RX5_podcast_Nisha Mehta, MD: Audio automatically transcribed by Sonix

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Narrator: ForbesBooks presents: Entrepreneur RX, with Dr. John Shufeldt. Helping health care professionals own their future.

John Shufeldt: Joining me this week is Dr. Nisha Mehta, a radiologist and the founder of Physician Side Gigs. Nisha is an international speaker and writer specializing in physician advocacy and addressing physician burnout. And I've been following her for a few years. Nisha, welcome to the podcast!

Nisha Mehta: Thank you so much for having me. I'm really excited to be here and excited about what you're doing!

John Shufeldt: Oh, thanks. It's my pleasure. OK, so I have to ask you, I mean, you are a fellowship-trained radiologist. How did you get, how did you even get into this? How did this even start? How did that hit your radar?

Nisha Mehta: Yeah. You know, I mean, so unlike a lot of people who are dipping into the entrepreneurial space, my journey was very unintentional. So I, I like you said, I was doing, I was on faculty at Chapel Hill and my husband was finishing his plastics fellowship. He's also a physician. And I was there for a few years and we were planning on moving back up to the Northeast to be closer to our families and start, you know, both of our real jobs over there. And then at the last minute, we actually decided to switch paths and take a job down in Charlotte, which, you know, when I say last minute, it really was like two, two months before we were supposed to move. So that left me in a position where I was trying to find a job because my husband had taken this job down here and I ended up with a few months off. And during that time, I think, you know, it's the first time in my career that I've had time like downtime. And I just had all these things that I wanted to talk about and write about, just about what I was seeing, about the culture of medicine. And I was seeing all this burnout and I was just encountering all these sorts of typical women in medicine issues, all of those things. So I started to write just for fun, just to get some things off my chest. And what I found was that I quickly developed a following of people who were kind of wanting to hear or just wanting to identify with somebody else who was feeling the same things that they were going through. And that for me, it was really a moment where I realized that, you know, it was funny because when I started writing those things, a lot of my mentors from Penn and NYU reached out to me and they were saying, you can't talk about this stuff, like this is not you know, you're never going to find a job. You're never going, nobody's going to want to employ you, you're never going to get promoted. You just, you can't talk about lifestyle and medicine. And for a number of reasons, it was the right time in my life to be doing that. And so I did end up taking a full-time job in radiology but continued on the side to develop this writing and speaking career. And while I was doing that, I realized I didn't know a lot of people who were physicians that had followed a similar path that I had and were doing things outside of medicine. So I started the small online community of just five or six people really trying to connect with some people who were also doing some things on the side where I could ask them some questions of how they were kind of managing to do it all. And that community, I guess, for lack of, you know, I'll spare you the details of the growth, but it has really exploded into this community of one hundred and twenty-five thousand physicians now. And so the one thing that I realized as I kind of went on or when as I started originally, it was all about side gigs, but then it just became so obvious how little we learn about business and finance during our training and how much that actually holds us back. Even if we want to just pursue straightforward clinical careers in medicine and not do anything on the side. The lack of business and finance skills can really preclude people from having the career in medicine that they want. And so that became a big part of my mission, got integrated into the groups, and now is also a large part of what I do is really being able to hopefully help to create a generation of more business and finance savvy physicians, part and parcel to that I think there's so many issues in the changing health care landscape that I was passionate about from day one. And having this opportunity to have so many people on the communities has really given me a voice that I'm really grateful for. And so I've really been trying to do a lot more advocacy on behalf of physicians and really trying to leverage the power of those numbers to be able to really impact health care on a national level, not only for physicians but also for patients. So it's become a real passion project.

John Shufeldt: I love that. And for me, I found sort of I think I've got a few years on you, sadly. And I mean, that was I was on my side. And so I have it easy. I mean, I did emergency medicine, whereas as you all know, it's very shift-related work. So I found an easy time starting these side businesses. And I never called them side gigs, it was a business. And, you know, I did everything, from owning Hot Dog stands at one point to start an urgent care centers, so I've had it relatively easy but I've seen like you just said, I've seen over the past, particularly the last few years, a lot of physicians saying, hey, I love taking care of people, man, I have to do something else, or at least I wanted something on top of that or what you describe as a side gig, which is, you know, you're, I belong to your Facebook group. It's the perfect group to kind of, broadcast this message, give me an idea, because I think you have a census, what are the demographics, or are there any demographics in that group that stand out or just span all ages and all specialties?

