Interview with Dr. Andrew Tisser
Dr. Andrew Tisser is an emergency medicine physician and physician career strategist. He also hosts the Talk2MeDoc Podcast.
The podcast and Dr. Tisser's work as a career strategist focus on the unique issues of the early career physician. He works with his clients to accelerate their goals to completion!
Andrew earned his medical degree at the New York Institute of Technology, College of Osteopathic Medicine. He then completed his residency at Upstate Medical University in Syracuse, NY. He is currently the Associate Chair of Emergency Medicine at Sisters of Charity Hospital in Buffalo.
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Emergency Medicine, Leadership and Podcasting
Andrew has been featured on NBC, NPR, and MTV News. He is a popular podcast guest. He was recently named as one of the “50 Best Doctors to Follow on Instagram in 2021” and “Top 21 Medical Podcasts.” Dr. Tisser lives in Western New York state with his wife Alysia, daughter Marlowe, and dog Lillie.
Realize that you have options… The first step is figuring out who you are. The second step is what you want. The third is going and getting it. – Dr. Andrew Tisser
Today Dr. Tisser and I will be talking about his experiences with burnout, nonclinical side gigs he has done, how he is helping other clinicians as a career strategist, and three limiting beliefs that hold physicians back from finding their best career.
Physician Career Strategist Offers His Advice
I like Andrew’s approach to his career and to helping others with theirs. During our conversation, we covered several topics, including:
1) His experiences with burnout during med school, residency, and early practice years;
2) What he did to overcome burnout;
3) The part-time nonclinical jobs he has tried;
4) How he now balances clinical and nonclinical work;
5) His podcast and how it helps early-career physicians learn strategies to advance their careers and overcome burnout;
6) His work as a physician career strategist;
6) And three common limiting beliefs that hold us back and how to address them.
Summary
Andrew Tisser describes the burnout he experienced from medical school through his early clinical career. He then explains what he has done to overcome burnout. He still practices emergency medicine and provides leadership at his hospital. Finally, he assists other burned-out physicians as a career strategist.
NOTE: Look below for a transcript of today's episode.
Links for Today's Episode:
- Talk2MeDoc Podcast
- Dr. Andrew Tisser's Website
- Sisters of Charity Hospital in Buffalo, NY
- Dr. Andrew Tisser's Free Video Series
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Transcription PNC Podcast Episode 220
Three Top Tips from a Physician Career Strategist
- Interview with Dr. Andrew Tisser
John: Nonclinical nation, Andrew Tisser, DO, specializes in emergency medicine and is the host of Talk2MeDoc podcast. The podcast and Dr. Tisser's work as a career strategist focus on unique issues pertaining to the early career physician.
He works tirelessly with his clients to accelerate their goals to completion. Andrew earned his medical degree at the New York Institute of Technology college of osteopathic medicine. He then completed his residency at Upstate Medical University in Syracuse, New York.
He is currently the associate chair of emergency medicine at Sisters of Charity hospital in Buffalo, New York. Andrew has been featured on NBC, NPR and MTV News as well as multiple podcasts. I was actually on his podcast twice. He was most recently named as one of the 50 best doctors to follow on Instagram in 2021 and top 2021 medical podcasts. Andrew lives in Western New York with his wife, Alysia, daughter Marlowe, and dog Lillie.
Today, Dr. Tisser and I will be talking about his experiences with burnout, nonclinical side gigs he's done, how he is helping other clinicians as a career strategist, and three limiting beliefs that hold physicians back from finding their best career. Here we go.
Some of you may know Dr. Andrew Tisser because I have been a guest on his show twice, and I think I've let you know about that and you probably have listened and that's on Talk2MeDoc podcast.
I recently posted an episode about coaches and consultants and strategists. I mentioned Andrew as being a coach that I had interviewed. And then I realized looking when I tried to put a link to it, there was no interview. So, I felt like I've been talking to him so much off and on in the last few years that I had interviewed him and I hadn't. So, he's here today. Andrew Tisser, welcome to the podcast.
Dr. Andrew Tisser: Hey John, thanks so much for having me.
John: Yeah. I couldn't believe it. I felt like a fool, like, man, I thought I had interviewed him, but it was the other way around. So, this is going to be fun. I want to hear what you've been up to and also your background and everything else and get a lot of good information for the listeners today. And so, why don't we start as we usually do by just giving us a short summary of your background from let's say med school through what you're doing now and maybe touch on some of the things you're doing.
Dr. Andrew Tisser: Yeah. Thanks, John. I just want to start off by saying this is a real treat and a real honor for me because you were the first medical podcast that I listened to. When I found your podcast I went back and listened to every episode, and you got me through some really lonely, long drives in residency. So, I want to thank you for that. And really my interest in alternative careers started with you. So, thank you for that.
I was telling my wife this morning, I was like, "Oh my God, it's John Jurica". And she's like, "All right, yeah, but you talk to him all the time". I'm like, "I know". But anyway...
John: Thanks for that. I appreciate it. That's a good testimonial. I have to cut that out and use that somewhere.
Dr. Andrew Tisser: Oh yeah, please do. Anyway, I went to the New York Institute of Technology college of osteopathic medicine, for medical school on Long Island. Graduated and moved on to emergency medicine residency at Upstate University in Syracuse, New York. After that, I followed my wife out to Chicago, where she did her rheumatology fellowship. And I worked at a lot of different hospitals during that time.
I didn't really know what I wanted to do. I suffered from a lot of burnouts actually in med school and residency. And so, I decided I was going to take a whole bunch of different locums and part-time jobs to see what I liked. And I knew that we were only there temporarily. So, that's what I did. And so, I worked from little tiny places up to massive teaching hospitals and everything in between, that was all drivable from inner-city Chicago because there are just so many hospitals.
