphasizing the need to establish win-win professional relationships, protect valuable clients, and avoid restrictive contracts. Stanley highlights practical strategies for preventing burnout, maximizing career options, and treating medical practice as a personal business. Listeners will learn how adopting this mindset shift can create resilience, financial independence, and long-term career satisfaction.

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Transcript

Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast. Today we welcome back Stanley Liu. He is a cardiologist. Today’s KevinMD article is “The business lesson new doctors must unlearn.” Stanley, welcome back to the show.

Stanley Liu: Thanks for having me back, Kevin.

Kevin Pho: All right, so tell us what this latest article is about.

Stanley Liu: I wrote this article after a residency program director nearby asked me to give a financial talk for his graduating residents at a retreat. Since I practice both as a cardiologist and as a financial planner, I could not make the retreat. I thought about what really are the lessons that new doctors need to have that they probably did not learn in training. I thought about something I had learned from Dr. Nneka Unachukwu in her podcast, and I know she has been a guest on KevinMD as well, talking about entrepreneurship in medicine. One of the concepts that she taught that stuck with me was that you should be the CEO of your own business.

While that is certainly true if you are in private practice, it is not often the case that we think about this if we are, say, a resident or an employed physician. That is not the case where you are really part of the employed hospital staff or employed clinical staff, that kind of thing. When I started personally applying that mindset to my life a year or so ago, it really changed a few things, and it is something that I wish I had a chance to learn as a resident or as an early-career attending. I still do some mentoring informally to trainees and students, and this is one of those things that I feel that experienced doctors like you and I might talk more about than, say, trainees or early-career physicians. So I want to spread that message to plant that seed in the younger generations.

Kevin Pho: All right, so what does it mean to be a CEO of your own professional life, especially if you are not in a private practice, if you are in some type of employed setting? What does that mindset mean?

Stanley Liu: So one of the common things that you might say if somebody asks you where you work is, “Oh, I am a physician at,” and you insert your practice here, the name of your practice. It is changing that mindset to, “I am the CEO of my own business as a physician, and one of my clients is,” and you insert that same practice. What that does is it changes a few things. Before, you were part of a team at that practice, employed by that practice to achieve that practice’s aims and goals. Now you are working to help that team achieve its goals in a way that also benefits your own business in a very win-win situation.

This does not mean that you are no longer a team player or that you do not care about the rest of the team or you are going in on your own. You are not self-centered, nothing like that. It is simply a mentality that you are dedicated to this team, but you treat your employer as a client rather than your boss who tells you what to do.

That has a couple of implications. First, imagine if you are the CEO of a business and your client tells you to do something that just does not make sense or is not sustainable. In a physician example, let us say they now want you to drive fifty miles away every Tuesday to help work at a small clinic that they just opened. That was not part of your contract, nothing like that, but let us say they have the power to do that. If you are a good soldier, if you follow the whole “be a good soldier” mentality that you learned in medical school and residency, you do it with a smile on your face. You are tireless, and you do everything you can to help serve your employer’s aims to do the best that you can.

What a CEO would do would say, “I am not sure how this arrangement is mutually professionally sustainable. Can we discuss?” That mentality may be very uncomfortable for a lot of physicians, especially since as residents, as fellows, and even as early-career attendings, we are used to doing what we are told. You hear that phrase all the time, “being a good soldier.” But imagine if it were the other way around. If there was something that your employer was not happy about with how you were doing things, would they hesitate to talk to you about that? The idea is to adopt a more two-way relationship, a more win-win relationship so that you can find something that works sustainably for the benefit of both parties. That is one of the major implications.

Kevin Pho: Now, for those who are not physicians who may be listening to this, you talk about that “good soldier” mentality, and that is something I completely agree with you on. Even just getting into medical school, you just have to follow rules and do what you are told, or else you will not even get in. The same goes for progressing through clinical rotations, internship, residency, and fellowship. So talk more about that “good soldier” mentality that is really ingrained into a lot of young physicians today and how difficult that is to break.