Nisha Mehta: So we certainly have you know, the group is independent of specialty, gender, stage of practice, any of those things. So we've certainly got members spanning the full gamut, that said the majority of our physicians, and part of this is also because of the fact that it exists on Facebook, and so you're going to get a certain demographic of people that use Facebook, so the majority of our physicians do tend to be within their first decade and a half of practice. We've got everything from resident physicians to retired physicians. And I think that that's actually so valuable because they're able to bring in the perspective of, able to get so many different views on a particular topic. And I think that that's really powerful because so many times you find yourself in these echo chambers where people are just telling you exactly what you want to hear and they have the same experience. And this has been really nice to be able to see people coming together across different interests and specialties and stages of practice to really help each other. So we do have a very wide range in demographics. In terms of the demographics that are particularly interested in side hustles or businesses, I think that that is something like you said, that has really exploded over the past few years. And I think part of that is really driven by the changes in the health care landscape that are really making career longevity more challenging. And of course, we all hear all the stuff about physician burnout. I think there's a lot more of an emphasis on how do you make sure that you have the life that you want in medicine such that you can do this for the next 10, 20, 30 years. The other thing is, is when we start talking about burnout, people start realizing, well, it's OK for me to think about myself as a person and not just a physician. And I think the traditional pathway is I'm a physician first and everything else second. And what this sort of side gig and burnout movement have simultaneously spurred is this recognition of there are other things in my life and I had all these other interests prior to dedicating my life to medicine, and maybe I've developed some new ones since I dedicated my life to medicine, and how is it that I can take those things and actually find a way to incorporate them in my life in a meaningful way? And for some people that's monetized and some people that's not, right, some people will just take up a hobby and really start pursuing it while other people say, well, hey, how can I turn this hobby into a business, so that will actually allow me to supplement income streams and maybe even potentially allow me to take that extra half-day off a week or to be able to say maybe I'm going to retire early because I've got this other cash flow, or maybe I'm just doing this because it's a passion of mine and it fills me and it's a pathway to something else. But I'm going to try to find some ways to monetize it. So everybody's reasons for doing what they do is very different. I think for a lot of people also, the last year has been really eye-opening in terms of just the reliance of being able to count on one income stream has become a little bit precarious, and that's become very apparent over the past year because we saw when the pandemic hit, so many people saw their incomes go down or maybe they were furloughed or maybe they were actually laid off. A lot of practices saw their income go down. And, you know, I know from my own family, my husband does plastic surgery, right, they shut down for quite some time because they weren't exactly, you know, essential. And for myself now, I used to work full time as a radiologist, but I now work per diem at the same place that I used to work full time. And obviously, as volumes went down, my clinical income also decreased. And so we saw a situation in which both of our clinical incomes had decreased, but we didn't have to worry about it because we had so many other ancillary income streams bringing in revenue that it wasn't that we were worried about having to dip into our savings. And I think for those people who weren't on the whole side gig bandwagon before, if they had something like that happen over the past year, they've realized, well, I kind of want a backup plan. I want an insurance plan, or maybe I just want to make sure that I'm not putting all my eggs into one basket. And so all of those things, I think, have really fueled that movement towards entrepreneurship and alternative income streams.

John Shufeldt: Yeah, it's funny. I've been talking about this. I feel like for years and you hit it on the head about not having your eggs in one basket and multiple streams of income, you know, in emergency medicine. I used to think that we're recession-proof, because, at the end of the day, you may not need plastic surgery, times may go down, but people are still coming to the emergency department now. They may not be able to pay for it, but there's still people coming in. But what I learned is we're not covid proof. I mean, ED volume has fell all over the country. And I have a lot of colleagues who are like, holy crap, I, this is, this is it for me. If I'm laid off, if our volumes go down, I don't have. And they were living paycheck to paycheck, which always kind of startles me, but at the end of the day, that was their reality, and I agree with you, I think this physician side, like you wrote this blog post a little bit ago, on why physicians need side gigs. And I so identified with it because I'm like, this is what I've been preaching, but, boy, I think now people have really woken up to that blog post and said, you know, she was exactly right for the exact reasons you said we need some other streams of income because this is all we got and if something goes wrong, we're screwed.

