How to Find Work Life Harmony in Your Beloved Profession

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Transcription PNC Podcast Episode 417

How to Find Work Life Harmony in Your Beloved Profession

with Dr. Anne Hirsch

John: Today's guest has had a long career as an internist and recently, relatively recently, she transitioned out of practice and into physician coaching. It's been a while since I've interviewed a physician coach and I thought it would be interesting to get her perspective on the coaching itself and you know, things have changed recently in terms of how physicians are dealing with the current, you know, situation in healthcare and burnout and so forth. So, with that, Dr. Anne Hirsch, welcome to the PNC podcast.

Dr. Anne Hirsch: Thank you so much for having me. I really feel honored and humbled to be asked to be a guest on your podcast.

John: Well, I think it's going to be fun to talk because I kind of trying to do a little research on you and, you know, look at things on LinkedIn and so forth. There's a lot of interesting things. That's why I want to get you on here. But not the least of which is just this fact that, okay, so like many physicians, we reach a point where, okay, we put in 30 years or more of practice and we're not going to do this forever. I mean, I know one surgeon that's like 80 and still practicing, but that's not me. And, you know, but then again, we don't want to just do nothing. We want to use some of those skills we've developed, maybe add new ones. And so since you transitioned into coaching, I thought it was a perfect thing to talk about. So let's start with you just talking about your medical background, your training and your previous practice. And then from there, we'll get into what you're doing now.

Dr. Anne Hirsch: So thanks, I actually got my MD degree at the University of Kansas and came out to Oregon, Portland, Oregon for my internship and residency at Oregon Health Sciences University in internal medicine. And I was in practice in a private practice for 32 and a half years before retiring in December of 2024. Since then, I decided that I wanted to utilize my skills in a way that would allow me to still help people, but just differently from helping patients, which I have to say, I loved every minute of my practice. Well, that may not be true, actually. I didn't like the administrative stuff, but I liked everything else. I love seeing patients, helping them, diagnosing them, being there for them, being empathetic. But now I feel like I'm doing that by helping coach physicians who are dealing with all of the pain points and struggles in medicine that they're all suffering from, burnout being a huge one of those. But we talk about anything in coaching. It could be perfectionism or not able to close charts because of perfectionism or imposter syndrome or all the things that we deal with. So it's been a really nice segue for me and my practice to be able to use my skills in a way that really helps individual physicians to deal with all the struggles.

John: So now for the last five or 10 years of your practice, you still really enjoyed it and felt like you could really engage with your patients, notwithstanding maybe some time pressure, but you still enjoyed it a lot?

Dr. Anne Hirsch: I really did. I enjoyed every minute of it, literally, other than the administrator stuff. In fact, it was a little bit hard to step away from that, but I realized that it was the right time for me. I wanted to go out on a high note as opposed to being burned out and frustrated. And I wasn't at that point. So I thought this is a good time to go and make a change.

John: You were in a pretty good practice, right? I think, I don't know, 20, 30 physicians from what I understand and the multiple kind of specialties. It wasn't a huge multi-specialty clinic, but just tell me about that a little bit. Cause I think maybe that helped, you know, make it a better environment than being like in a two or three person group.

Dr. Anne Hirsch: For sure, I agree with that. I worked at Broadway Medical Clinic in Northeast Portland, which is a group of about 10 internists, about eight pediatricians. I think we had four or five behavioral health people. We have a couple of APPs who work with us. And I think that the small atmosphere, I mean, that's small-ish, really allowed us to feel like a home. And the building is kind of an old home. And so we've built onto that. But it kind of started that whole feeling of it being a home. And of course, we're now a medical home. But there's just that feeling when you have a small-ish practice that everybody knows everybody else and gets along and that teamwork is really important. So it was a great setting to practice medicine.

John: That does sound like, you know, I obviously still meet people that do enjoy medicine and they maybe have certain skills that they're better with people, better with time management and so forth. But, you know, a lot of us are like, oh, I got to do something else. So why did you choose the coaching? You mentioned a little bit about that. But I mean, there are other things you could have done. So tell me why you chose that and what you've, how you found it to be since you've been doing it now for, I think several years. Cause I think you were starting that well before you retired and just go from there.

