Entrepreneurship is an amazing avenue to build extra wealth beyond your clinical practice, but it’s not for everyone. When I left my job as a family doctor after 5 years, I would not have been successful if I was not mentally, emotionally, and financially prepared, as well as having a network surrounding me to support my “out of the box” endeavors.
We all know physician burnout is a real issue, and I’ve had to say no to mentoring many clients because it was just not the right time. That’s why it’s such as an important topic here at BootstrapMD. If you’re feeling burned out, it’s important to take action to restore your energy and happiness.
Dr. Pam Pappas is a transformational coach for doctors to help them work through the stresses of medicine into wholehearted living and leading by balancing their professional lives in an effortless way. On the episode, I opened up about my own battles with burnout in residency and how it affected me later in my career. If you suspect you may have burnout, I respectfully encourage you to listen to this important episode.
Dr. Pam Pappas Website:
Dr. Pam Pappas’ Physician Coaches Profile:
The #1 Doctor Directory for Physician Coaches, Consultants, and Mentors
Dr. Mike Woo-Ming: Hey guys, this is Dr. Mike Woo-Ming. Welcome to another edition of Bootstrap MD we’re continuing to interview the movers and shakers in the physician coaching industry. And I’m so happy to have my next guest. She is a board certified psychiatrist and integrative physician is over 35 years experience caring for patients.
Many of whom are medical doctors. She’s a multiple certified personal and executive coach and who works with physicians who are suffering. Maybe not sure that they’re there even a patient, she’s a founder to the founder and CEO of wholehearted doctoring. It’s a practice devoted to restoring humanity, clarity and compassion in medicine and in the world.
And I’m so excited to have her and I, and since I’ve gotten to know her, she’s actually has a very good sense of humor, which I really appreciate. So why don’t you welcome to the program Dr. Pam Pappas! Pam, how are you doing.
Dr. Pam Pappas MD: Oh, it’s a beautiful day in Scottsdale right now. And of course, all of us are so happy because it was up to 120 in the summer.
Dr. Mike Woo-Ming: Oh. As we talked about, I did my residency over at mail Arizona back in the nineties, and I remember. Pushing my now 24 year old in a stroller at 10 o’clock at night, because that was the only time that was seen enough to be there. And there was like me and a hundred other couples out there pushing their carts too. But it was certainly was a great time to be in Phoenix. It’s just a beautiful area.
Dr. Pam Pappas MD: Thank you. I’m so happy to be here with you today. My thank you for inviting.
Dr. Mike Woo-Ming: So let’s talk about it. As I mentioned, this podcast we have in our audience, physician entrepreneurs, many of whom want to become a coach. And they said it’s found helpful just to follow people. Who’ve already gone through the steps and gone through it. So let’s talk about your journey on how you became a physician coach. You started out in psychiatry and how did it, how did you end up being involved?
Dr. Pam Pappas MD: Well, I started out my career seeing medical students who would come to me surreptitiously even when I was a psychiatric resident.
So I have a long and storied career with assisting my colleagues. And the thing is that I ended up developing a mental health service for medical students and residents. Beginning when I was a resident, but then by the time I was done with my residency in psychiatry, I had about 25 of these people who were coming, just wanting for help during their training.
So I was approached by the chairman of psychiatry and the Dean of the medical school. This is either this was east Carolina medical schools and Pam, you can’t leave. We gotta make a job for you. And. Kindly. I said, I’m sorry, I’ll sign on. And I developed and kept running for the next 12, 13 years, this service that kept growing and growing.
So this started, way back when, but the thing. Helping my colleagues as a psychiatrist, treating patients has never not been part of what I do no matter where I went academically and academic services or geography, but I noticed that not everybody needed to be a patient, meaning a DSM diagnosed conditions.
That required medication or whatever. I was an excellent therapist and got a great deal of fulfillment in helping him move forward in that kind of way. Unraveling long-term conflicts and relationship troubles that were being revisited in their current life. But I knew there was a ton of people out in the world that were suffering.