During that time, I was extreme, my burnout got way worse. I was at this point where I'm sure a lot of your listeners are where they're just like, if I could just replace my salary, I would do literally anything. I would put the labels on whiteout containers if that's what it took to get out of clinical medicine. And I had just graduated, so it was a little bit more jarring to me. And also, I had close to half a million dollars in student loan debt.
I started looking at everything. I had listened to all your episodes like I said. I knew certain things that didn't interest me like the pharmaceutical industry I had heavily researched and I just was not interested. I tried a whole bunch of different things. I actually shadowed an aesthetics person at one of their spas and that was not for me. I got into some utilization work.
I was doing everything. And my wife was getting really upset because it was like today, I was going to do this, and tomorrow I was going to do this and the next day was going to do something else. And she's like, "Just figure it out. And when we move back to Buffalo where we are now, you can go after it", which was really sage advice.
And then, following that, we moved back to Buffalo, New York. I took a position at a small rural hospital, which was actually a really good organization, and started working on getting involved in administration, which is something that I do enjoy. And then, I quickly became the urgent care director over there. I also continued to do utilization work on the side. I started my podcast. I started my consulting business. And really recently as of August, I took a position as the associate chair of emergency medicine at another hospital here in Buffalo. And so, that's kind of where I'm at now.
John: Nice, nice. Do you feel a little more balance and comfort with the clinical side now with all that you're doing?
Dr. Andrew Tisser: Absolutely. I think a lot of people, and we'll get to this later. But a lot of people think it's all or nothing, right? Like you have to either leave clinical medicine, or you have to stay. And that's not really true. I've hodgepodge a career together at this point that is financially good enough for me and my family, it's personally rewarding. I remember in one episode, you talked to somebody who does a whole bunch of stuff and you said, "Well, aren't you so busy?" And he was like, "Yes, but that also brings me personal fulfillment". Yeah, I'm about 50% clinical these days and it makes the clinical shifts a lot better doing all the other stuff.
John: Awesome. Yeah. That is a good plan I think for some people. It works out really well. I think it's difficult to keep having a different schedule once you can get to something that's a little bit more routine. Habits are good for humans. It helps make things go more smoothly and easily and lowers the level of chaos and stress. When you can get into that rhythm and have two or three different things that you enjoy doing, rather than one thing that you hate doing, it can really work out.
Dr. Andrew Tisser: Yeah, absolutely.
John: And then along the way you have other options in terms of saying, well, maybe 10 years, 15 years, whatever down the road, I'm going to segue into doing this
one really mostly over everything else as I sort of approach retirement. But it's not really retirement. It's just simply trying to get a little more freedom in your schedule after a while. And when you've paid off those bills and families halfway grown and you can think about other things and about yourself.
Dr. Andrew Tisser: Yeah. And what I've found along the way is that each of those things lends itself to other opportunities. If I didn't do the urgent care directorship, yeah, sure. That's some administrative work, but also, I was recruited for this job because of my consulting business and because of my social media presence. Because they wanted someone young and up to date, and someone who's got a finger on those types of things. That really granted me medical directorship, not just the standard administrative work.
And now I'm starting to do in-house utilization for my current place as well, which the utilization work helped with. It's just one thing that builds on the other thing. and leads to really, really fun opportunities I feel.
John: Yeah. Other people have told me that sometimes they don't know where it's going to go, but you stack certain scales, get certain experiences that don't seem to be directly related to what you might do in three to five years or so. But ultimately, they often come up as another good skill that will apply to a new position or even a hobby or a side gig or whatever.
Dr. Andrew Tisser: Absolutely. Yeah. It's been fun.
John: We try to be, as physicians, lifelong learners. I think that helps. And if we can stick with that, but just expand our horizon to other types of learning like maybe writing, I don't know, just different things that don't seem directly related. But even the whole thing, like understanding finances or understanding how to be a consultant. Those things will come in handy in almost any job that you decide to pursue.
Dr. Andrew Tisser: Yeah. It's stacking skills as you said. Physicians have a core set of qualifications that make them really marketable people in general, but then you start adding other little sprinkles on top and it really gets some opportunities open for you.
John: As you mentioned that you've been doing some either coaching or consulting. I'm using the term career strategist. Tell us about that. What interests you about that? Is there a difference between a coach, a strategist, and a consultant? Or do they all kind of overlap?
Dr. Andrew Tisser: Yeah, there is some overlap for sure. I don't call myself a straight coach because I don't only coach. Because coaching really entails helping people come to the answer from within so to speak. And there are a lot of times when I'm working with clients that I tell them what to do. That's more of a consultant. You put on your consultant hat or your coach hat. But a lot of the strategy is strategy. It's figuring out what the next best move is for the person and what that entails. And whether that is restructuring their current position, whether that is leaving their clinical job for another clinical job, whether it is profitable side gigs or leaving clinical medicine or whatever. There is just a lot that goes into careers. And that's why I feel strategist is the appropriate hat to wear, the umbrella term.
Like I said, I started talking to my own mentors, my own coaches when I was so burnt out, to figure out what I wanted to do. And I did a lot of soul searching and kind of inner work when I was trying to figure out what it was that I wanted to do. And then after I started designing a career for myself, once we got back to Buffalo, some of my colleagues and friends from growing up and from medical school were like, "Hey, you're not miserable anymore. What happened?"
I started talking to them through a similar process that I had done and it worked well for them. And then after a while, my good friend from growing up was like, "Hey, you could charge for this". I was like, "That is true". I've always loved getting people jobs. Even all the way back to college. I love making connections. I love the networking and the strategy itself that goes into getting someone a job. That's really what my platform is based on. Getting people their next job and figuring out what will be the best fit. And it goes to career design more so than just what's the next job to add to their resume, so to speak.
John: Whether it's with some of the informal mentoring you've been doing and the actual career strategist activity, does it seem like the people that you're working with have similar challenges or is it just unique to each individual when you kind of step back and look across who you've been working with?