Nisha Mehta: I think the other thing that is really powerful about the site and before I say this, and I found two side gig, happy, I do want to say that, I don't want people to be leaving medicine to pursue side gigs. And I think some people sometimes get that impression. I'm actually all about career longevity. And if I can practice medicine on the terms that I practice right now, I would practice till I was 80 very happily. But I think what happens, for a lot of people, is the fact that they get dragged into bad situations and feel like they don't have an out because they're so dependent on that paycheck. And that's where I think that the side gigs can really give you a little bit of a leg up at the negotiation table because you can walk away from a bad situation and not be afraid of it. And so I actually think having those negotiating skills and having that backup from the fact that you're not completely reliant on one thing actually enhances your career longevity and your ... because it allows you to walk away from the things that are really detracting from that career longevity and are telling you that you need to quit. And so, you know, whether it is taking extra call or whether it is a particular shift that you don't like or a particular procedure you don't like, being able to drop those things from your repertoire, if there really things that make you unhappy about your job is going to overall enhance your career longevity. So I think there's a lot of reasons to not to do side gigs just because you're trying to cut back clinically, but actually to be able to do more of the things that you want to do.

John Shufeldt: Yes, it's funny, it's almost a weird dichotomy because I remember, you know, back when I was in my 30s and started, starting these businesses, you know, my colleagues would say, you know, what are you doing? I mean, do, you really wanna need to work three or four days a week? You're working seven. You're going back to school. And my answer is always because I want to, I want to be like Pablo Picasso, I want to be in the studio of the emergency department till the day before I die. It's because I love practicing emergency medicine still after 32 years, but I think the main reason is, is because I've had other outlets that I've never put my creative energy into. So when I walk into the emergency department now 8 or 10 days a month, I'm like, you know, this inner-city emergency department is crazy. I'm like, I'm excited to be here because it's not, I'm not just crushed by doing it, you know, five days a week like, you know, I did for a few years. Do you see some of these physicians, do, do people get this, that the side gig actually increases their longevity, actually decreases burnout? Do you think that's hit people's cortex yet?

Nisha Mehta: I think it actually is starting to at a much greater degree. I think at first people thought, oh, these are people trying to leave medicine. And I think now there is sort of this feeling of, no, it's not I'm trying to leave medicine, it's I'm trying to work smarter, not harder. And in order to be able to do that for so many people, it becomes, you know, I mean, again, because we've got so many people on the group, there are so many different reasons that each person has for doing what they do. For some people it's, you know, I want to be able to leverage my money to make more money. And maybe I need to learn how to invest better, or maybe I need to learn how to be smarter about my taxes. The other people are saying, well, I really want to be able to cut back in this way. And this is the exact amount that I need to earn to be able to do that. And I'm going to Moonlite so that I make exactly that amount of money and then it will give me some more options or, you know, there's different approaches to that. I do think that people are starting to see that when they explore other things that interests them, regardless of whether they're monetized or not, or regardless of whether they're monetized in a way that's really productive enough to make a difference in their financial life, they are seeing that they are happier by being able to use different parts of their brain to be able to network with people, I mean, there are so many fun things that come with side gigs that it's not all about the money, right, it's also just really being able to be excited about learning something new. I think most physicians are lifelong learners and we really enjoy that academic stimulation that comes from being faced with something new or being faced with new challenges and having to be able to adapt to them. And of course, to some degree, we're always doing that at our work, right? We're always learning, there's always CME, there's always new technology. But this allows us to explore something that's totally different. And I think that can be really reinvigorating for a lot of people.

John Shufeldt: Yeah, it's definitely, it definitely puts a spring back in your step. And I've you know, I've worked with a number of physicians that I want to talk to you about, you know, ways that the physician side gig community can kind of band together to help promote each other. So you've obviously been pitched a lot of ideas, if for no other reason than saying, hey, Nisha, what do you think? What are some of the more fun, crazy ideas, physician-driven ideas that you've heard of?