Dr. Anne Hirsch: Yeah, that's correct. I started, I got my certification for coaching in 2022. So I've been doing it kind of on the side, but you know, hard to do when you have a full-time medical practice. My interest in coaching started in kind of a strange way. I am the chair of the peer review committee at our local hospital. And I thought, you know, if I'm going to deal with the disciplinary side of medicine, maybe I should deal with the wellness side of medicine as well. And so we had some initiatives at our hospital where they brought in coaching and to a person, every single doctor who did the one-on-one coaching sessions with another physician coach said that they loved that the most. And there was this immediate feeling of, "I've got to be a coach." And so I immediately sought out certification for coaching and started doing it. And it has been probably one of the most rewarding things I've done because I know when I help a single physician, I'm helping all of their patients as well. And hopefully, hopefully keeping them in a career that they can begin to love again.

John: You know, the way I look at it, coaching is like, especially for a burned out physicians who are becoming coaches, not in your case, but it has all the good things of being a physician without the negative. You're not on call. You don't do long hours and squeeze in 20, 30 patients. And you just, get to help your clients like you do as a physician. Very similar, but obviously needs a certain set of skills that I don't think that many physicians really have.

Dr. Anne Hirsch: Yeah, I think that's true. And it's interesting because I think, as you know, physicians tend to be reluctant to reach out to mental health therapists when they are struggling, but there's less stigma reaching out to a coach. And I think that for good or bad, I think I've been able to help people as a result of that. And so I think what you're saying is absolutely true.

John: Now are the issues that most of your clients come with to you, what do they entail? Because I'm always thinking, well, it's going to be burnout, moral injury or something like that. But I mean, there's obviously hundreds of issues that can come to you with. So what have you found that they need the most help with?

Dr. Anne Hirsch: I agree with you. Burnout and moral injury are probably the most important. Because of my peer review background, I really like working with physicians who've gone through the peer review process at their hospital or clinic and have been, unfortunately, sometimes mandated to work with a coach because of behavioral issues. Not knowing how to communicate well with nurses or other hospital staff, being inappropriate or rude or gruff, especially when tensions are high in the operating room and the patient's crumping and you got to do something quickly. That's when our worst comes out of us. And just helping people to kind of see that and be able to reframe that and to be able to do some role playing with, you know, situations maybe that happened where they responded a certain way and maybe they should have responded a different way. It's so much easier to look at it from the outside. In fact, I know people can see my faults from the outside much easier than I can see my own. So it's much easier as a coach to be able to see where people maybe need some help. And so that's where I've really been able to focus. But we do burn out, moral injury. I have a person who just hated getting up to go to work every day, you know, you name it.

John: Yeah, you know something's wrong when you dread getting up and going to work. It's not how life has to be, obviously. Although many of us put up with that for years and years. And you're right, there's not only reluctance for coaching or therapy for sure, but I think coaching, even that, there's a barrier to many people. But once they've tried it, it's like, oh, that's really helpful. I never had a coach for years and years until I became a CMO and you know, our CEO was had a coach and then he brought the coach in so all the team could use his coach. And they're just having that feedback, the things that bounce off of that coach. And it's not like the coaches say, well, you need to do this A, B and C it's, you know, the way you interact and try and get them to have their own "aha" moments. I suppose is what I've been told by other coaches.

Dr. Anne Hirsch: Exactly. We try not to give advice. In fact, sometimes it's really hard not to, but you know, think what they should do, but you know, you don't know their life. They know the best. And so what you try to do is ask probing questions that really get to the why and why is that and why is that and why is that. And then hopefully you can help them see kind of they've got the answers. They just sometimes need help getting to them. So yeah, it's, definitely not giving advice much as we want to sometimes.

John: It sounds like a root cause analysis right there. Getting to the why behind the why behind the why.

Dr. Anne Hirsch: Absolutely.