That either they didn’t need to be done. Didn’t need to be patients or they were scared to be. Or that they thought there was going to be some kind of licensure repercussions if they did or lose prestige. So about a decade ago, I started saying, okay, I’m going to…
Gather some more trainings and coaching, and I’m going to make myself available to this more population of my colleagues.
It’s out there. I know they’re out there because I was seeing them as patients and the PA and the patients were saying, you’ve helped me a lot, but boy, I’ve got these people on my service in my hospital, and boy, they could really use you, but they’re steered in. How do I, how do we get them help?
So the coaching, I started out with a brief course that I don’t know, I guess that was about three months and it had a lot of neuro-linguistic programming and various kinds of. Attributes to it. And I learned some, but I was very aware. This was not the whole enchilada and that I needed to do some more.
So I went on and I worked with the integrative health coaching people at duke medical center. This is before the University of Arizona created its own. I got certified as an executive coach through another school and Sarasota, Florida, the the center for executive coaching. And then I noticed that you can’t separate what’s going on in the office from what’s going on internally.
Personally with the physician themselves. So I went to the college of executive coaching, which blended the two. So it’s a personal coach and an executive coaching, and these were much longer and deeper and more. And so you say variety more extensive, additional trainings. Ah, I guess my desire to make myself the most accessible and skilled in, in various ways.
Some things that I had never heard of, I didn’t even know about emotional intelligence before I went into coach and they didn’t train us in that stuff in psychiatry or anything else. And I was. Going I could have used somebody helping me with this when I was a resident or when I was an early faculty member or when I was trying to negotiate my way through some of these promotions or, tenure committees, which I have been through, all of this was just huge.
And it’s my eyes were opened. And how do you combine this? So the more I learned, the more excited I got, there’ve been some coaching trainings that I entered and then stopped because I could see that this was not the way I wanted to work with my clients. And I got more discerning along the way. It’s been an adventure.
Dr. Mike Woo-Ming: Yeah. It amazes me that, some people think this physician coaching is a recent phenomenon. You’ve been doing this for some time. If you can remember back then about when you were working with, since like residents and they would just doing it on the side, what were the issues that were, that they were discussing?
Was it much different than it is now?
Dr. Pam Pappas MD: That’s an interesting question. Back then when I started this would have been 1983 when I started the service and the term burnout was not being used so much. That was a freshly developed term, maybe in the mid to late seventies. And the people were, and it was medical students residents, and some of the faculty from other services were sneaking in.
Cause they yeah, because they heard that I was reasonably compassionate, somewhat sane, and PR approachable. So they were all levels of training. There they’re talking exhaustion, they’re talking dread to come into work, even though this is what they have worked hard to do and to become, they were feeling like they were like cogs in a machine.
All of these things, they were talking about this. Is similar to what they talk about. Now. Only people call it burnout, people call it moral injury, moral distress, and you know that the three primary criteria of burnout, the exhaustion, the loss of compassion and the feeling of inefficiency or Wilmington.
To most physicians now, based on, what in the social media and what you hear talks on it, almost every medical organization, conference meetings. So they’re used to it, but they don’t, sometimes they don’t understand that this translates to themselves. It’s not just their friends.
So the issue is. I think we’re similar, they just called it different or they didn’t recognize it in the same way as we do now.
Dr. Mike Woo-Ming: Now, it seems now hopefully that, mental health is now more out in the open when it sounds like when you were working in there, it was just. Hey, you helped them so you can fix them.
And then they come back, get back into the workplace, which I guess is not so much different than it is now, but at least now, mental health is more out in the open. Would you agree or disagree?
Dr. Pam Pappas MD: Oh, that’s another good question, Mike. First of all, I don’t regard myself as fixing anyone.