Stanley Liu: That is a great question. So let us take a step back. What are we talking about here? For many physicians, I know this is an unconscious lesson that we have learned. In medical school, when you do your clinical rotations, you are trying to get the highest evaluations possible. That means when you are asked to do extra work, to show up early, to stay late, you do not complain. You do it with a smile on your face. When you are a resident, if somebody messed up the schedule and your night shift now bleeds into a long day, you do not complain. The best residents do not complain. They keep their chin up, they suck it up, and they do it with a smile on their face, impressing everyone around them until they can collapse in the privacy of their own bedrooms at home.

Those are the people who become chief residents. Those are the people who are prime candidates for fellowship that get the best letters of recommendation because they take one for the team and they never, ever show signs of weakness or any sense that they are not fully committed to the team. I have actually heard the phrase “good soldier” in training. I have even heard it amongst senior attendings in their fifties. That culture is very much part of medicine, and that can be very hard to both recognize and to unlearn if it has been indoctrinated into you since you were in training.

Kevin Pho: And what are some of the dangers of maintaining that mentality throughout a physician’s career?

Stanley Liu: Great question. If you never bring up areas that need improvement in your career or in your workplace settings, things will never get better. That is one, from a system standpoint. Now, on a more selfish standpoint, if you never question what you are paid or the accounting behind what determines what goes into your paycheck every two weeks—and by the way, in residency, that paycheck is determined, there is no negotiating there—if you never learn to do that, A, you never learn how much you are worth, and B, you will never get how much you are worth. Only when you actually question how that figure is determined, seeing what other physicians are earning for the same work, and understanding what value you bring, do you realize how much you are actually worth. That will help you earn what you make and also get the respect that you deserve.

Kevin Pho: So this, of course, sounds great, unlearning that “good soldier” mentality. But from what you have seen talking to young physicians or your colleagues or even yourself, what does that unlearning look like in a practical sense? Give us an example or a story of a physician who transformed from a good soldier into that CEO mentality. What would that look like?

Stanley Liu: That is a great question. Unfortunately, I do not see it happen frequently enough. But it starts internally. It is really hard to shake off the mindset that you have learned through a decade of training. What I tell people is it starts by simply changing how you describe yourself. Instead of, “I am a physician at whatever university, whatever clinic, whatever hospital,” change that to, “I am the CEO of my own medical practice. One of my clients is this employer. My job is to make sure that I provide the best value for that client, so long as that client reimburses me and rewards me accordingly.”

If you start thinking that and applying that mindset to everyday scenarios, let us say you have a minor conflict at work or a minor scheduling snafu, ask yourself, “How would a CEO react?” Now, you do not have to do anything necessarily right now. You do not have to take action. You do not need to do anything rash. But even think about how “old good soldier” would react versus “new CEO,” and see how that feels. What is uncomfortable about it? What is exciting about it?

Eventually, you can start applying that CEO mentality to the areas that are a little lower risk until you feel more comfortable about doing the bigger things. When they do it right, for example, they want to change their clinic schedule to better accommodate work-life balance, like commitments to kids, that kind of thing. People are afraid to ask for accommodations. What they will do is shift to that CEO mentality and say, “I would like to make this more sustainable by changing the clinic hours to this. I can replace that value by doing something else for the employer,” and then presenting it as a win-win type of thing. That is one difference as an example of what you can try to achieve using that CEO mentality.

Kevin Pho: So it sounds like a change in mindset when it comes to negotiation. This is like a negotiating tactic, changing that situation into a win-win. Now, from the perspective of the employers, I am sure you do not need me to tell you, a lot of employers, a lot of hospital systems like their physicians to be good soldiers. Sometimes if they speak up or if they come at these hospital systems from the perspective of a CEO, that can raise some tensions between that physician and the administrator. That physician may be labeled as disruptive. So tell me what you are seeing. For physicians who speak up with a CEO mentality, do you ever see them come into tension with the powers that be at an academic medical center or a hospital?

