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Urologist Tracy Gapin discusses their article “Is your medical career a golden cage?” Tracy explores the paradox of achieving professional success while feeling trapped in a demoralizing and insurance-driven health care system. The conversation highlights how factors like short visits and administrative burdens contribute to physician burnout and alarmingly high rates of suicide among doctors. By identifying the limiting beliefs that hold medical professionals hostage in their careers, Tracy outlines a path toward freedom through a cash-based precision medicine model. This episode examines the necessity of prioritizing personal well-being over systemic demands and encourages doctors to reinvent how they practice to find purpose again. Redefining your medical career might be the only way to save your life.

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Transcript

Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast. Today, we welcome back Tracy Gapin. He is a urologist. Today’s KevinMD article is “Is your medical career a golden cage?” Tracy, welcome to the show.

Tracy Gapin: Thanks, Kevin. Glad to be with you today.

Kevin Pho: All right, so we will talk about your article in a little bit, but briefly share your story and journey first.

Tracy Gapin: I like to joke that I am a recovering urologist. I spent 25-plus years in traditional medicine running a very busy surgical practice. I did robotic surgery, prostate cancer, you name it. It was really a very high-volume urology practice. About halfway through, I hit a wall that so many doctors experience. It was not just burnout. It was just being miserable. I was in poor health. I did not like who I was. I did not like what I was doing, and it was really affecting me.

I found the entire new world of precision performance medicine, as I call it. It is optimization, epigenetics, functional medicine, hormones, peptides, and longevity. It is all of this amazing science that they do not teach us in medical school. I really recognized that I am an entrepreneur stuck in a doctor’s body as well. So I built a business around it, and I jumped off that figurative cliff in 2020 and launched Gapin Institute, where I help high-performing leaders feel better, live better, and lead better now. I have to tell you, Kevin, I freaking love what I do now. I could not say that for over two decades.

Kevin Pho: I have talked to so many doctors on this podcast, and they write on my site. You mentioned that doctors sometimes have entrepreneurs trapped in that body. Was there an inciting event that caused you to jump out of that shell and into what you are doing now? Or was it just a gradual buildup of frustration of traditional clinical practice?

Tracy Gapin: I hit a health scare. I was 40 years old, so this was 13 years ago. I was miserable. My wife and I were about to have our first son, and I was prompted by my wife to go for a physical. We are often seeing doctors ourselves. I was 30 pounds overweight. My cholesterol numbers were terrible. My liver enzymes were not great. My creatinine was 1.4. I was very unhealthy. I was stressed out, felt like crap, and did not like who I was or what I was doing. I was not taking care of myself.

Here I am, the “men’s health expert” urologist, and I did not have a clue what the hell to do. That got me diving down rabbit hole after rabbit hole of this whole other world of medicine that they do not teach us. I tell you, Kevin, at that point, I was ready to do something entirely different, like financial services or completely leaving medicine because I was so unhappy. However, I found that I could actually still practice medicine but in a way that I loved and honored who I really am and what I am passionate about. That was really the big trigger for me: finding that there are other ways of practicing medicine that you can actually enjoy.

Kevin Pho: Now you share more about your story in your KevinMD article, “Is your medical career a golden cage?” For those who did not get a chance to read your article, tell us what it is about.

Tracy Gapin: I look at the mindset of how I was stuck. I was stuck in this surgical practice making great money. I call it the golden handcuffs, where you become accustomed to the lifestyle that is supported by that income. You can never even imagine leaving. But are you truly loving what you do? Can you imagine doing that for the rest of your life? If not, then what I say is there is a way to escape that cage and actually build a practice and a life that you love. You have to first of all get into the mindset shift that you are not trapped. There is a way out. This practice that you are in is a cage for a lot of doctors, but I talk about and help train doctors now on how to get out of that cage.

Kevin Pho: What are some techniques to get out of that cage? A lot of doctors, especially when they are just coming out of residency, have hundreds of thousands of dollars in debt. It is not always easy leaving the security of a stable paycheck to escape that cage.

Tracy Gapin: It starts with finding what you love. What are you really passionate about? What interests you and excites you that you will want to commit to for the long term? If it is not your practice, then take a deep soul-searching look into yourself and find out what it is that you love.

For me, it is all about building leaders now. I think of myself in terms of peak performance, like being the best dad that I can be. I am a father first, and everything I do is about how I can help myself be the best dad. It comes back to your health. It comes back to nutrition, hormones, gut health, sleep, and all this stuff they do not teach us.