That would be one of the first things that I would talk with. The, if somebody came in as a patient I would have a chat with them about, but the idea of getting them better so they can go back out into the battle. Quote, unquote is not unlike military medicine. Oh, you’re having trouble on your surgery rotation.
You, the attending surgeon is a real schmuck and he is doing this or some, in some cases it could be a woman surgeon.
Dr. Mike Woo-Ming: They call them disruptive physicians.
Dr. Pam Pappas MD: Now that was not a term, then, they have other kinds of more colorful scripts for these people. Schmuck would be one that’s that can be said, there’s one that begins with a and ends, that I probably better not say even though I would normally use that.
So they called it something different. And in the student or the resident or the, if it was a faculty they, they would be running into how to deal with this. And most of the time in working with me, they would get. Clear about, oh, wait a minute. I can think about this in a different way. I can learn something about myself or this is not in fact, my earlier situation this is a person who’s sick.
And do I want to get out of this situation or, stay in it. The same kind of questions come up for people. Now only a lot of them don’t seem to consider that they have. About what to do, you know what, once they get aware of all the suffering that’s inside and that they actually do have some agency to make a move or to try to negotiate changes in the job that they had.
They wouldn’t have ever considered that before. Most of them have never even asked themselves what they want. As practicing physicians, they’re just, they just got their heads down and, doing crisis management, th the cartoon comes to mind, that the train’s going, and it’s got a cow catcher that pointy thing on the front, and it’s going down the tracks and things are flinging out of the way. That’s the mode that some of these people are in. And they’re just trying to make. Any which way they can.
I’m dating myself, but it reminds me like when we were in residency and we had these things that my son knows nothing about called beepers. And you’d have to take when you would hand the beeper on, or you would turn on the beeper and that’s when the fire start.
And you would work for that 24 hour or 36 hour period until you’re able to turn off the beeper handed to that your fellow resident. That’s why that kind of reminds me of, and it gets, yeah, it gets to when you’re saying they’re not even sure what they want it I think it’s a good transition to what you’re known for as an expert in is just.
Is just discussing about self-compassion about having insight into yourself. What is all that about and how does that relate to what as the culture of medicine? That’s a big, that’s a big question. And just before I get into that, I just want to. Acknowledge your creativity and what you’ve done with your career and figuring out what you wanted and what was important to you and making the shifts and the changes that you’ve made. I had admired your work and you as a person for doing what you did for many years before we ever met.
Dr. Mike Woo-Ming: Also crazy, but…
Dr. Pam Pappas MD: Yeah, it can look like that from the outside to somebody else saying what’s warming up to, or pat this. Yeah. When I decided to do more integrative training, Yeah.
The chairman of that of my department of psychiatry just happened to be the president of the APA at the time. And he thought I was fricking nuts for leaving and going and doing this, but there, but it was like this little, I don’t know that this little beacon inside of me that knew, Hey, I need to do this.
Even though it looks Looney Tunes. So you asked about. Knowing yourself and what has got the, what is the self-compassion business? Anyway if you’re in crisis mode, the last thing you’re going to do probably is ask yourself, what do I do? Because that takes additional bandwidth. You’re dealing with that beeper and it’s going in what I used to call beeper epilepticus.
Cause it kept on beeping no matter, no matter how many phone calls you answered or emergencies that you’ve you fixed you. Cause you’re supposed to fix them.
Dr. Mike Woo-Ming: To vibrate it and use it as a self massager for the neck.
Dr. Pam Pappas MD: I once got so mad. In the emergency room because the nurses kept calling me in the emergency room, even though I was in the emergency room, seeing the people that they were calling me about, I came in and I threw that beeper and I thought against the wall, but not, add anybody.
But that was how impacted I was. I was really, you talk about looking crazy. I was looking crazy and that. Is the epitome of un-self compassion. That is the epitome of somebody that is not taking in what they need in order to live. Like maybe it had been hours since I went to the bathroom or had anything to eat, but I was just pissed because I felt like they were doing things. And that I was being brutalized by the system and I was defending myself now had I had some self-awareness some self-kindness like, I would say, if you were telling me that you were going through this, I would yell at you more.
I would try to find out what you need. But that’s not how I was treating myself. So self-kindness treating yourself like you would a good friend if they were, if you could see them there, they’re rusting or they’re crying or whatever that they’re doing or their child has got something wrong and you need to help them.
And then to recognize that I’m not the only one in the world that has. Suffering. It’s a common humanity. This is a moment of suffering or this is sheer shit. You know what? There are six psychiatry patients in the ER, that all of them have something important and noisy and psychotic and needs to be dealt with.
But the nurses are calling me from the front desk, interrupting me for doing that, which they’re calling. Hurry up and do, and I don’t have any backup. So what I needed and what I didn’t know then at that particular job was how to calm myself, how to tune in how just to put my hand on my heart and just breathe for 30 seconds.
That now that would have helped, but that didn’t even cross my mind. I just come to battle and I’m throwing the beeper, of course that was really charming. And I’m sure that, that got me written up in the program. So self compassion is an attitude of self-kindness and awareness and also mindfulness of what actually is happening.
Now, those nurses were not purposefully giving me a hard time. They had a crowded ER of people that have various kinds of extremists and they needed to have things move along. Then we’re also in Eastern North Carolina and not very comfortable with people that weren’t acting like. And there was a prejudice and a stigma against that.
And so some of the things that were going on in them were being visited upon the situation, but it wasn’t them being purposely against me in, I didn’t see it. So I misinterpreted the whole thing and got aggressive back. If I had been more mindful, I would’ve seen the thing from a whole systems perspective, which I did not at the time, I just saw my own, little needs and I, which I had a right to.
But the thing is, I guess I was my, you’ve heard of mindfulness based stress reduction. I was mindless based stress production basically is what I was the exact opposite. So I was being unmindful. I was being unkind to myself and I felt like I was totally alone. I was the only one being brutalized in this particular way is true.
I was the only one on call for psychiatry that night, there’s other people having trouble.
Dr. Mike Woo-Ming: Yeah there, you definitely need to have insight, just as. When I was in primary care and we would have 40 patients who would come in that day and you have 40 different, you don’t know what you’re getting in those 40 people that are coming in.
And I would have some who are aggressive. I’ve had a few who’ve been confrontational. Those are the exceptions of the rule. And, they’re upset about something. But having insight is to almost like putting yourself in that bubble and saying, Hey, what’s going on? Yeah. What is, there’s something that is going on with you and maybe they’ve never been asked that question for that day.
Like, why are you upset? What is this? And it could’ve been something small. It could’ve been something big. We, I saw that in my residency program where, I saw, I firsthand, it felt like I was getting bullied by a second year resident America. And I was going do my OB rotation was very toxic and very, demeaning, but for me it was about, okay, what can I can control?
One of the things I can control is getting good with the nursing staff, getting good with, people who I could get to be my ally and believe me, they all had the same kind of traits. But if you’re able to have that insight, that compassion and realizing that there, they also have, are having this thing that has done to them and for them to, it’s that circle of abuse almost right?
Dr. Pam Pappas MD: Well, that’s the thing. And when you ask. The piece about medical culture. Yeah. That’s what happens because when we’re mindless based stress, productive people we don’t recognize the, we don’t have bandwidth to recognize the situation of the other person that we’re with at the time, from that larger perspective in.
Instead, it’s a very common reaction to identify with aggressors, so to speak who have done things to us in the past. And it may be unconscious. This is going on, but we end up doing it to somebody else with less power in our group. Like a resident that’s younger than us or a medical student, or God forbid the patient that’s a frequent flyer.
Or these, they’re back again and they aren’t really sick and watch it. Sometimes that person is the one that shows up with the diagnosis that puts everybody to shame. And I’ve seen this happen so many times, but we do this knee-jerk reaction of viewing out… you said toxicity Thing against other people.
And then those other people carry it forward because who are they going to? Spew it on somebody that’s lower than them. And then when they become supervising residents, oh it’s my turn. Cause I got the attendance. Or the chief resident and the attending on my case. And so that pressure mounts, and then the junior residents get it and the medical students get it, there’s the law, the frequently told story of people in the, or, and having to cut sutures off.
Would you like it too long or too short? The medical student will ask because there’s nothing you can get. Because this medical culture thing is happening.
Dr. Mike Woo-Ming: Yeah. And for me, I think what helps me was one finding a common interest. With them either, something outside of medicine.
Maria, at the time, like I, my wife was pregnant. So always asking them like, Hey, what baby stuff should I be purchasing? And just getting a, just like getting an a, on a human level. And then for me, I like to use humor as you. Hey, we’re in a really, bad situation right now, but Hey, let’s talk about how bad the food is, we’re, or something where it’s like, Hey, this is all of the gourmet food.
And just using that as a way of kind of deflecting it. It’s hard
Dr. Pam Pappas MD: to, oh, I hear I’m an American cause I hear you say deflecting, but I also hear that is connected. It is connected. You’re connecting with that other person. And you said finding a common interest. That’s not necessarily in this fray of medicine.
Dr. Mike Woo-Ming: Because for me, I like I’m, I’m talking about, this is back in the nineties and we’re reflecting. It’s I don’t need you to be my friend, but I need you. I’m here for the next two or three months. And we’re here to help these patients and I don’t need. Yes, you’re in, as you put an a and you’re here for this time of period.
And, but I can leave, I’ll be leaving in a few months. And I know that this is just a temporary part of my life that I just needed to get through. And, but, that takes insight as you said, but there are people who I know who still have PTSD from their residencies or their programs. And. It’s for me, it was always about, this is just a temporary part of my life.
Even in your own job that you’re in, you can always put your job
Dr. Pam Pappas MD: well, that’s because you had more bandwidth, you were healthy. That is, people will say in God you’re crazy. You’re doing this other kind of business thing, but actually you had some perspective. And that meant… you’re perfect for sure. I wouldn’t. I just told the story of throwing the dog on beeper, right now I’m not always like that, but that was like one of my low points right. In my life. I thought I need some help,
Dr. Mike Woo-Ming: so we want to discuss when you’re. A client or a new client. You talked about how you use any grams to evaluate them.
And maybe like you said, I have more bandwidth. How would you find, how do you use those first? What is in the agreement and how do you use that to help your
Dr. Pam Pappas MD: clients? The Enneagram is a very ancient system that looks at what are the basic. Patterns that humans do that, get them through life. And the thing is that it starts from the idea that we are spiritual beings in human form.
So let’s take a step back from when you became Dr. Mike will mean, or, Pam Pappas, here’s how we’re showing up today. We have kind of default positions of personality, behavior, emotional, mental patterns that help guide us through life, but they can get us into a jam when we bump up against somebody who’s opposite to that.
And you can get into a conflict about… now wait a minute. I’m in charge and you’re acting like you’re in charge. And so you can see how some scuffles would happen. The Enneagram is a way of understanding that and starting to get to know what is your fallback position when you’re too tired or you’re stressed.
And are there any other ways of dealing. Than that. And is there some way to see how healthy or unhealthy your seeing the world and yourself based on some of this work. And so a person can take a start with a basic online exam assessment rather, and that’s been validated quite well called the ready.
And I can start there and the person reviews the results that came and we can start a discussion. Does this ring true for you? Some cases it doesn’t at all and it could be there a little glitch with the numbers. Studying some of the closely related patterns, they can find something that, oh, now that this is more like what I’m motivated to do or why I’m doing what I’m doing, but the ideas that really, it gets them to look at their own internal makeup.
And what is the. Of well, what’s it like being on the receiving end of that? What might it be like? