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Rheumatologist Ananta Subedi discusses his article “The 4 foundations that sustain physicians through burnout and balance.” Ananta reflects on his journey from medical education in Nepal to building a rheumatology practice in the U.S., sharing how faith, family, meaningful work, and friendships form the pillars of resilience for physicians. He explains how spiritual grounding shapes compassionate patient care, why work-life integration matters more than rigid balance, and how entrepreneurship allows physicians to reconnect with the purpose of medicine. Ananta also emphasizes the importance of professional friendships and mentoring young physicians. Listeners will gain practical insights into sustaining personal well-being while navigating the challenges of modern health care practice.

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Transcript

Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast. Today we welcome Ananta Subedi. He’s a rheumatologist. Today’s KevinMD article is “The four foundations that sustained physicians through burnout and balance.” Ananta, welcome to the show.

Ananta Subedi: Thank you so much, Kevin. I have been hearing about you for a long, long time since I started my medical career. I eventually got to meet with you and talk with you, and I’m so glad that you accepted my article.

Kevin Pho: Well, thanks again for sharing your story. Just tell the listeners a little bit about that story briefly, and then we’ll talk about your article.

Ananta Subedi: Absolutely. My journey and medical career started in Nepal. I’m originally from Nepal, finished most of my training, including medical school, and I also did some work there for a few years before moving on to the U.S. When I was in my medical school, we were fortunate to get a lot of good training from some good mentors and instructors, and they were from the U.S.

I got an opportunity to learn a little more about the health care system in the U.S., and I even used to read books from Mayo Clinic, Johns Hopkins, and Duke University. I always had that dream that I wish I could get some training from some of the mavens in medicine. That’s why I thought that the U.S. would be a good place for me to get further training in an internal medicine residency as well as in rheumatology.

That’s why I jumped into preparing for the board exams to get to the U.S. While I was trying to prepare for the boards, I also had some financial issues, so I had to work a little bit. I even spent a year in China as part of the preparation for the boards and also for getting some financial stability. I spent a year in China teaching basic sciences in a medical school. I had a lot of experience and interest in physiology and pathophysiology. That’s what I did after my medical school training, and then eventually came to the U.S.

I finished my residency at Good Samaritan Hospital, which is based in Baltimore and is one of the affiliate hospitals of Johns Hopkins. I was so fortunate enough to talk with and learn from some of the leaders in rheumatology. That’s how I got into rheumatology from my Hopkins training, and then eventually did my fellowship at the NIH in Bethesda, where I finished my fellowship training.

Kevin Pho: Your KevinMD article is titled “The Four Foundations That Sustained Physicians Through Burnout and Balance.” For those who didn’t get a chance to read your article, tell us what it’s about.

Ananta Subedi: Absolutely. As I have been thinking in my career, I started as an employed physician. I was an employed doc, a rheumatologist in one of the big health care systems in the Raleigh area called WakeMed. I was going through this career, and then after that, I felt a little uncomfortable with that job. There was not a lot of growth, so I jumped into starting my own private practice. I was fortunate to get one of my other colleagues, whom I know from another friend, so we teamed up together and started our private practice. As I was transitioning from different career paths, I was always thinking and asking that question: “What truly brings happiness to me?” I was asking that question all the time. “Is it opening a private practice? Is it seeing patients and making them feel better?” That question always haunted me.

I was thinking, does it truly matter what I do or how much money I make? Does that truly make me feel happy? And the question was no. I always had that thought, “From this level, what’s the next level?” From residency, then fellowship, attending, opening the practice. That was not very fulfilling. I was asking a bigger question of what makes me truly fulfilled, and I was trying to create a framework. That’s why I created this framework I call the “Four Fs: Fuel for Lasting Joy and Happiness.” That’s why I created this article. The Four Fs that I discussed in that article were Faith, Family, Friends, and Fulfillment. Those are the four I call the pillars for lasting happiness.

As I relate those Four Fs to the current problem, we are in a very negative world where we think of a lot of negative things. We think of what is happening wrong and what is the wrong happening around us. That’s why I wanted to create something more positive. That was my effort of creating some positive vibe in the world of writing that article of the Four Fs. What it tells us is to be happy, we need to focus on those four pillars, which include Faith, Family, Friends, and Fulfillment.

Now, faith, many of you might be aware of why it’s important to be grounded on a bigger self. You might even call it a God, guru, or book, or any type of higher figure more than just humans, more than just the world, or more than just nature. It’s more of a supernatural force that makes you feel grounded. That’s faith. Now, friends, that is another important pillar where friends will help you get that support in your career, in your personal life, or whenever you have any problem or when you have happiness. That is where you spend most of your time with your friends.