Nisha Mehta: It's funny. There's just so many things that people are doing and they're so interesting, right, so whether it is writing books and not books about medical topics necessarily, but, you know, fantasy books or adventure books or writing something, children's books, right, or being able to go and start a vineyard or start a brewery or a lot of the musical side hustles that I think are really interesting and really fun. Some, some members of the group have actually come together to work on some musical pursuits together, which I think is really interesting. And then you're, of course, seeing a lot of collaboration within the health-tech space and a lot of people coming together and the physician-finance space. And, you know, I mean, I think it's really cool how people have really found whatever niche it is that interests them and that drives them and have come together around those interests. But, you know, we have everybody, I'm trying to think like my house is full of random things from members, that people have sent me from their side hustles. And there's everything from clothing to soap to cutting boards to pictures on my wall. And so, I mean, I think that people are doing some really, really great things and finding ways to express themselves. And I think that's my favorite, is when I see somebody really come into their personality and just go all out and, go all in, I'm sorry, and really just enjoy themselves when they're doing what they're doing. There's a lot of things that I feel are more trite in the sense that there's a pathway and you do it. And, you know, it really just depends on what the goals for your side gig are, so not to call real estate investing trite, because I do a lot of real estate investing, but, but, you know, there's a pathway there and it's not necessarily, there it is about the return on investment and not as much about the camaraderie of it or the different ways. And I mean, I shouldn't knock it. There are definitely some things that are interesting that I find intellectually stimulating because I'm a nerd. But, you know, they're not as creative or they're not necessarily as expressive as some of the other things. And the big thing that I always tell people is find what it is that you're actually passionate about and go after that because otherwise you're just trading one thing for another in terms of headache and effort and you're going to burn out from that thing as well. So the reality is, is that there are very few side hustles that will consistently, for the majority of people, bring in as much income as their primary income is. Obviously a lot of exceptions to that rule where people have done incredibly well financially from their side hustles. But for the vast majority of people, it's going to be a little bit of extra money that's fun and it's bonus money and allows you to do something that you might not have been able to do or felt comfortable doing if it was money from your clinical job. And if you're going to spend a lot of effort and a lot of time into developing that secondary income stream, in my mind, it's got to be something that you enjoy, not only so that it doesn't burn you out and you just give up, because that happens to a lot of people when they pursue things that they don't really enjoy. But also because you're just trading, if you get to a point where you're just trading time for money in a different thing and you're not actually enjoying it. Also, people start to pick up on that, right, and so unlike medicine, where in a lot of cases you're providing a service and you're getting paid for it, in a lot of these side hustles, people buy-in to what you do because they buy-in to your passion. And so if you're not passionate about what it is that you're doing, then it's very easy for people to sense that you're just doing it for the money and then they don't buy-in to it and you're just not going to be as successful. So my biggest advice to everyone is find that thing that really gets you going and gets that adrenaline pumping and that allows you to sort of spew that passion for it such that you will be able to really enjoy it long term and other people will join on to it.

John Shufeldt: Yeah, I totally agree, on that, on the passion piece of that. And if you don't, if you're not believing in it, nobody else will either. Let me switch topics a little bit here. So, you know, I would say in medicine, I have it easy. I'm now an older, tall, white male with graying hair. And so I had it in, you know what I'm talking about, I have a very easy in medicine. I walk into the room and people go, oh, he looks like a doctor, he must be, you know, he must be the doctor. And believe me, I'm no one, I was not one of the Mayo brothers in medical school, but as a, as a female in medicine, and you've been doing it for a while now, do you see this, this, you know what I'm talking about, this culture of medicine changing, and when you started coming out with this, you know, you said this early, it must have been like, oh, my God, she's rocking the boat. Who is this woman rocking the boat? Did you get a lot of pushback?

Nisha Mehta: Yeah. I mean,

John Shufeldt: Where are you headed?

