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Board-certified pediatrician and certified coach Jessie Mahoney discusses her article “Why doctors must stop waiting and reclaim their lives.” Jessie explains how medical training conditions doctors to view endurance as a virtue and delay their own basic needs for the sake of the profession. She argues that the health care system exploits this willingness to wait, using physician silence to maintain the status quo. The conversation highlights the heavy personal cost of this resignation, from eroded relationships to lost joy. Jessie shares her own terrifying yet clarifying experience of leaving a job after eighteen years to choose alignment over approval. Discover how reclaiming your agency today can unlock a life of fulfillment before it is too late.

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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 coach. Today’s KevinMD article is “Why doctors must stop waiting and reclaim their lives.” Jessie, welcome back to the show.

Jessie Mahoney: Nice to be here.

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

Jessie Mahoney: So this article is about waiting and how we are trained in the medical system to just wait and wait and wait. It occurred to me recently, not quite sure why it took so long, but that we are trained to wait in residency and we are trained to wait. This sort of delayed gratification. But we are also trained to wait once we finish residency. We are trained to wait to have our families and wait to move wherever it is. Then we are trained to wait for our health care organizations. We are continually asked to wait. We are great waiters apparently. But this idea that we should be waiting for the system to be fixed or waiting for our organization to address X, Y, or Z problem.

What became clear to me is that it is really this willingness to wait that is allowing so many things to happen. The system is benefiting by us waiting. We are waiting for them to staff up before we can take our vacation. It is this awareness of waiting and the impact of waiting that can change our whole experience at practicing medicine. It is like asking: “What are we waiting for?”

Kevin Pho: And how does that affect physicians? This constant cycle of waiting, and I am going to infer that there is an undercurrent of self-sacrifice as well, right? A continuous loop of self-sacrifice and waiting. How does that affect physicians?

Jessie Mahoney: Well, I think we are taught that waiting is loyalty or it is professionalism. Many times physicians will speak up about how things should change and maybe we do not do it in the best way because we are exhausted and depleted. But I think that then people are unprofessional if they do not wait. I remember always being told: “Well, you know that it can’t happen that fast. It just can’t happen.” And so then we end up literally filling in the gaps and stop-gapping.

The result of this on physicians is tremendous depletion and burnout. In many systems, short staffing is a huge issue right now. So we are always taught like: “Oh, you will just have to fill in or see extra patients until we hire up.” And we take that on as our job because we take on the patient care responsibility as our job. Yet our willingness to wait until it gets fixed has this huge cost. Many people sort of begin to postpone their lives and postpone what they really want. I see many of us get so willing to wait that we actually feel stuck. It is like: “Well, I don’t even know what I am waiting for, but I am here doing this thing.” And it is very hard to give yourself permission to stop waiting.

Kevin Pho: I always say this: Physicians take the Hippocratic Oath and, you know, “First, do no harm,” and patient care comes first. But MBAs and administrators and pretty much everyone else in their health care system don’t abide by the same oath. And subsequently, physicians are always the last line.

Jessie Mahoney: Yeah, well, we are waiting for health care organizations to treat us in the same way that we take care of patients, which it is not set up for. In fact, many of us do not even include ourselves in that Hippocratic Oath of “do no harm.” So not only do the people who are above us in the hierarchies not take the Hippocratic Oath, but we are not including ourselves in it. So it becomes this very much one-way street. We can wait to sleep, we can wait to eat, we can wait to do all the things in our lives. We just get used to it. This sort of endurance and waiting are actually rewarded. But then we do that the rest of our career.

As a leader, actually, it occurred to me that we are also asked to wait. We are asked to run the department and wait for more money or wait for different political changes or wait for this or wait for that. That just becomes part of our job: how do we function while we are waiting as opposed to flipping into agency? We should ask better questions like: “What can we do now? What can we do?” Okay, we do not have all this money, but what can we do? What can we change? That is what we bring to patient care. We actually don’t wait when it comes to patients. We don’t say: “Let’s just wait for that new chemo to come out.” We ask: “What can we do today? What can we do tomorrow?”