For doctors out there listening, first find what you are passionate about. I promise you that you can build a business around that. I never suggest any doctor jump off a cliff and leave your practice, and then financially you are screwed. I do not suggest that at all. I talk about a bridge model where you can add cash-based services to your existing practice, whatever your specialty is. Start to get some momentum and get some experience. How do I be an entrepreneur? How do I sell? How do I offer true value and provide service?

Then you can start to build upon that. It builds momentum until you are finally ready. Like I was, it was years of planning and preparation before I finally jumped off that cliff. I knew when I jumped off that cliff that my parachute was going to open because I was prepared for that. So I am not at all suggesting doctors just jump and leave their practice.

Kevin Pho: So tell us a little bit more about that transition period. You were a dissatisfied urologist. You had a young family, and your health was not as good. Then you talk about these years of a transition period where you were trying to define your passion and figure out how to transition into what you are doing now. Tell us about those years and how you learned to even make that transition.

Tracy Gapin: I spent a lot of time in business training, business courses, masterminds, and mentorship to really learn how to be an entrepreneur. It is a very different mindset. I actually wrote a book that will be published next year about the mindset of shifting from a doctor to a CEO mentality. You have to think of yourself as a leader of a team or a business, not as the practitioner or the clinician necessarily focused on just patient care. There is a lot more to it than that.

It starts with asking yourself: What is the value you are providing? What is the service you are providing? Who is your avatar? That is a word for the exact ideal client that you are trying to serve. You want to get crystal clear about who that person is. What are their real fears and challenges? What is their “bleeding neck” issue, or the real thing that they will actually seek care for and pay for?

In our insurance-based practice, we get sent patients. Blue Cross and Medicare just send you patients. When you are an entrepreneur, you have to actually provide value, provide service, and justify why people should come to you. It is a very different perspective. You have to provide value, and you have to identify the pain point you are solving and how you can do that better than anyone else. There is a lot of sales, marketing, and business development. All of that is founded on leadership skills and personal development.

I learned on a personal front that I had an awful childhood like a lot of doctors. I had some trauma and abuse. I chose to become a doctor in fourth grade. Now I realize it was out of fear and the need for love and acceptance. Achievement and success are how you get acceptance by your parents, for example. Being a doctor perpetuates that trauma. It is never good enough. You have to keep grinding, work harder, and sacrifice yourself. You neglect yourself for the sake of your patients, but you are always chasing that dangling carrot that you can never reach.

Now, I actually focus on what I love to do and what I am passionate about. I get to come at it from a very different angle. To answer your question, it starts with identifying who is the person you want to serve and what is the problem you are trying to solve.

Kevin Pho: Sometimes I talk to physicians, and when they transition outside of clinical practice, there is a feeling sometimes of guilt to their patients and to their colleagues that they are going to let them down because they may not be able to see them anymore. Colleagues sometimes ask them: “You did all this training only to transition outside of what you trained for?” Did you have any feelings of guilt?

Tracy Gapin: That is a great question. I have zero guilt. I hear that a lot, and I talk to a lot of doctors who have the same issue. I look at it this way: You are honoring and leveraging everything you have done. It is a stepping stone. It is who you are. My experience as a surgeon, doing robotic surgery, treating prostate cancer, and treating tens of thousands of patients made me who I am. I bring that experience to what I do now.

When we talk about my work at Gapin Institute and Peak Launch and how I serve clients, I take that experience and still use it, but in a very different way that I can actually enjoy and provide value from. I do not feel guilty about that at all. I feel like I am providing a higher-level service now while still honoring me. I think that doctors are notorious for neglecting ourselves and sacrificing ourselves for the sake of everyone else. It is time to put your oxygen mask on first.

Kevin Pho: Now, as you know, in medicine in general, the culture clings to tradition. So when you transitioned into what you are doing now, what kind of response did you get from your colleagues?

Tracy Gapin: It is funny, Kevin. They all thought I was batshit crazy at first when I first talked about leaving. I was talking about epigenetics, hormones, longevity, gut health, and sleep. They were all like: “What the hell? What are you talking about? Why?” They could not understand the concept that I am a urologist treating kidney stones and prostate cancer and doing vasectomies, and suddenly I am doing this. My colleagues thought I was absolutely crazy.

Now, years later, they are coming to me. Many of them have come to me asking: “How did you make that transition? How did you do that? What is it like on the other side?” Now they are trying to recognize that there is a path forward.