Nisha Mehta: I continue to get a lot of pushback, but I got a lot of pushback initially for sure, and which has thankfully waned a little bit, right, I think I now have the backing and the ability to say, well, if one hundred and twenty-five thousand physicians are following my communities, then I can't be totally wrong with what the sentiment is. But I do think that there was a lot of why are you challenging the way things are? I think whenever somebody comes up with a new idea or really promotes a new idea, there's going to be a lot of raised eyebrows. And I think there's going to be some pushback and fear from the system about what it is that you're perpetuating and what it could do in terms of a movement. And it's funny because sometimes they get invited to these institutions to speak and people are kind of like, you're not going to want to make all of our physicians want to leave medicine, are you like, is this really a great idea to have you come in and speak? And it's funny because I always tell them and like, you want your doctors to be happy, at the end of the day, career longevity amongst all of these physicians is very, very important. And having physicians feel empowered and feel as though they're an active part of the process, I think is key to preventing them from leaving, right. So especially when we talk about demographics in medicine, right, 40 percent of female physicians will actually leave medicine or cut back within their first five years of practice, which is scary, right, if you think about the fact that over 50 percent of currently enrolled medical students are female and you look at the fact that statistically 40 percent of them are either going to cut back or leave medicine within the first five years, there's something wrong with the system. And if we don't address those underlying issues, we're going to come to a situation where an already existing physician shortage is going to be exacerbated by so much more. For me, you know, health policy is a big thing, I'm really passionate about it. And when I look at those numbers, I just worry about who's going to take care of people 10 years from now, 15 years from now, including myself, right, like who's going to take care of me if all these people are leaving medicine? So what is it that we need to do to systemically make these big shifts that allow people to enjoy their careers more? 70 percent of physicians say that they wouldn't recommend a career in medicine to their children. And that's really a striking number. You know, you see all these numbers about burnout. And for me, that one is actually the most impactful because a lot of people say that they're burnt out across professions. But the fact that people who have spent, you know, as many years as we have in training go through that entire system and are at the end of the day, come back and look at it and say that they could not, in good faith, recommend a career in medicine to their children is very, very scary in terms of just the depth of dissatisfaction or the depth of feeling as though something wasn't worth it that the physician community at large is experiencing. So I think that while there was some pushback, there was also a lot of recognition that whether people wanted to admit it or not, the stuff was happening within the system. And it was coming to a point where there really was a, an impending sort of larger situation that could not be avoided, right. So it was kind of like watching this wrecking ball go towards this wall and there wasn't a whole lot that you could do to stop it. And so at some point, I think systems really needed to acknowledge the fact that burnout existed. And it is funny that you know, five years ago or six years ago, when I first started writing about this stuff, nobody was talking about burnout. And I was getting that pushback. And nowadays you can't go to a conference or open a journal or open your social media feed without seeing a ton of stuff about burnout. So, you know, we've definitely come a long way as a community in terms of acknowledging that these issues exist and being more open about talking to them or talking about them. The bigger problem is, of course, what are we going to do about it, and what are solutions that actually move the needle? And I think that's at least in my work where I'm really trying to take things and say, OK, fine. Now we've all acknowledged there's an issue, but we really need to start coming up with some solutions because in the meantime, people are leaving. People are deciding that it's not worth it. And that's, that's scary because it's got long-term consequences for the system.

John Shufeldt: I totally agree. And you know what's more scary and I speak to a lot of different medical school groups on this, on this very subject that I read what you wrote, and I think we come out of pretty much the same way. First off, it's kind of funny. You know, there are so you can never be a prophet in your own land. And I think a few probably five years ago, you know, you said that raised eyebrows. Well, I think the landscape's changed quite a bit. And now you're probably considered the prophet. And as much as this is a flag you raised a while ago before people really beamed up to the fact that this was, this was a reality for a lot of people. And I think what, what scares me the most about it, and I know you know about this, is the amount of physician suicides, that is striking, and it's one of the things I speak and write about because, you know, we're not taking care of each other. And I don't think the medical boards are making it easier for physicians to say, you know what, I'm struggling. I need some help because the second they throw the fly up, oops, now they're, now they're on some program within their state medical board that although maybe private, they're kind of forever on the radar. What's your thought process on that?