Dr. Andrew Tisser: Yeah. I think there's a theme. I mostly work with early-career people. And I define that as like 7 to 10 years out. And I've worked with a couple of non-physicians as well, that also are in the early career space. But right now, student loans are a big hot-button topic.
I've asked this question before, "If your loans are wiped out tomorrow, but you were never allowed to be a doctor again, would you take that deal?" And a lot of people say yes, which after a million years of training and how much time you've spent and sacrifices you made, it's kind of jarring to hear that. But I was in that place.
Student loans are big. Increasing hours and decreasing compensation. Increasing administrative oversight and requirements. I think my generation was brought into medicine with this kind of charting. So, I think that's just expected. And then people don't want to work 80 hours a week and be on call every third day anymore. That was the expectation back in the day. But people want to have time with their family and they want to have a couple of weekends off here and again and enjoy life once they've deferred it up until their thirties at this point. I think that's a big one.
And the other really big thing I hear as well is "All right. Well, what do I do?" That's the biggest question I get. "I don't like this, but what do I do?" And that's not an easy question to answer. I was like, "Well, I don't know, but let's try to figure that out". And that depends on a lot of different things.
John: Interesting. Interesting. I don't know. It seems like I'm kind of put aside because I'm in an older generation. A lot of times with the people I'm talking to are kind of closer to retirement, so they don't have the student loan issue. It sounds like that's kind of an integral part. Like you've got to deal with that while you're dealing with the other emotional things. And I'm assuming having those monstrous loans doesn't help just the emotional state of somebody because you just feel like you're trapped.
Dr. Andrew Tisser: For sure. I think golden handcuffs apply here too. But it's certainly the case and I try to work with people there too, to just get a plan together. Whatever the plan is, whether it's all the different things you can do with your loans. And then it becomes like another bill instead of like, "Well, I have this monster. - Nope, this is how you're going to pay it off and now let's move on". And that may be a 15-year plan and it might be a 20-year plan. it really just depends on your situation. But yeah, it does not help.
John: You kind of compartmentalize that it exists, but it's not good or bad. It's just something you have to deal with and deal with the other issues at the same time.
Dr. Andrew Tisser: Exactly. Yeah. I think that's the main thing right now with the student loans. They are. And I don't think anyone assumes that we're ever going to get student loan forgiveness for doctors unless you're in public service loan forgiveness. I don't think that's going to happen. It needs to be dealt with, and then you got to move on.
But I think the other big issue I run into is this "all or nothing" effect that we talked about before. It's that I have to leave or I have to stay and there's no in between. And sometimes when you bring up this issue to people like, "Well, what about cutting back and trying something else on the side?" A lot of people are like, "Oh, I can do that". Like, well, yeah, you can do anything. You can do anything you want.
John: I know some of us are so indoctrinated. We just have one view of what medicine is. Like you said, it's the 80 hours, it's the being on call. Or if you're doing, let's say more shift work, well, it's doing three or four or five, 12-hour shifts until I get my loans paid off. Yeah, there are situations where you can say no. Maybe I'm going to do eight-hour shifts. I'm going to do something else. Or I'm going to work only two or three days a week in that setting like an ER. Lot of people do maybe a little bit of emergency medicine, and some do maybe urgent care which I don't know how that feels going back and forth, but it's just something different.
Dr. Andrew Tisser: Yeah. There is literally an unlimited amount of options. And that's the point of your show. There are so many options for people. Whether that's part-time, per diem, whether or not you're trying to find a non-clinical job and you do locums as a bridge, or what have you. There are just so many options. And people want to be told what they should do.
A lot of people want to be told, "Well this is what's going to happen". And I can't tell people what's going to happen. I could just help them realize that there are other options and there are an unlimited amount of options. There are people that completely change. I forgot her name. There's that one doctor who decided she was wanting to sell cars instead of being an OB-GYN. She makes more doing that because she loves cars. You have to figure out what's right for you and what's right for your family and not get pigeonholed into "This is all there is".
John: Well, I hadn't heard that one. That one sounds pretty interesting. I know a lot of docs have gone into real estate and left medicine. I know one who became a disability insurance broker and she's doing very well. But yeah, pretty much we can do anything. I kind of liked that. That maybe physicians will go into something related to healthcare, but they don't have to, of course.
One of the ways I like to look at this sometimes when I'm talking to someone who's helping others is to turn it around and kind of look at it from, "Okay, what are the three mistakes or blunders?" And you may have touched on it in talking about the people that you've helped, but are there trends in terms of the big mistakes, if everyone could just deal with this and just know not to do this would help with their career transition or not even transition, but improvement?
Dr. Andrew Tisser: Sure. I think the big one is to not just assume that you're just screwed. For lack of a better term. I hear a lot of physicians that are like, "Well, I hate my specialty but this is just how it is. And this is what I picked. It's just my life and it sucks. But I have these financial obligations and I have to make X amount of money. Or this is just how the administration is everywhere or they won't be willing to work something out with me where I cannot work on Fridays and exchange for longer days".
People don't even try. And you never know until you ask. A big one is just remaining stuck, and remaining in your position where you just feel like there's no hope. I heard it a lot also, "You're too young to be burnt out", which is a really kind of annoyance to me because I hear it all the time. I used to hear that at every stage.
When I was a medical student, they're like, "Well wait till you get on the wards, then it will be better". And then you get on the wards and they're like, "Oh, well, you don't have any real responsibility. Wait until you are an actual resident, that will be better". And then in residency they're like, "Oh, it's residency. It's supposed to be terrible. Wait until you're out there and then it'll get better".