So is your family. Family is what keeps you grounded, what gives you all the support in good times and also in bad times. Then the last one was purpose, a bigger purpose of serving other people, serving your family, taking care of your kids. That’s my other fourth pillar. The bigger purpose could be in your family, taking care of your kids, taking care of your family, or even at your job where you feel very fulfilled helping other people. In particular in health care, we live in a stressful environment where there’s a lot of pressure, work pressure, administrative pressure. But if you have that bigger purpose of serving your patients and serving your bigger community, then you feel fulfilled even in those stressful situations.

Kevin Pho: Sometimes in medicine, as you know, it could be all-consuming, where it takes up a disproportionate amount of your life and you’re not able to focus on some of those other pillars. How do you do it as a rheumatologist? How do you balance the demands of medicine with some of these Four Fs, these pillars that you talked about?

Ananta Subedi: Absolutely. I even call those Four Fs your fuel for lasting happiness. It depends on what part of your career you are in right now. As we talk about this integration, we used to talk about work-life balance. Now that term is a misnomer; you cannot balance both things together. Depending on your career path, sometimes you need to focus on one particular area. For example, if you are in your residency or medical school, you focus on your bigger purpose: your bigger purpose of completing your medical school, completing your training program so that you can be a good doctor or you can be a good professional. At that point of the career, you focus on your career or purpose.

Now when you are done, you focus on your family and friends. I think having more of a work-life integration is what I call more important, rather than trying to balance everything together. Balancing is important, and when you try to balance, we have to ask a true question: “What is truly important to me at this part of my career?” For a medical student, finishing up your medical school might be the most important thing to do. You may not be able to focus too much with your friends or too much with your family. You focus on that area at that part of your life. When you have all of those, then you start thinking about faith, connecting with a higher power, whether it’s God or any other things that keep you grounded so that you feel more fulfilled in your overall career.

Kevin Pho: Now give us an example for mid-career physicians. We have a lot of mid-career physicians who write on KevinMD and appear on the show, and they’re feeling burned out and unable to have all of these parts of their lives thriving. How do you do that? How do you integrate some of these pillars into your work, and what does that look like for you?

Ananta Subedi: Absolutely. That’s a very good question. If I reflect by myself, if I go back in time and think of myself when I was in my fellowship, I needed to focus on my training. That’s where I had to focus. But fortunately, I have so many good mentors. My program director was so supportive, even though I had a lot of family issues because of illness with my little one, he supported me so much. I think one of the most important things is asking for help and also reflecting. Reflecting on how you are feeling every day. You need to ask yourself, “Am I feeling good? Do I need to ask for help?”

Right now, we live in an era where there are so many resources available. It could be a coach, and I’ll give you my personal example. One of the major life transformations happening in my life was when I hired a coach. You might be thinking, “Why do I need to hire a coach?” If you look back, some of the most successful people have coaches behind them. You may not know, but all of them do hire coaches, either for mindset, for personal growth, for speaking, or for helping their business. You always need some support from a coach. I always think of a coach as a person who can tell you your blind spots. We sometimes as humans have blind spots, so your coaches will give you that perspective.

Asking for a coach, or even these days with AI, you can use so many AI tools to help you find your blind spots and also to support and improve your efficiency, your mindset, your financial freedom, or your financial knowledge. You can use all of those tools to understand where you are and where you want to go. Having that goal of where you are now and where you want to go is the key. I think that is what it is, based on my personal experience.

Kevin Pho: What was that coaching like for you? Take us into some of those coaching sessions. A lot of physicians, like you said, sometimes don’t feel the need to hire a coach for things like mindset. How did a coach in particular turn your life around, and tell us about some of the sessions that they’ve gone through with you.

Ananta Subedi: Absolutely. I was part of a mastermind program, and the coach is a physician too, who runs the program. Most of the doctors in that group were doctors, so we had a common theme: all of us were looking for some ways on how to improve our quality of life. Now, most of them were very successful physicians who were burned out or they were not happy with their career path, so they were looking for better options. That was the community of all the doctors, so I was able to learn from each other. A lot of them were from the private practice area. A lot of them were investing in other alternative assets, including investment in crypto and investment in real estate. It was a good community that helped me to understand what else is available out there beyond my regular clinical practice.