Nisha Mehta: Yeah, I think that physician mental health is one of those things that until we can erase the stigma associated with it, not only on an individual level but on a systemic level, like you said, with medical boards and with our societies and with our organizations, it's something that we're having a really hard time getting ahead of. As you said, physician suicide rates are atrocious. They're higher than any other professional group in this country. Physician's substance abuse rates are higher than the general population, despite us knowing better than anyone what the long-term effects of substance abuse are. And, you know, those numbers are really, really scary. And part of it is, is that stigma associated with what will happen if, on a personal level amongst my colleagues, we're all trained to be soldiers, right, we all think we can handle everything and we're taught to just get through everything. And that's what our training prepares us to do. However, it doesn't always allow us to acknowledge that we're human or that we need help. And I think until we as a society or as a profession really force ourselves to recognize those things, we become a little bit more comfortable with asking each other how we're doing. When we see something that seems a little bit off, you know, people always assume that somebody else is going to ask someone when things are off because they feel like they're not as comfortable with that person and it's not their place in all of these things. But what happens is that a lot of these cases that in retrospect, had some red flags go under the radar because nobody's willing to speak up or nobody's willing to have that conversation. And I think that in the recent past, we've developed a few more resources that I think are really good for people to be able to reach out confidentially and even free in some cases, which I think that that's great. I know I've been working with some programs that are really aiming to be able to address physician mental health in a much more comprehensive way. I know we're making some headway on the national level in terms of funding for these programs. We just passed the Lorna Breen act, in reference to a physician who committed suicide early in the pandemic. And there is awareness that this is an issue. The big thing has to be, though, that we back that up with taking away all of these punitive measures that not intentionally punitive, but which will, which have side effects of being punitive for reaching out for help. You know, it's hard. We are always telling the residents get disability insurance now, because the minute you put something on your resume that says that there's a mental health issue, that can be a reason that you're denied disability insurance. If, you know, I actually spoke to somebody who had just gotten grief counseling after their mother had died and they were denied disability insurance on that basis. And these things happen a lot within our system and they really actively discourage people from moving forward. So I think it's really important that our institutions have some resources readily available that are accessible on a very confidential way that allow people to feel comfortable because otherwise there's just so much brewing below the surface. And, you know, we're used to taking care of everyone else, we're not very good at taking care of ourselves. And that needs to be a mentality that shifts. And I always tell people, if you can't do it for yourself, tell yourself you're doing it for your patients, right? We're all better doctors when we are fully there and fully present. And having these issues on the side can really prevent us from being who we want to be, both personally and professionally. So, again, really just opening up that dialogue and making people understand exactly how common it is. I mean, it's sad where I can name at least four suicides that I know of in the past few weeks amongst physicians. And this stuff is all happening, but in many cases just not very openly discussed because of the stigma associated with it and people don't realize that, at least from what I've seen from that trajectory, there's sort of that tipping point for everyone where it goes from, OK, this has been brewing into the background to all of a sudden it becomes very dramatic really quickly. And that's what gets scary. And it's the same thing with burnout in careers also, right, where people kind of steam along doing what they're doing at this baseline level of unrest. And then all of a sudden I'll get these phone calls that are like, I've decided I need to leave medicine, this is just not working for me and I'm like, OK, well, hold on, let's take a step back and see, like, are there things about your job that you can change? Is it just that you need to be doing fewer hours? Is it just that you need a different job but you don't need to leave medicine? Right. But a lot of things become very binary when they get to a point where they get so drastic. And so I think our goal as a society or as a profession really needs to be to catch these things as early as possible and intervene and make changes, whether it be in regards to mental health or whether it be in regards to burnout, to really make sure that we're giving everybody the best possible chance of having that career longevity.

John Shufeldt: And you know what I looked at the, you know, I read about physician suicides, the survivors said they tended to make these decisions, just like you said, very binary was like one day enough was enough. And I did X and I survived, thank God. But some switch flipped in my head. And the physician you reference, I think it's an emergency medicine physician. And I donated to that. And I know people that know her because, you know, emergency medicine, at least what I started was a pretty small community.

Nisha Mehta: Of course.

John Shufeldt: And although you're younger than I am, I've had other attendings and residents over the years who worked with her, hands down they say that this woman was a rock star. Was the beam of light in that emergency department, was always positive, was patient-centric. I mean, just there could not be enough positive things said about her. And then you think, gosh, a person like that who is outwardly that dynamic and patient-centric, and giving and caring and empathetic, if it happens to them, it could happen to any one of us. And that one, I think, rocked a lot of us because we're like, holy crap. I mean, this if it happens to her, you know, am I next?