And then you get out and a lot of people have this existential moment where they get out of residency and they're attending and they don't like it. And they're like, "Oh my God, I got to do this for 50 years. What now?" And then it's like, "Oh, you're just a first-year attending. So, it's really hard. It'll get better". And it just goes on and on and on and on, or maybe it won't get better and you have to change your current situation because it doesn't fit with who you are as a person, or it's disparate to your core values or your belief system. So, maybe it won't.
John: I can't really think of too many other professions where it's just that awful. It just doesn't make sense. How could there be any kind of longevity in this business when medical school residency and practice for many people are something that you just despise? You think that it's just the way it is and you can do it, but you can only survive that for so long. So, it's just sad.
Dr. Andrew Tisser: It is sad. And you see it all the time from, again, your supposed superiors that are just like, "Oh, well". I don't understand that either. I think the lawyers are also kind of miserable, so they have it with us too. I was talking to my brother-in-law who was miserable at his corporate attorney job. And we did some of this stuff too. And he actually got a new job as an in-house counsel at a food company. And he's super happy now.
The first big issue is remaining stock. Number two is saying you're too young and you get burnt out and just grin and bear it. Because I hate that. The next thing I see with people is that there's only a couple of other things I can do, and I don't like any of them. And they tend to be the big three of utilization, pharma, and medical writing. They tend to be the ones that people say, "Oh, that's the only nonclinical career I can do". Well, have you listened to John Jurica's podcast? There are a lot more. But people get stuck in, and then you see these threads on Facebook groups with somebody posting a utilization job. And there are like 5,000 replies in 30 seconds.
John: That's true. People don't know what they don't know. And people have said to me, listeners and others, "Why don't they teach us this in med school? Why don't they tell us about these nonclinical careers in residency?" It's like, well, I don't expect them to do that. Number one, there's no time to add that to the curriculum. The curriculums are already packed with more than you can possibly learn. So, they're not going to even carve out an hour just to explain that to you, unless it's something on a weekend when you do it on your own. So, that's not going to happen.
But it is unfortunate that if you don't know those exist, then you feel fairly hopeless. And so, it's people like you and me and others. That's just part of the whole process, just opening their eyes, the fact that there are lots of options. And if we were really scientific about it, we might sit down and do some personality tests and checklists and try and figure out what fits with your personality and your desires, your mission in life, and all that. But I don't know too many people that have gone through that kind of a process. Basically, it's a matter of just starting to do your research, starting to dig and learn and getting a coach or a strategist or consultant or someone to help you if you need it. Just find out what's out there, take control of your life and then see what you can work out.
Dr. Andrew Tisser: Yeah. Careers should be designed in my opinion. A lot of people just let their career or their job happen to them instead of going out there proactively and designing a career. I'm happy where I am right now, but it could be even better. And that's a process. But I know my trajectory and my clients know their trajectory. And even if after 8, 12 weeks of working together they're not in their dream job, they've moved so far along that they know where they're going.
And don't get me wrong. I want people to stay in clinical medicine because I want somebody to take care of us, take care of me when I'm older. I don't want all the doctors to leave. And that's possible too, to stay and just restructure, like I did.
John: That's a good point too, about planning your career. Because I'll tell you, when I was working as chief medical officer, of course, I got to be exposed to a lot of nonphysician CFOs and CEOs and COOs. Many of them had a plan. They really knew when they were just coming on as a director of some small department, that they wanted to move up to the next directorship and then they wanted to be a VP, and then they wanted to do this and they wanted to do that. And it was a lot more planned out.
I guess when you compare it to clinical while we plan to go to med school and then pick a residency, maybe a fellowship, that's basically as far as it goes, I think. And it should continue as you're saying.
Dr. Andrew Tisser: Yeah, I agree. Especially when we are talking about the administrative pathway too. I know many people encourage others to join committees. But you just can't just join a bunch of committees and expect something to happen. You want to target committees that you have an interest in so that you can potentially chair. There is a pathway instead of just letting things happen. I recently gave a lecture at my wife's residency, she's a program director for internal medicine, about career design.
And I had a resident come up after the talk. She was like "Thank you because I just assumed that this was the path that I was on and I didn't really have any choices. And now it's given me so much to think about". And she was I believe either a first- or second-year resident. And I was like, yeah, start thinking about this stuff now so that your first job could be planned very well. And not just like, hey, give me the biggest sign-on bonus or something.
John: Yeah. Oh, man. I think they are probably just so happy to have their eyes opened by hearing what you had to say. All right. We're going to run out of time here. I want to talk a little bit about some other things just for a minute.
Now you've been doing a podcast for quite a while. And so, I know it started out initially with more talking about communication, and that sort of thing. What is the theme of your podcast for the last 6 to 12 months or so?
Dr. Andrew Tisser: Yes. We've shifted into just issues relating to the early career physician in general. The communication topic was great. And we had a lot of really interesting speakers from all different disciplines, but it got kind of stale just because everybody is saying the same thing. Everybody's part of the team. Everybody has a voice. And I agree with all that. It was a great first season, but then as my interests have changed and I realized that my demographic has certain other challenges I moved into just talking about everything and anything that could be related to the early career physician.
John: Okay. That's good. The thing we're talking about today, if people are interested, they should just go to Talk2MeDoc podcast and listen in on those. And mostly it's interviews. Is that right?
Dr. Andrew Tisser: Yeah. A couple of solo shows, but the vast majority are interviews.
John: Okay. And then you've got a website that probably links to that as well as other things that you do at andrewtisserdo.com. Correct?
Dr. Andrew Tisser: You got it. Everything's there.
John: All right. I will definitely put links to those two for sure. And if the listeners want to learn a little bit more about either what you do or get a little more advice from you, just an entry-level, I think you have some kind of video series. Tell us about that.
Dr. Andrew Tisser: Yeah, thanks. I have a four-part video series on my website. It's andrewtisserdo.com/video or there are links all over the site you'll find it, which really describes my pathway through burnout, where I am today, starting from medical school. Each video is about six, seven minutes long. It's just talking about what I went through and then I give a career strategy tip embedded into each video, and it's totally free.