John: Now as I was going through your website, you know, and LinkedIn and so forth, I saw some things that you wrote about, just it seemed like there were things that were interesting to you. And one of those was like "work, life, harmony". You talked about the harmony between, you know, I guess you're saying your non work life and your work life. I mean, so I did have a specific question for you. Are there certain rules or secrets or tips or tricks to achieve that if you feel like things are really lopsided in the middle of your career?

Dr. Anne Hirsch: The short answer to that is there's no one-size-fits-all by any means. But there are a few basic things that people can utilize to help in that regard. And again, I kind of take people from where they are because not everybody starts in the same place in that regard. But I think the first one is boundaries. It's really hard to not only put up boundaries, but then to maintain them. And I certainly am a victim of that myself. I'll put up a boundary and then I'm the one who says, oh, well, we'll just put that patient in anyway. But recognizing that our boundaries are non-negotiable and saying no is a complete sentence. And we don't have to explain why we're saying no. We just need to say, no, this isn't right for me. The other is having self-worth beyond just being a physician, which honestly is something that people struggle with a lot as they go through the pre retirement phase and into retirement. And I've certainly been struggling with, how am I going to be relevant and how am I going to do something that still gives me an identity as a physician, but doesn't make me feel worthless or like a wimp for, you know, leaving medicine. Time management, I think not only with just, you know, approaching your schedule on a daily basis, but also kind of making sure that you schedule things that are important to you kind of ahead of time so that other things don't creep in. Because as you know, things take as much time as we allow them to take. And if you allow two hours for something, it's going to take you at least two hours. But if you allow an hour, you'll probably get it completed in an hour. And I think important things like date nights and time with your kids and your kids' plays or games or whatever is so important. And also self-care time, which I think we tend to forget. And we think, oh, that means going to the spa and getting a massage. But it doesn't. It means whatever it is that kind of helps to re-charge us and re-energize us and fills our cup. So I think all those can be helpful. I think connecting to community, a lot of hospitals, especially at ours, the doctor's lounge used to be kind of a great place where we all kind of congregated and talked to each other. And there was a sense of camaraderie. And I think with the pandemic, a lot of that went away. And I think a lot of hospitals, certainly ours, is starting to see more of that. Now there's food in the doctor's lounge, so of course everybody congregates there. But I think that connection is so important. And I think that's where group coaching can be so helpful, is to understand you're not alone. You're not the only one going through this. And then I think the other thing is just understanding your why, as we talked about before, the why underneath the why. Really understanding what it is that's important to you and making sure that your current clinical situation fits with your values, because sometimes it's really easy to get far from that and realize you're doing something that does not fit with your values at all and you need to make a change. And I think that's when, that's especially where coaching can help, because we can help people see that and help them get to that clarity.

John: The other thing I saw in some of the things you've written and put on your website and so forth is mastering communications. Now, I think you even were like maybe teaching a little bit about that or you had some kind of course or something, but tell me what, like, what is your interest in communication? Why do you think that is important in terms of just, you know, functioning better and having a more balanced lifestyle?

Dr. Anne Hirsch: I think it's so important and I kind of realized this in my peer review work that the majority of the complaints in the hospital were related to communication. And recognizing that it's only 7% of what we say that actually matters, the other 93% of our communication has to do with our body language and our tone. And that's where sometimes a coach can help because sometimes it's not the words, it's the way it's said or the demeanor of the person. And so I think mastering that can make the difference between preserving a person's career or them leaving medicine altogether. I think it also can reduce patient errors. I know I've seen physicians who have been a little bit scritchy with nurses and if they've had a bad interaction one time, that nurse is not likely to call that doctor at two in the morning for an order that probably is more important than just Tylenol because they recognize that, "oh, I don't really want to have that conversation with this doctor because they were kind of mean to me the last time." And so they tend to not reach out and maybe they should and then patient care will suffer. So I think that's a really important aspect of it. I think leadership. Doctors sometimes don't think of themselves as leaders, but recognizing that just by having the letters MD or DO after your name, you are a leader. And you have to recognize that in your communication style and recognize you're the leader of that team. And so it's important to be able to communicate with that team and utilize everyone to the top of their license. I think it also helps prevent burnout because when you have good communication, there's not misunderstandings and resentment and the exhaustion that can go along with so many of the things we deal with in medicine. So I found that to be true. And then from a patient perspective, obviously patients that feel heard are more likely to adhere to the treatment regimen that you've outlined for them. And there's so many people that feel like the doctor just rushed through, they only had 10 minutes and they spent three minutes in the room with me and they didn't listen and they feel very unheard. And sometimes just hearing them and understanding and saying, "I get it, I hear you, and we're gonna figure out how we're gonna approach this situation" can make all the difference. So really it's on multiple levels that communication is so important.