Nisha Mehta: I think that that's something that we all have to realize on so many different levels, because the more and more of this work I do and the more that I have people reaching out with confidential stories and things like that, the more I realize that there is just so much more below the surface and all of our lives that we just you know, you really don't know when somebody gives you a horrible sign out and you're you're seething about it, right, are you thinking about what might be going on that resulted in them giving you that sign out? Because most of us don't like to leave work unfinished and most of us don't like to dump on our colleagues. And so, you know, before we jump to the conclusion that that person is a horrible person, do they have something else going on? Do you give them the benefit of the doubt, at least the first time or the second time, right? And I think that those are the sorts of things where we've been trained to have this professional face, and that's the one that we put forward, which makes sense for a ton of reasons, right, I mean, good patient care requires us having that professional sort of outward, everything is very coming together, but amongst ourselves, are we supporting each other and acknowledging the fact that we're not perfect, that we've got things going on in our lives that could be tumultuous, whether they'd be divorce, whether they be financial issues, whether they be substance abuse, whether, you know, I mean, there's just so many things that can be going on in our lives. And I think that we are expected to fully put those things aside when we show up at work. But we're human at the end of the day, and we need to be able to acknowledge that and be able to help each other out. And part of what is really sad in this change in the health care landscape where everything has become so RVU-driven and everything has become so production-driven, is that when we go to work, we turn into machines and we forget about the human side of things and we don't have time for the human side of things nearly as much. So whether that's our connection with our patients or whether that's our connection with our colleagues, a lot of that has really been detracted from. So I always like to tell the story. My dad's a cardiologist and when I was younger, his partners were a part of everything in our lives. They came to my Sweet Sixteen, they came to my high school graduation, my college graduation, my engagement party, my baby shower, my wedding, you know, everything. They were really part of the family. And these days I feel like so many people don't know their colleagues. Sometimes I'll go to these retreats to speak and I'll see people talking to each other for the first time, even though they work in the same department. And they'll be asking each other things like, well, where do you live? Do you have kids? And I'm like, are they new to the department? And I'll find out that both of them have been in the department for multiple years, they just haven't had the time to talk about their personal lives at all. And so where is it that we need to really be able to talk to each other so that we understand and can support each other the best? And I think we really need to be able to create that sense of community. And that's why the online communities that I host mean so much to me because I see people connecting on a different level. And I think that that's really good for us when we see, like, oh, gosh, I just got hit with this lawsuit and then I go on to the group and I see that you know, I post about that maybe anonymously. And one hundred people write back saying, yep, it's going to happen if you've been practicing long enough. You know, statistically speaking, most of us have gotten hit with a lawsuit and we'll get through it like, it's not the end of your career, it's not the end of your life, and just supporting each other and being able to talk about those things that we don't normally talk about is so important.

John Shufeldt: Yeah, I love that. I love reading the posts there because that's when I remember is that's actually responding to somebody. You know, I do this speaking as an attorney. This is going to, this is going to be fine. You know, what you talked about earlier reminds me of that quote. And I was, I was giving credit to Maya Angelou and I'm not sure if she was going to start it but, behind everyone's fighting a hard battle.

Nisha Mehta: Absolutely.

John Shufeldt: And when, when I have those sign-outs, I'm there's just David Foster Wallace graduation speech called This is Water. And you can buy the book, too. And I probably listen to it once a month because he literally talks about exactly what you just said. He goes basically, you have no idea what's going on in this person's background. And they may have stayed up all night with a sick, sick spouse or a sick child and, you know, basically give them a break because what they're facing may be a lot more than what you see on the surface. And then tragically, he commits suicide a few years after giving this just unbelievable commencement address called This Is Water. But you spoke about it very eloquently. So I'm of the same ilk. Switching subjects one more time. You know, it's been now over a year since the start of the pandemic. You know, we've had north of four thousand health care workers have died from covid, how has this impacted your community? Have you seen more togetherness, more empathy, or have you seemed more disenfranchised, more where people are like, you know, I didn't sign up for this?