John: Okay, awesome. I will put a link to that directly too, in case someone just wants to take a look at that. Well, before I let you go, any last advice for physicians who are feeling just frustrated and burnt out right now that might sum up a little bit of what we talked about today?
Dr. Andrew Tisser: Yeah, thanks. Just realizing you have options. The options are unlimited for what you want to do, what you want your career to look like. You just have to figure out what it is you want, and then you can go get it. The first step is figuring out who you are. The second step is what you want and the third is going and getting it. So, don't remain in your position, go change your life.
John: Excellent. Words of wisdom. I love it. And I liked the three steps. That's a little in a nutshell how to do the process. Of course, each step might take a little while, but it's a good summary.
All right, Andrew. I'm so happy we had a chance to talk today on my podcast for a change. This has been great and I hope to maybe see you again in the future.
Dr. Andrew Tisser: Yeah, John, thanks again so much. I'm honored.
John: All right. Best of luck. And I'll see you down the road.
Dr. Andrew Tisser: Bye-bye.
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Transcription PNC Podcast Episode 220
Three Top Tips from a Physician Career Strategist
- Interview with Dr. Andrew Tisser
John: Nonclinical nation, Andrew Tisser, DO, specializes in emergency medicine and is the host of Talk2MeDoc podcast. The podcast and Dr. Tisser's work as a career strategist focus on unique issues pertaining to the early career physician.
He works tirelessly with his clients to accelerate their goals to completion. Andrew earned his medical degree at the New York Institute of Technology college of osteopathic medicine. He then completed his residency at Upstate Medical University in Syracuse, New York.
He is currently the associate chair of emergency medicine at Sisters of Charity hospital in Buffalo, New York. Andrew has been featured on NBC, NPR and MTV News as well as multiple podcasts. I was actually on his podcast twice. He was most recently named as one of the 50 best doctors to follow on Instagram in 2021 and top 2021 medical podcasts. Andrew lives in Western New York with his wife, Alysia, daughter Marlowe, and dog Lillie.
Today, Dr. Tisser and I will be talking about his experiences with burnout, nonclinical side gigs he's done, how he is helping other clinicians as a career strategist, and three limiting beliefs that hold physicians back from finding their best career. Here we go.
Some of you may know Dr. Andrew Tisser because I have been a guest on his show twice, and I think I've let you know about that and you probably have listened and that's on Talk2MeDoc podcast.
I recently posted an episode about coaches and consultants and strategists. I mentioned Andrew as being a coach that I had interviewed. And then I realized looking when I tried to put a link to it, there was no interview. So, I felt like I've been talking to him so much off and on in the last few years that I had interviewed him and I hadn't. So, he's here today. Andrew Tisser, welcome to the podcast.
Dr. Andrew Tisser: Hey John, thanks so much for having me.
John: Yeah. I couldn't believe it. I felt like a fool, like, man, I thought I had interviewed him, but it was the other way around. So, this is going to be fun. I want to hear what you've been up to and also your background and everything else and get a lot of good information for the listeners today. And so, why don't we start as we usually do by just giving us a short summary of your background from let's say med school through what you're doing now and maybe touch on some of the things you're doing.
Dr. Andrew Tisser: Yeah. Thanks, John. I just want to start off by saying this is a real treat and a real honor for me because you were the first medical podcast that I listened to. When I found your podcast I went back and listened to every episode, and you got me through some really lonely, long drives in residency. So, I want to thank you for that. And really my interest in alternative careers started with you. So, thank you for that.
I was telling my wife this morning, I was like, "Oh my God, it's John Jurica". And she's like, "All right, yeah, but you talk to him all the time". I'm like, "I know". But anyway...
John: Thanks for that. I appreciate it. That's a good testimonial. I have to cut that out and use that somewhere.
Dr. Andrew Tisser: Oh yeah, please do. Anyway, I went to the New York Institute of Technology college of osteopathic medicine, for medical school on Long Island. Graduated and moved on to emergency medicine residency at Upstate University in Syracuse, New York. After that, I followed my wife out to Chicago, where she did her rheumatology fellowship. And I worked at a lot of different hospitals during that time.
I didn't really know what I wanted to do. I suffered from a lot of burnouts actually in med school and residency. And so, I decided I was going to take a whole bunch of different locums and part-time jobs to see what I liked. And I knew that we were only there temporarily. So, that's what I did. And so, I worked from little tiny places up to massive teaching hospitals and everything in between, that was all drivable from inner-city Chicago because there are just so many hospitals.
During that time, I was extreme, my burnout got way worse. I was at this point where I'm sure a lot of your listeners are where they're just like, if I could just replace my salary, I would do literally anything. I would put the labels on whiteout containers if that's what it took to get out of clinical medicine. And I had just graduated, so it was a little bit more jarring to me. And also, I had close to half a million dollars in student loan debt.
I started looking at everything. I had listened to all your episodes like I said. I knew certain things that didn't interest me like the pharmaceutical industry I had heavily researched and I just was not interested. I tried a whole bunch of different things. I actually shadowed an aesthetics person at one of their spas and that was not for me. I got into some utilization work.
I was doing everything. And my wife was getting really upset because it was like today, I was going to do this, and tomorrow I was going to do this and the next day was going to do something else. And she's like, "Just figure it out. And when we move back to Buffalo where we are now, you can go after it", which was really sage advice.
And then, following that, we moved back to Buffalo, New York. I took a position at a small rural hospital, which was actually a really good organization, and started working on getting involved in administration, which is something that I do enjoy. And then, I quickly became the urgent care director over there. I also continued to do utilization work on the side. I started my podcast. I started my consulting business. And really recently as of August, I took a position as the associate chair of emergency medicine at another hospital here in Buffalo. And so, that's kind of where I'm at now.