John: No, that's for sure. I'm just thinking my own situation. Well, there's so many things that you said that triggered thoughts. You know, we used to do root cause analyses, you know, because something would happen to a patient. And there were quite a few times when the issue was that very one that you mentioned that the nurses would not communicate with the physician because the physician had previously chastised them or even was just angry on the phone for actually no good reason. They were just calling with information that was important and they needed and yet they're taking it out on their nurse because they're tired or they're overworked or what have you. It is really a patient safety issue at the end of the day. So definitely work on communication. Important. So how do you deal though with the issue? It seems like as a physician, we're going to say, it's all well and good, but I don't really have time to sit there for 20 minutes and explain things in a nice, quiet, slow way that they're going to understand. Any more ideas for how to overcome that? Or maybe you can get it all down into a three-minute conversation if you do it the right way.

Dr. Anne Hirsch: I think the latter is actually true. You don't have to explain every single thought process that you're going through, but I do think it's important to make sure that the people working with the patient directly at the bedside understand what your thinking is. There was recently a case in our peer review where a physician was thought to be not kind of dismissive and not paying attention to what the nurse's concerns were. And in actuality, when he explained what he was doing and what he was thinking, the reason he didn't intubate the patient, he was fearful that giving them medication to intubate them would cause hypotension and they were already hypotensive. So there was a totally good rationale for them doing what they did, but they didn't communicate that with the nurses and he got written up as a result of that because they felt he was being dismissive of their concerns. It wouldn't have taken him very long to say, "hey, this person's hypertensive, it's really not safe to intubate right now. We need to wait till the blood comes from the blood bank to get this patient tanked up before we try to do anything further." And that would have taken all of 30 seconds. So it's something that definitely can be done, I think, in less than 20 minutes.

John: Well, let's take a pause here for a minute so we can make sure we know where we can find you because sometimes not everyone listens to the very end where we put these things. So you definitely have a site where they can reach out to you. So I've got that as PhysicianCoachingWithAnne.com.

Dr. Anne Hirsch: Yeah, that's Ann with an E.

John: Ann with an E. And so tell us what they'll find there.

Dr. Anne Hirsch: That's just my basic website that has some of the information about me and what I do. It's actually somewhat old and so I probably need to update it, but it's all still relevant. There is a way to contact me there and there's some frequently asked questions and a coaching contract and all the legal stuff there as well.

John: I thought it was a very good website. It was very clear and definitely there's a contact form there to get ahold of you. Oh, I was going to comment on the fact, as I'm listening to you speak here, you know, in current medicine, it's very common for physicians to only have an outpatient, you know, practice or some maybe just an inpatient. So it sounds to me like you've done. You're doing a lot in the hospital and you also have an out, you still have the traditional kind of doing both.

Dr. Anne Hirsch: Yes, absolutely. You know, I know of a physician who I think he probably went through five MAs because of his communication with his MA, you know, yelling at them in the halls in front of patients with an earshot. Not okay. And when your MA is crying at the end of the day, again, not okay. I think he went through five of them before the clinic finally said, okay, we need to do something about this. Maybe you're the problem and not the MA because doctors tend to want to brush that aside and say, it was the team, was so-and-so didn't do whatever, and recognizing that. So I work with both, certainly people who work in a more clinical setting, in a clinic setting, and more in a hospital setting as well. We do both.

John: I think it's helpful because I think people can have the misconception, well, I work strictly in the hospital, so I have to make sure that this coach understands that, which they can easily do. Do you do like short 15 minute introductory kind of conversation for people interested in getting coaching.