My message to any doctor out there who is still stuck in that traditional insurance world is that there is a path forward. You can do it. It is a slow path. You want to do it safely. Again, I am not going to suggest that it was an easy path. It was a process of iteration and refinement. Every day I would try something a little different, tweak, test, pivot, and iterate. I like to think of the concept that you are either winning or you are learning. That is how you find success.

Kevin Pho: Now, tell us the type of physician clients who come to you for help. Tell us the stories that they tell you about what it is like to practice in a traditional insurance-based model.

Tracy Gapin: I have a neurologist in New York, a rheumatologist in California, a urologist in Texas, and a nurse practitioner in Georgia. They all have the same complaints: they are burned out, broken, frustrated, and overworked. They are making good money. Money is not the problem. It is the time. It is the freedom of time and the freedom of impact that I think doctors lose.

They are stuck. They do not know how to get out, but they do not find fulfillment in what they are doing anymore. It seems insurmountable. In this world that I am in now of optimization and cash-based models, there are a lot of charlatans and influencers who act like they know what they are doing and act like they are smarter or better than you.

I like to think of it this way, Kevin. For those of us who are doctors, think of how hard it was to become a doctor. Think of all the shit we had to go through. You have already succeeded. We have already done the hardest possible thing you could possibly do, and that is becoming a doctor. This next step is easy, but it is all about the mindset. You have to be willing to commit to it, own it, and follow your passion and heart. That is the biggest part of it. In the beginning, I was negative, skeptical, resistant, and frustrated. That was the pivot for me: believing that I can do it.

Kevin Pho: So tell us what your life is like now. I think we are a very similar age. You alluded to earlier that you are in your early 50s. Now you are running this practice that is fulfilling your passion. Tell us how that has impacted your health and your career satisfaction.

Tracy Gapin: I love what I do. I will echo that again. I get to work out when I want to. I get to travel when I want to. We are taking literally three ski trips this year with my family because my son is not only a golfer but is addicted to skiing. He has golf tournaments around the world. He is a high-level golfer. I get to travel with him whenever I want to and whenever I need to. I have that freedom of time.

I have a team. I have two PAs. I have 24 employees total. I have a doctor working with me, four functional medicine-trained coaches, a concierge, a full-time pharmacy team, and client care coordinators. We built a program. We have a client-facing app. I am now training other doctors as well through my Peak Launch Institute on how to make the same transition I have made. I am spending about 80 percent on the core business, Gapin Institute, and 20 percent on Peak Launch Institute.

Right now, I see two patients. That is by choice. I have my team, and I work with them. We review cases together, but when I am in an exam room, I feel trapped. I feel like I can have such a bigger impact, and I find it so much more fulfilling to train my team and reach more people through creating content, keynotes, webinars, and sharing content. So I spend a lot of time on content creation, business development, and leadership stuff. I have time freedom now. Financially, I am doing better than I was in urology, believe it or not.

Patients who want to see me pay a lot of money to see me personally. Otherwise, they enroll in our programs knowing they are seeing my team, but they know that I am behind the curtain reviewing every lab, every protocol, and every test. If there is a question, I am happy to jump on calls with clients. But they are clients, not patients. That is really a key distinction here for us.

I tell doctors: If you want to keep seeing patients and that is what you love to do, do it. But hire people to help you. I have six virtual assistants (VAs) in the Philippines. They speak perfect English. I have one to help me with accounting, one to help me with clinical work, one to help me with patient outreach, one with pharmacy, one with content, and one with graphic design. Each one of them is $8 an hour, and they do amazing work.

I like to buy back my time. I could pay a VA $8 an hour, and now I have more freedom of time to do something more important. I like to think that my time is worth $1,000 an hour, let’s just say. Is the work I am doing $1,000 an hour work? If it is not, I am not allowed to do it. That is the shift in mindset that has allowed me to free up my time to do bigger stuff.

Kevin Pho: We are talking to Tracy Gapin. He is a urologist. Today’s KevinMD article is “Is your medical career a golden cage?” Tracy, let’s end with some take-home messages that you want to leave with the KevinMD audience.

Tracy Gapin: I will just tell any doctor out there who is listening: If you are burned out, frustrated, hate your life, are miserable, and feel stuck, there is a way out to build a practice and a life that you love. I have done it. If I can do it, any doctor out there can do it. It is not easy by any means, but it can be done. It can be incredibly rewarding and fulfilling and give you the freedom of time or freedom of impact that so many doctors are missing.

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

Tracy Gapin: You bet.