John: Nice, nice. Do you feel a little more balance and comfort with the clinical side now with all that you're doing?
Dr. Andrew Tisser: Absolutely. I think a lot of people, and we'll get to this later. But a lot of people think it's all or nothing, right? Like you have to either leave clinical medicine, or you have to stay. And that's not really true. I've hodgepodge a career together at this point that is financially good enough for me and my family, it's personally rewarding. I remember in one episode, you talked to somebody who does a whole bunch of stuff and you said, "Well, aren't you so busy?" And he was like, "Yes, but that also brings me personal fulfillment". Yeah, I'm about 50% clinical these days and it makes the clinical shifts a lot better doing all the other stuff.
John: Awesome. Yeah. That is a good plan I think for some people. It works out really well. I think it's difficult to keep having a different schedule once you can get to something that's a little bit more routine. Habits are good for humans. It helps make things go more smoothly and easily and lowers the level of chaos and stress. When you can get into that rhythm and have two or three different things that you enjoy doing, rather than one thing that you hate doing, it can really work out.
Dr. Andrew Tisser: Yeah, absolutely.
John: And then along the way you have other options in terms of saying, well, maybe 10 years, 15 years, whatever down the road, I'm going to segue into doing this
one really mostly over everything else as I sort of approach retirement. But it's not really retirement. It's just simply trying to get a little more freedom in your schedule after a while. And when you've paid off those bills and families halfway grown and you can think about other things and about yourself.
Dr. Andrew Tisser: Yeah. And what I've found along the way is that each of those things lends itself to other opportunities. If I didn't do the urgent care directorship, yeah, sure. That's some administrative work, but also, I was recruited for this job because of my consulting business and because of my social media presence. Because they wanted someone young and up to date, and someone who's got a finger on those types of things. That really granted me medical directorship, not just the standard administrative work.
And now I'm starting to do in-house utilization for my current place as well, which the utilization work helped with. It's just one thing that builds on the other thing. and leads to really, really fun opportunities I feel.
John: Yeah. Other people have told me that sometimes they don't know where it's going to go, but you stack certain scales, get certain experiences that don't seem to be directly related to what you might do in three to five years or so. But ultimately, they often come up as another good skill that will apply to a new position or even a hobby or a side gig or whatever.
Dr. Andrew Tisser: Absolutely. Yeah. It's been fun.
John: We try to be, as physicians, lifelong learners. I think that helps. And if we can stick with that, but just expand our horizon to other types of learning like maybe writing, I don't know, just different things that don't seem directly related. But even the whole thing, like understanding finances or understanding how to be a consultant. Those things will come in handy in almost any job that you decide to pursue.
Dr. Andrew Tisser: Yeah. It's stacking skills as you said. Physicians have a core set of qualifications that make them really marketable people in general, but then you start adding other little sprinkles on top and it really gets some opportunities open for you.
John: As you mentioned that you've been doing some either coaching or consulting. I'm using the term career strategist. Tell us about that. What interests you about that? Is there a difference between a coach, a strategist, and a consultant? Or do they all kind of overlap?
Dr. Andrew Tisser: Yeah, there is some overlap for sure. I don't call myself a straight coach because I don't only coach. Because coaching really entails helping people come to the answer from within so to speak. And there are a lot of times when I'm working with clients that I tell them what to do. That's more of a consultant. You put on your consultant hat or your coach hat. But a lot of the strategy is strategy. It's figuring out what the next best move is for the person and what that entails. And whether that is restructuring their current position, whether that is leaving their clinical job for another clinical job, whether it is profitable side gigs or leaving clinical medicine or whatever. There is just a lot that goes into careers. And that's why I feel strategist is the appropriate hat to wear, the umbrella term.
Like I said, I started talking to my own mentors, my own coaches when I was so burnt out, to figure out what I wanted to do. And I did a lot of soul searching and kind of inner work when I was trying to figure out what it was that I wanted to do. And then after I started designing a career for myself, once we got back to Buffalo, some of my colleagues and friends from growing up and from medical school were like, "Hey, you're not miserable anymore. What happened?"
I started talking to them through a similar process that I had done and it worked well for them. And then after a while, my good friend from growing up was like, "Hey, you could charge for this". I was like, "That is true". I've always loved getting people jobs. Even all the way back to college. I love making connections. I love the networking and the strategy itself that goes into getting someone a job. That's really what my platform is based on. Getting people their next job and figuring out what will be the best fit. And it goes to career design more so than just what's the next job to add to their resume, so to speak.
John: Whether it's with some of the informal mentoring you've been doing and the actual career strategist activity, does it seem like the people that you're working with have similar challenges or is it just unique to each individual when you kind of step back and look across who you've been working with?
Dr. Andrew Tisser: Yeah. I think there's a theme. I mostly work with early-career people. And I define that as like 7 to 10 years out. And I've worked with a couple of non-physicians as well, that also are in the early career space. But right now, student loans are a big hot-button topic.
I've asked this question before, "If your loans are wiped out tomorrow, but you were never allowed to be a doctor again, would you take that deal?" And a lot of people say yes, which after a million years of training and how much time you've spent and sacrifices you made, it's kind of jarring to hear that. But I was in that place.
Student loans are big. Increasing hours and decreasing compensation. Increasing administrative oversight and requirements. I think my generation was brought into medicine with this kind of charting. So, I think that's just expected. And then people don't want to work 80 hours a week and be on call every third day anymore. That was the expectation back in the day. But people want to have time with their family and they want to have a couple of weekends off here and again and enjoy life once they've deferred it up until their thirties at this point. I think that's a big one.
And the other really big thing I hear as well is "All right. Well, what do I do?" That's the biggest question I get. "I don't like this, but what do I do?" And that's not an easy question to answer. I was like, "Well, I don't know, but let's try to figure that out". And that depends on a lot of different things.