Dr. Anne Hirsch: I do. It's usually more like 30 minutes and honestly sometimes it stretches to 60 because we get busy talking and we really commiserate and it's important to develop rapport and see if maybe I'm not the right person for that person. And it's important for them to understand my personality and for me to understand theirs because if I think somebody might do a better job for them or be a specialist in a certain area, I will refer them to someone else. I really want to make sure that they get the best for the time and money and effort they're putting into this, that they get the best outcome.

John: Yeah, it was interesting too that you're doing something else. I think it's not a big part of your coaching per se, but it's I think instructive to see that once you start doing something like you're doing now, you also have another real minor part-time issue where you use those skills doing other things. So maybe you can just explain that because I think physicians are worried about, "well, what am I going to do when I retire from practice? And are there really going to be opportunities for me?"

Dr. Anne Hirsch: There really are so many things you can do. What I chose to do is I'm working with a group called "Healthy Practices", which is a company in Portland that basically helps medical practices stay, survive. So whatever issues come up, whether it be front desk things, revenue cycle issues, personnel issues, they maybe want to open an ASC or another clinic, close down a clinic, dissolve a partnership, you know, whatever it is, they help. And I am their medical director and a consultant for them. And one of the things that we've done is we've created something called "Code Mastery", which is a program where we educate physicians to make sure that they're maximizing their coding so that they get paid for the work that they've already done without having to see more patients or spend more time or do more documentation. Just make sure the right documentation is there. And what I've noticed from that is not only is there a huge financial benefit for the physician and clinic, but the esprit de corps and confidence and feeling valued for the work they do makes all the difference. And that's kind of what keeps me going doing that because coding, let's face it, it's not very sexy. But when you see that improvement in people's confidence and feeling valued for the work that they do, it drives me to want to do more of that. So that's been really a fun part of my post-retirement practice as well.

John: It's basically a business base. It's like helping businesses succeed and particularly physician businesses. Are you basically the main clinician that is there to support that type of, I guess, consulting?

Dr. Anne Hirsch: I'm it. Everyone else there is typically a former clinic administrator, hospital administrator. You know, we have all kinds of specialists that do legal things and onboarding, you know, contract renewal, all that kind of stuff. So I am the physician. And so I actually can go into clinics and help them when they're dealing with. Maybe issues between administration and physicians where sometimes they don't get along and they don't know how to communicate. We all want the same thing. We just go about it in a different manner.

John: I think it'd be nice to be in that kind of a business as the only physician, you know, it's not like there's three or four others they have to pick from if they have a case come up or something. So, yeah, that sounds like it can be a lot of fun and not take that much time. Well, let's go back to the coaching for one minute. So what about physicians who might be thinking of becoming a coach, any advice for them in terms of how to know if you might like it or you know, what are the things that you get beyond, you know, out of it beyond what we've already spoken about? Just do you think it's something that physicians should consider if they, you know, had a really successful career? Maybe you can share that information with others who are struggling.

Dr. Anne Hirsch: I do think that's the case. You know, when I first thought about doing coaching, I thought, well, who the heck would pay me to do coaching? What do I know? And then I had some friends who said, you've been in medical practice for 32 and a half years. You know a lot. And I have been through a lot of things in my career, especially with the peer review stuff. The first thing is to not question yourself and recognize you probably do have the skills. It's just a little bit of honing them and getting the certification. I think the first step for somebody who thinks they might be interested is get a coach. Talk to a coach and kind of get a sense as to what they do because I think that'll give everybody a sense as to "could I be this other person on the other side and they can help you through the steps". There are many different certification programs, some more geared towards physicians, which is what I did, and some that are less geared towards physicians, but you can get a lot of experience. I know we practiced on each other, you know, and it was all physicians in the room, so we got to practice on each other. And I think that'll give you a sense as to whether you're really interested in it, but start with a coach. Honestly, that's the best way to go.