So we have this sort of dual approach. Can we take the same approach to say that we matter as much as anyone else in the system? I would offer that our not waiting might actually be some of the solution when we take agency and say: “Well, we can’t wait for this, so what are we going to do today? What am I going to do?” Sometimes it is permission, giving ourselves permission to make change or ourselves permission to just decide we are not going to wait. As a leader, it doesn’t mean you are going against all of the rules. You are just getting creative and finding solutions. But when we have waited for everyone else, we are still waiting years and years later for the system to fix itself.

Kevin Pho: And you shared in your KevinMD article your own personal story of waiting. Right. So tell us about that.

Jessie Mahoney: Oh, yeah. I waited forever. There were a few things. One, I was someone, and I think this resonates with many leaders in medicine, that the people who do not like waiting get to step into leadership roles and try to make change. But then as a leader, we are asked to wait because it can’t happen yet because systems are so big, which is actually to some degree true. So I used to tell myself this story that my organization would change three to five years after I thought something was a good idea. That is when it could potentially be implemented. But I recognized that that actually got me to wait longer. I was just like: “Oh, well I just have to wait three to five years.”

So then I would kind of park things and find that I would lose energy and enthusiasm and that passion and purpose or get frustrated. When you finally decide that you are not going to wait, that you are going to do the thing that lights you up, everything shifts. Again, it doesn’t mean you are going against the grain. You are just getting creative or giving yourself permission to bring your ideas to the forefront and see what happens. All of a sudden, everything shifts.

I saw that in my own life. I shifted into doing physician wellness work full-time, which was part of my job and my bigger organization, because I thought: “I can’t wait.” The answer was we can’t move fast enough within an organization, which I a hundred percent agree with. It is not that they didn’t want to, but when you decide not to wait and you do things on your own, you can be much more nimble. So it is really giving yourself permission that that is okay to do. I think so many physicians are so resourced and creative and just phenomenal humans who could bring change if we stopped waiting.

Kevin Pho: So one of the biggest ways to break out of the cycle, like you said, is to stop waiting. Yeah. Now it is a mindset issue, right? Because physicians have been trained to wait ever since they were premedical students. What are some ways that you coach physicians to break out of that waiting cycle and not push up against that waiting boundary?

Jessie Mahoney: Yeah. Well, the first thing is to recognize it, which is why I wrote the article. If we do not realize that we are trained to wait, then we just keep waiting for something and waiting for permission or waiting for that job or waiting to not be afraid of the change. So the first thing is to notice that you are waiting.

The second piece is really working on your nervous system. If you are afraid of the consequences of not waiting, and if our culture says that it is professionalism to wait and it is glorified to wait and that is what a good doctor does, it is incredibly hard to switch that with a nervous system that is sensing danger and fear. So that is really working on mindfulness, working on breathing techniques, resting, and refilling because we can’t change from a place of depletion or sympathetic storm.

Then it is really working on your mindset and recognizing that you can potentially bring even greater good and greater impact to your patients and or your families. We deserve this. I think many of us have sort of decided: “Well, I am here to serve a hundred percent and therefore we don’t deserve this.” Yet that is where we get into these unsustainable loops.

So that piece of it is beginning to work on your mindset and to decide that you do not need to wait. You are waiting for permission that is not coming. We are waiting for someone coming to save the health care system that is not coming. So it is: “What do you want to do? Where is your agency for your own life?” I think we do not realize that we have given away that agency and we are just showing up sort of fitting in the mold.

The work is really to recognize it, and then it is tremendous courage, honestly, to decide to pivot. We get stuck in the fear. We are trained that the discomfort and the fear means it is dangerous and we shouldn’t do it. When I would argue it is unfamiliar. And of course not waiting is unfamiliar because we have been waiting our whole lives in medicine. It is like: “You have to do this, then you do this, then you do this.”

So what I see is when people decide they are not going to wait, because we are such overfunctioners and incredibly resourced, we can actually make tremendous change very quickly once we make that decision. The other piece that is really challenging in making the switch is trusting ourselves because we were taught not to trust ourselves and to look outside ourselves for external validation, which when you stop waiting, you are not going to get in the beginning because the culture says you should wait.