John: Interesting. Interesting. I don't know. It seems like I'm kind of put aside because I'm in an older generation. A lot of times with the people I'm talking to are kind of closer to retirement, so they don't have the student loan issue. It sounds like that's kind of an integral part. Like you've got to deal with that while you're dealing with the other emotional things. And I'm assuming having those monstrous loans doesn't help just the emotional state of somebody because you just feel like you're trapped.
Dr. Andrew Tisser: For sure. I think golden handcuffs apply here too. But it's certainly the case and I try to work with people there too, to just get a plan together. Whatever the plan is, whether it's all the different things you can do with your loans. And then it becomes like another bill instead of like, "Well, I have this monster. - Nope, this is how you're going to pay it off and now let's move on". And that may be a 15-year plan and it might be a 20-year plan. it really just depends on your situation. But yeah, it does not help.
John: You kind of compartmentalize that it exists, but it's not good or bad. It's just something you have to deal with and deal with the other issues at the same time.
Dr. Andrew Tisser: Exactly. Yeah. I think that's the main thing right now with the student loans. They are. And I don't think anyone assumes that we're ever going to get student loan forgiveness for doctors unless you're in public service loan forgiveness. I don't think that's going to happen. It needs to be dealt with, and then you got to move on.
But I think the other big issue I run into is this "all or nothing" effect that we talked about before. It's that I have to leave or I have to stay and there's no in between. And sometimes when you bring up this issue to people like, "Well, what about cutting back and trying something else on the side?" A lot of people are like, "Oh, I can do that". Like, well, yeah, you can do anything. You can do anything you want.
John: I know some of us are so indoctrinated. We just have one view of what medicine is. Like you said, it's the 80 hours, it's the being on call. Or if you're doing, let's say more shift work, well, it's doing three or four or five, 12-hour shifts until I get my loans paid off. Yeah, there are situations where you can say no. Maybe I'm going to do eight-hour shifts. I'm going to do something else. Or I'm going to work only two or three days a week in that setting like an ER. Lot of people do maybe a little bit of emergency medicine, and some do maybe urgent care which I don't know how that feels going back and forth, but it's just something different.
Dr. Andrew Tisser: Yeah. There is literally an unlimited amount of options. And that's the point of your show. There are so many options for people. Whether that's part-time, per diem, whether or not you're trying to find a non-clinical job and you do locums as a bridge, or what have you. There are just so many options. And people want to be told what they should do.
A lot of people want to be told, "Well this is what's going to happen". And I can't tell people what's going to happen. I could just help them realize that there are other options and there are an unlimited amount of options. There are people that completely change. I forgot her name. There's that one doctor who decided she was wanting to sell cars instead of being an OB-GYN. She makes more doing that because she loves cars. You have to figure out what's right for you and what's right for your family and not get pigeonholed into "This is all there is".
John: Well, I hadn't heard that one. That one sounds pretty interesting. I know a lot of docs have gone into real estate and left medicine. I know one who became a disability insurance broker and she's doing very well. But yeah, pretty much we can do anything. I kind of liked that. That maybe physicians will go into something related to healthcare, but they don't have to, of course.
One of the ways I like to look at this sometimes when I'm talking to someone who's helping others is to turn it around and kind of look at it from, "Okay, what are the three mistakes or blunders?" And you may have touched on it in talking about the people that you've helped, but are there trends in terms of the big mistakes, if everyone could just deal with this and just know not to do this would help with their career transition or not even transition, but improvement?
Dr. Andrew Tisser: Sure. I think the big one is to not just assume that you're just screwed. For lack of a better term. I hear a lot of physicians that are like, "Well, I hate my specialty but this is just how it is. And this is what I picked. It's just my life and it sucks. But I have these financial obligations and I have to make X amount of money. Or this is just how the administration is everywhere or they won't be willing to work something out with me where I cannot work on Fridays and exchange for longer days".
People don't even try. And you never know until you ask. A big one is just remaining stuck, and remaining in your position where you just feel like there's no hope. I heard it a lot also, "You're too young to be burnt out", which is a really kind of annoyance to me because I hear it all the time. I used to hear that at every stage.
When I was a medical student, they're like, "Well wait till you get on the wards, then it will be better". And then you get on the wards and they're like, "Oh, well, you don't have any real responsibility. Wait until you are an actual resident, that will be better". And then in residency they're like, "Oh, it's residency. It's supposed to be terrible. Wait until you're out there and then it'll get better".
And then you get out and a lot of people have this existential moment where they get out of residency and they're attending and they don't like it. And they're like, "Oh my God, I got to do this for 50 years. What now?" And then it's like, "Oh, you're just a first-year attending. So, it's really hard. It'll get better". And it just goes on and on and on and on, or maybe it won't get better and you have to change your current situation because it doesn't fit with who you are as a person, or it's disparate to your core values or your belief system. So, maybe it won't.
John: I can't really think of too many other professions where it's just that awful. It just doesn't make sense. How could there be any kind of longevity in this business when medical school residency and practice for many people are something that you just despise? You think that it's just the way it is and you can do it, but you can only survive that for so long. So, it's just sad.
Dr. Andrew Tisser: It is sad. And you see it all the time from, again, your supposed superiors that are just like, "Oh, well". I don't understand that either. I think the lawyers are also kind of miserable, so they have it with us too. I was talking to my brother-in-law who was miserable at his corporate attorney job. And we did some of this stuff too. And he actually got a new job as an in-house counsel at a food company. And he's super happy now.