John: Yeah, I mean, particularly like if you're just struggling to figure out what you want to do, a coach can help you sort it down and maybe they'll come up with, well, maybe you just want to be a coach like I am. But yeah, I think physicians again, maybe I said this earlier, they kind of notorious for avoiding, you know, coaching, even though in the business world, it's been used for years and years and most, you know, big CEOs of big companies have been doing coaching or receiving coaching for years. So it's definitely been proven to be of benefit. It seems to accelerate whatever you're trying to get done, you know, whether it's in medicine or some other business. I know the question I was going to ask you, I'm curious about in Oregon. Is the issue with the state level peer review, is that a thing, you know, disruptive physician and getting reported and sometimes a data bank, which is a national thing. I'm just curious in Oregon how things are and whether, again, they could use somebody like you if some, you know, try and catch them before it gets to that point.

Dr. Anne Hirsch: For sure. Yes. The Oregon Medical Board tends to want to know everything that happens. And so they really want us to report every little thing. And they do a lot of investigations. Thankfully, the majority of them they close. There are times through the peer review process that we do have to report people to the OMB and to the National Practitioner Data Bank. We hate doing that and we always try to think really strongly to make sure that it's the appropriate thing and that it really is protecting patients if this physician goes on to another state or whatever. But we try to have it be as little punitive potential as possible. We really want it to be more of an educational, like how can we help preserve your career as opposed to you're a bad doctor and you need to go do X, Y, Z.

John: If someone in your state does end up getting, you know, sanctioned in some way, maybe temporarily, do they usually make it back to practice in general and your experience?

Dr. Anne Hirsch: Yes, they send out, our Oregon Medical Board sends out a quarterly newsletter, so we kind of know what's happening with our colleagues. And I would say it's very rare for them to actually pull someone's license. It's happened for sure, but it's very rare. Many times there's a bit of a, maybe a one or two year lapse where they'll say, "okay, you need to not practice until we're able to fully investigate this". But I would say the majority of people, get sanctioned, they get education, help however they need it, and they're able to go back to their medical practice.

John: Okay. Because there are some states, and I've heard horror stories where, I mean, once they were reported and they were forced to do something and they were told they had to retake a residency or they had to go to some, you know, remediation for a year and they never made it back to practice. And so that can be a real terrible story, but it sounds like things are, you know, pretty good shape in Oregon. If you've got people like you that can help, that helps a lot. Basically, we're kind of near the end. Let me ask you this. You have a LinkedIn profile and you also have, I think, a way to contact you on the website, which even like, I think an email they could contact. Do you have a preference? Some people like to reach out on LinkedIn. Does it matter if it's there or on your, like your website email?

Dr. Anne Hirsch: It doesn't make any difference. I'll get it one way or the other. My email is amhirsch@comcast.net, but that, my LinkedIn profile, my website, doesn't matter. I'm happy to talk people and see if working together makes sense.

John: I will put all of that in the show notes for sure. You think this is something you really, it's something that's sustainable?

Dr. Anne Hirsch: I really do. I have to say I retired earlier for medicine than I expected to simply because I wanted to pursue this, but I could see doing this well into my seventies. It's so much fun. I mean, thankfully I'm only 29, just so you know. But it really is so much fun. And when you see the difference that you can make and the preservation of someone's career or help them to make the decision to leave the career, you know, whatever it might be, it just, gives you a warm fuzzy feeling that's very different from what you get with taking care of a patient, but very similar in many ways. And so, yeah, I do think it's a very sustainable post medical career practice.

John: Well, we're going to say goodbye in a second here. Again it's physiciancoachingwithanne.com. Anne Hirsch, Dr. Anne Hirsch, who is a very experienced clinician, who also is now an experienced coach, and they can find you at that site. And I just want to thank you again for being here today. I think I've learned a lot and I think it's been very interesting for our listeners. So I appreciate it.

Dr. Anne Hirsch: Thank you so much for asking me. And I think what you're doing with this podcast is amazing. So it really is helping a lot of physicians who might be thinking about what their next step is and what they want to do after retirement. So I appreciate you doing the podcast. Thank you for having me.

John: It's been my pleasure to talk to you and to continue doing the podcast, at least for now.

Dr. Anne Hirsch: Thank you.

John: All right, then I'll be done. Bye bye.

Dr. Anne Hirsch: Bye.

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