Kevin Pho: Tell us a success story where you successfully coached a physician to stop waiting. And what would breaking out of that waiting cycle look like in real life?

Jessie Mahoney: Yeah, so I had a physician a couple of years ago who really started as sort of a victim of the system, waiting for things. Nothing was changing. It takes several months of real work on yourself exploring your beliefs and exploring the thoughts about what you are bringing as opposed to what you have been trained to think.

Then once you start to believe that: “Wow, I actually am a very capable, high-functioning human who has a lot to bring,” you can actually decide that despite the discomfort, you can change things. So this physician actually changed jobs and moved and changed their relationships. Like everything can happen quite quickly once you decide because there are so many things we have put off.

Often it is that cascade of momentum. Once you recognize that you are still waiting and you do not want to be waiting, like you are waiting for life to begin and here you are, it is your life, then the change can happen quite quickly. I see that quite often. Some people have to do a tiny shift and a tiny shift, like a 1 percent change. It is like dipping a toe in.

We are all starting where we are and have different life experiences and different nervous systems that we are bringing to it. While it might seem like: “The nervous system, what does that have to do with waiting?” We can’t change out of these patterns if we feel threatened. We have been trained to wait because that is what you are supposed to do. We do not like to get in trouble. We do not like to rock the boat.

Yet I would offer that when we stop waiting is actually where a lot of these solutions we are waiting for in medicine come from. It is a strategic shift. I think that many people want to make the change. They want to stop waiting, so they start speaking up in more of like a bull in a china shop way. And that doesn’t get us anywhere.

So it is stopping waiting in a very strategic way where you are working on your physiology, you are working on how you advocate, and you are working on what it is that I can bring and what creative ideas I have. If you have brought them to your administration and they are not working, it is like: “Well, how else can I make a shift? Maybe I need to build my own practice,” which you see a lot. Maybe I need to move to a different location. Sometimes it is just getting unstuck that shifts that momentum.

The thing that I keep coming back to here is it is the recognition that we are waiting for something, but we do not even know what we are waiting for. It is not actually better for us as humans or as the system to wait. I have been watching us wait in medicine for the solutions to come for 20 years, and I believe we have to be part of the solution. As physicians, we have these great ideas. So if we were to stop waiting and to stop believing that it is our job to wait for someone else to make the decisions or for someone else to hire someone, then that is where the change will begin.

Kevin Pho: I like your bull in a china shop metaphor. When physicians have had enough and they just can’t take it anymore, they are often not the most diplomatic, right? So stopping waiting before that is key. Being more strategic, maybe stepping into leadership roles and maybe affecting change from within is the more effective option.

Jessie Mahoney: Yeah, absolutely. The bull in the china shop also hasn’t gotten us anywhere, and I think that comes from waiting too long where we just do not know what else to do. It is really a reactionary approach. I think the power of this recognition is asking: “What are you waiting for?” We are preserving the structure by waiting. Once we stop, we can be more thoughtful upfront about: “OK, well how do I want to stop waiting? Where are the cracks where I can impact change? Or maybe I need to be somewhere else to impact change.” I would offer also that I think it takes support to do that. Not just because I am someone who offers support, but because when I did it, I also needed support. I think that to have someone who understands how your mind works and the traps that we are getting ourselves into is really a kind action and allows you to do it in a not “bull in a china shop” way.

Kevin Pho: We are talking to Jessie Mahoney, pediatrician and certified coach. Today’s KevinMD article is “Why doctors must stop waiting and reclaim their lives.” Jessie, as always, let’s end with take-home messages that you want to leave with the KevinMD audience.

Jessie Mahoney: I mean, my message would be to stop waiting but to set yourself up well for success. As you stop waiting, be thoughtful about the path forward. Amazing things might happen if you stop waiting and figure out what it is you want to bring to this world in medicine and beyond.

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

Jessie Mahoney: My pleasure.