Even in clinical practice, since I didn’t have a lot of business training in medicine, as you know, we get trained on all the art and science of medicine, but nobody will teach you the business side of medicine. That’s why that mastermind program also helped me learn the business side of medicine. That was very powerful, and it also helped me and opened up my mind on the importance of mindset, particularly the importance of having a growth mindset where you don’t worry about problems, you don’t worry about mistakes, and you learn from those mistakes. I think that was a powerful thing. The change of mindset was the most important thing that happened with the coaching program. That’s why I will highly recommend it. Even though it’s an investment, it’s an investment in yourself. Unless you invest in yourself, even though you might earn as much money as possible, it will not bring the fulfillment or the happiness. That’s why hiring a coach was one of the best things that I did in my personal journey, and that helped me improve my personal journey.

Kevin Pho: I just want to emphasize that pillar of fulfillment. For some physicians, that fulfillment doesn’t necessarily have to come from clinical medicine, right?

Ananta Subedi: Absolutely.

Kevin Pho: And just like you talked about in your coaching session, there are other avenues outside of clinical medicine that can contribute to that pillar of fulfillment.

Ananta Subedi: Absolutely. That’s one of my goals too. I have been through a lot. I have had a lot of ups and downs in my career. One of my fulfilling long-term goals is also, at some point, helping my fellow colleagues. I want to focus particularly on international medical graduates. We have to go through a lot of painful steps. Even after being an attending, they are not fulfilled. They’re still struggling with seeing patients, struggling with having good finances. They are struggling with all of those things, and they don’t know all of the tools available. So I want to be their guiding coach. That’s my long-term goal as a fulfilling career. Even though I want to practice medicine, that is what keeps me fulfilled, but helping those fellow physicians who are in burnout or who are not satisfied, I want to give them some guidance based on my prior experience. That’s my other long-term goal.

Kevin Pho: Now, tell me about those physicians who may be stuck in clinical medicine or a job that takes up so much of their time and resources and yet is not fulfilling. You mentioned your four pillars, the Four Fs: Friends, Family, Faith, and Fulfillment. But for those physicians who don’t know where to start and may find just jumping on those pillars overwhelming, give them some advice in terms of how they can get started.

Ananta Subedi: Absolutely. I think that goes back to the basics of how you make some behavioral changes. I go back to the basics. To make those behavioral changes, first, you need to be aware that there is a problem. I think self-reflection is the key. When I look back at my career, one of the best habits that I started was journaling. I think that was a game-changer in my career, where I started writing my thoughts, expressing my thoughts to myself, and then doing some retrospection where I thought about myself: “Where am I? Where am I heading? Is this the right path for me?”

From that reflection, I started creating some action plans. I started thinking about, “Oh, this is a problem I’m having now, and this is where I want to go from here,” and then making that path. You need to have a good action plan. That’s why I usually think of all of this as: understand where you are now, ask the tough questions, and be honest with yourself. Journaling is one of the ways of being honest with yourself. If you are stuck, like any of you who are listening to the podcast, if you are feeling that you are stuck, first, sit down, have quiet time with nature, and then start journaling. That will give you an idea of where you are now.

Then, make a plan. If your goal is to open a practice, look at all the people who have already done it so they can be your guide. They could be your mentor. You don’t have to be physically present with them, but you can learn from their books, you can learn from their podcasts, you can learn from their journey. That will be your biggest teacher. They will teach you how to get there. That’s why I think journaling and what I call self-reflection might be the best thing to do so that you know where you are and what resources are available out there so that you can get to the next level.

Kevin Pho: We’re talking to Ananta Subedi. He’s a rheumatologist. Today’s KevinMD article is “The four foundations that sustained physicians through burnout and balance.” Ananta, tell us some take-home messages that you want to leave with the KevinMD audience.

Ananta Subedi: I think the biggest takeaway is if you feel stuck, if you are unhappy where you are either in your clinical practice or in your academic setting, always look for options. There are always new options. Always talk with your colleagues. Try to find a mentor or a coach, or try to read some books, which will help you get unstuck. At this point in the era where we have so many resources, either human resources or artificial intelligence (AI), which can be your biggest resources to get unstuck, you don’t have to be feeling stuck in your career.

Always look at those four pillars because at the end of the day, we need to be fulfilled in what we are doing. Whether you are a clinician taking care of patients, or you have a private practice, or you could be in an academic setting or research, whatever you do, you need to look at those four pillars and ask the question of where you are on those four pillars and where you need to focus on where you are lacking. Having that idea of where you are now will help you get unstuck, and then you can focus on those four pillars of Faith, Family, Friends, and Fulfillment, and that will be your fulfilling career.

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

Ananta Subedi: Thank you, Kevin, for inviting me, and I’m so excited to share my story with you all. Thank you. Bye-bye.