Stanley Liu: Kevin, I agree completely. This is not what hospital leaders or administrators want their physicians to do. It is much easier if their employed physicians toe the line. You have to be smart about it. You have to realize what the climate is and what the potential downsides or blowback are. One of the other aspects of this mindset is that you are not necessarily tied to having just one client. There is nothing that says you cannot have more than one client. If you do not have a situation where your client, your employer, is willing to give you the respect that you deserve, ask yourself if there are other clients out there for whom you could better create a win-win relationship.

As of the time of our recording, there is a health care shortage out there, and that does benefit physicians, depending on specialty and location, where that can give you a little bit more power. In my case, I did happen to leave the academic center I was part of because I just could not achieve the win-win relationship that I wanted, and now I have multiple clients, so to speak, where I have negotiated my own win-win contracts with them. I treat each one as a very, very important client, and they treat me as a very valuable asset or consultant. That works very well.

The first thing I would say is you can have more than one client. If you have more than one client or you are open to having more than one client, that takes away the power that hospital administrators or leaders have over you. The second thing I would ask is, yes, that may cause some blowback, but how long do you want to spend your career living in fear of retaliation when there is a whole world out there of different clients that, as the CEO of your business, you could work with?

Kevin Pho: And sometimes those other clients do not need to be associated with medicine at all. So obviously you are a cardiologist, but then you also do financial planning, and I am an internal medicine physician, and of course, I do this podcast and my work on KevinMD. So those other clients do not necessarily have to be other clinical jobs. It could be things completely outside of medicine, right?

Stanley Liu: Absolutely. If you adopt the same mentality where you insist on win-win relationships, that will lead to success in multiple different fields, and it can lead to a very fulfilling and very satisfying career. I want to emphasize that the win-win relationship is not just something you demand of an employer or a client; it is also a responsibility for you to uphold. Let us say you actually have an employer who is wonderful, who treats you wonderfully. You never want to leave this employer. You want to make sure that that employer keeps you forever. You want to make sure you bring as much value as you can to that employer. That is where the grit, the hard work, and the work ethic that you learned in residency and medical school is obviously a huge plus. The difference, though, is that you are not being their good soldier. You are owning these skills as part of your brand, as the CEO of your business, so that they will never be the first ones to let you go.

Kevin Pho: Now, obviously you and I are established physicians, and you said that you gave this talk to younger physicians or people just coming out of residency or fellowship. How difficult is it for younger physicians who may not have a job lined up and may not be as established as we are? Is it not more difficult for them to adopt that CEO mentality when they are just starting out?

Stanley Liu: It totally is. Most of us, certainly I did, I do not know about you, but when I started as a first-year attending, I certainly had imposter syndrome. To talk about being the CEO of my own business would have been absurd back then. At the same time, many of them do not fully realize how valuable they are. They are coming out of training with the most up-to-date training skillset. They are hungry. They have good work ethics. They cannot wait to get started. They are about to build a practice. They are a wonderful long-term investment, and they do not realize that. They do not see that from the other side.

What I first tell younger doctors is, first of all, you need to realize how valuable you are. Do not let anyone tell you that you are less than that or suggest that you are replaceable. That is number one. Then step two is if you do not believe it, make it happen. Do something in your first year as an attending to bring value that no one else has done to make yourself valuable. Find a pain point for your client, your employer, that you are uniquely positioned to help solve, to help make better, and get started. Then the reality follows the mindset, and that is how you make that transition.

Kevin Pho: We are talking to Stanley Liu, he is a cardiologist. Today’s KevinMD article is “The business lesson new doctors must unlearn.” Stanley, let us end with some take-home messages that you want to leave with the KevinMD audience.

Stanley Liu: The take-home is, I hope everyone can embrace a different mindset. You are now a CEO of your own business, not somebody else’s good soldier. The corollary to that is you do not have an employer; you have a professional client with whom you will only accept a win-win relationship. Once you have that, you will work fiercely to earn it and protect it.

Finally, you can feel free to work with more than one client. Always keep those options open. Never sign a contract that takes that option away. Kevin, you and I have talked about non-competes as an example of that. Keep that power in your hands so that you will lead a satisfying career with win-win relationships with the clients that you serve, who are grateful to have you.

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

Stanley Liu: Thanks so much, Kevin.