The first big issue is remaining stock. Number two is saying you're too young and you get burnt out and just grin and bear it. Because I hate that. The next thing I see with people is that there's only a couple of other things I can do, and I don't like any of them. And they tend to be the big three of utilization, pharma, and medical writing. They tend to be the ones that people say, "Oh, that's the only nonclinical career I can do". Well, have you listened to John Jurica's podcast? There are a lot more. But people get stuck in, and then you see these threads on Facebook groups with somebody posting a utilization job. And there are like 5,000 replies in 30 seconds.
John: That's true. People don't know what they don't know. And people have said to me, listeners and others, "Why don't they teach us this in med school? Why don't they tell us about these nonclinical careers in residency?" It's like, well, I don't expect them to do that. Number one, there's no time to add that to the curriculum. The curriculums are already packed with more than you can possibly learn. So, they're not going to even carve out an hour just to explain that to you, unless it's something on a weekend when you do it on your own. So, that's not going to happen.
But it is unfortunate that if you don't know those exist, then you feel fairly hopeless. And so, it's people like you and me and others. That's just part of the whole process, just opening their eyes, the fact that there are lots of options. And if we were really scientific about it, we might sit down and do some personality tests and checklists and try and figure out what fits with your personality and your desires, your mission in life, and all that. But I don't know too many people that have gone through that kind of a process. Basically, it's a matter of just starting to do your research, starting to dig and learn and getting a coach or a strategist or consultant or someone to help you if you need it. Just find out what's out there, take control of your life and then see what you can work out.
Dr. Andrew Tisser: Yeah. Careers should be designed in my opinion. A lot of people just let their career or their job happen to them instead of going out there proactively and designing a career. I'm happy where I am right now, but it could be even better. And that's a process. But I know my trajectory and my clients know their trajectory. And even if after 8, 12 weeks of working together they're not in their dream job, they've moved so far along that they know where they're going.
And don't get me wrong. I want people to stay in clinical medicine because I want somebody to take care of us, take care of me when I'm older. I don't want all the doctors to leave. And that's possible too, to stay and just restructure, like I did.
John: That's a good point too, about planning your career. Because I'll tell you, when I was working as chief medical officer, of course, I got to be exposed to a lot of nonphysician CFOs and CEOs and COOs. Many of them had a plan. They really knew when they were just coming on as a director of some small department, that they wanted to move up to the next directorship and then they wanted to be a VP, and then they wanted to do this and they wanted to do that. And it was a lot more planned out.
I guess when you compare it to clinical while we plan to go to med school and then pick a residency, maybe a fellowship, that's basically as far as it goes, I think. And it should continue as you're saying.
Dr. Andrew Tisser: Yeah, I agree. Especially when we are talking about the administrative pathway too. I know many people encourage others to join committees. But you just can't just join a bunch of committees and expect something to happen. You want to target committees that you have an interest in so that you can potentially chair. There is a pathway instead of just letting things happen. I recently gave a lecture at my wife's residency, she's a program director for internal medicine, about career design.
And I had a resident come up after the talk. She was like "Thank you because I just assumed that this was the path that I was on and I didn't really have any choices. And now it's given me so much to think about". And she was I believe either a first- or second-year resident. And I was like, yeah, start thinking about this stuff now so that your first job could be planned very well. And not just like, hey, give me the biggest sign-on bonus or something.
John: Yeah. Oh, man. I think they are probably just so happy to have their eyes opened by hearing what you had to say. All right. We're going to run out of time here. I want to talk a little bit about some other things just for a minute.
Now you've been doing a podcast for quite a while. And so, I know it started out initially with more talking about communication, and that sort of thing. What is the theme of your podcast for the last 6 to 12 months or so?
Dr. Andrew Tisser: Yes. We've shifted into just issues relating to the early career physician in general. The communication topic was great. And we had a lot of really interesting speakers from all different disciplines, but it got kind of stale just because everybody is saying the same thing. Everybody's part of the team. Everybody has a voice. And I agree with all that. It was a great first season, but then as my interests have changed and I realized that my demographic has certain other challenges I moved into just talking about everything and anything that could be related to the early career physician.
John: Okay. That's good. The thing we're talking about today, if people are interested, they should just go to Talk2MeDoc podcast and listen in on those. And mostly it's interviews. Is that right?
Dr. Andrew Tisser: Yeah. A couple of solo shows, but the vast majority are interviews.
John: Okay. And then you've got a website that probably links to that as well as other things that you do at andrewtisserdo.com. Correct?
Dr. Andrew Tisser: You got it. Everything's there.
John: All right. I will definitely put links to those two for sure. And if the listeners want to learn a little bit more about either what you do or get a little more advice from you, just an entry-level, I think you have some kind of video series. Tell us about that.
Dr. Andrew Tisser: Yeah, thanks. I have a four-part video series on my website. It's andrewtisserdo.com/video or there are links all over the site you'll find it, which really describes my pathway through burnout, where I am today, starting from medical school. Each video is about six, seven minutes long. It's just talking about what I went through and then I give a career strategy tip embedded into each video, and it's totally free.
John: Okay, awesome. I will put a link to that directly too, in case someone just wants to take a look at that. Well, before I let you go, any last advice for physicians who are feeling just frustrated and burnt out right now that might sum up a little bit of what we talked about today?
Dr. Andrew Tisser: Yeah, thanks. Just realizing you have options. The options are unlimited for what you want to do, what you want your career to look like. You just have to figure out what it is you want, and then you can go get it. The first step is figuring out who you are. The second step is what you want and the third is going and getting it. So, don't remain in your position, go change your life.
John: Excellent. Words of wisdom. I love it. And I liked the three steps. That's a little in a nutshell how to do the process. Of course, each step might take a little while, but it's a good summary.
All right, Andrew. I'm so happy we had a chance to talk today on my podcast for a change. This has been great and I hope to maybe see you again in the future.
Dr. Andrew Tisser: Yeah, John, thanks again so much. I'm honored.
John: All right. Best of luck. And I'll see you down the road.
Dr. Andrew Tisser: Bye-bye.
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