Nisha Mehta: I mean, obviously, it's different for everyone, number one. And it's probably different along different lines of things. I think the health care community itself, I think physicians have come together in a way that they have never come together before. And I think that that has been really powerful for me to witness. When this pandemic started, we created this act, we called it the covid-19 Pandemic Physician Protection Act, and we had hundreds of thousands of people sign this petition. And we actually took it straight to senior congressional leadership. That was the first time we came together as a community on the group to put together this document, had everybody's input. Everybody was super active with it and getting the word out. And we were able to actually advocate together on a national level in a way that I at least in my career, which obviously is shorter than yours. But I've been in medicine for a long time because my father has been in medicine and so, I just, you know, I think that one of the things that we don't do well as a community is come together just because we're so busy that that's how.

John Shufeldt: Exactly.

Nisha Mehta: So, I've been glad about physicians coming together in terms of their actual careers. I think that people have gone, there's a lot of skepticism that has arisen from just how physicians were treated on the national level and what has happened in terms of expansion of maybe commoditizing medicine to some degree. And, you know, I think as certain aspects of, people had to make a lot of accommodations to be able to effectively deliver health care in this space. But the question is, is, you know, long term, are those accommodations going to be good for physicians and patients or are they going to detract from patient care? And I think that that is one area where a lot of physicians are very apprehensive about the direction in which they're seeing health care commoditized. And that, I think, has led to a degree of skepticism among the community that really in a lot of people's minds threatens their job security and threatens the way that medicine has traditionally been practiced. Not to say that there shouldn't be change. I think there's always some good and change. That said, I think physicians are feeling more and more as though there are these huge forces in health care that sometimes get more credence than what they do as the head of the health care team. And that has led to a lot of disillusionment amongst a lot of physicians. And I think that that's the part where we really need to come together as a profession and say we're best positioned to do what's best for our patients and how do we come together as a community and really advocate for quality care and acknowledge the fact that we are a crucial piece to this puzzle that really can't be, can't be marginalized. But they are the people that want to pursue those routes. And then there's other people that really just have gotten so disillusioned by it that they've elected to either find a different pathway within medicine or leave entirely. And they think that we haven't really seen the full, sort of consequences of that movement that has started because of covid.

John Shufeldt: Now I agree, and I think there's a go-along to get along with people. There's people that are like I'm not changing the system, so I'm going to leave the system. But I look back now, I started I got out of residency in '89 and I could see it than where we kind of we physicians kind of shot ourselves in the footway back when with managed care plans and we did not have a collective seat at the table. And not that we should have unionized, but we should have certainly come together in a more cohesive, forceful way than we did. And I think that ship has left the harbor, so to speak. But I do agree with you that I think the tide is turning in the sense that now there's a spotlight on this and with the growing disillusionment and with people, as you said, with, you know, more than 50 percent of women in medical school and 40 percent of them after five years have a decreased amount of hours or leave medicine, something has to be done or it's going to be a sea change of care opportunities because there'll nobody to care for folks, and that will change the world.

Nisha Mehta: Absolutely. I think that you know, we're in for a rocky ride over the next decade or so. And if you believe that everything at the end of the day works out the way that it should, hopefully, we'll get to a point where, you know, we've made some changes for the better. But I think in the short term, there's a lot of challenges that unfortunately for a lot of people are very, are contributing to a lot of disillusionment.

John Shufeldt: Nisha, I totally agree. And it has been a, literary, honor to talk to you. Thank you so much for what you've done for physicians and bringing some of these challenging topics to light into the forefront and do it in such an eloquent and caring, professional manner. I really appreciate it. Thank you for being on the podcast.

Nisha Mehta: Thank you for your kind words, for inviting me to be here and for all the work that you've been doing as well.

John Shufeldt: Thank you. You connect with Nisha online at Nisha MehtaMDcom or follow her on Twitter and at NishMehtaMD, you can also find Physicians Side Gigs as a group on Facebook. Thank you all. We'll see you next time, ans Nisha, thank you.

Nisha Mehta: Thank you.

Narrator: Thanks for listening to Entrepreneur RX with Dr. John Shufeldt. To find out how to start a business and help secure your future, go to JohnShufeldtMD.com. This has been a presentation of ForbesBooks.

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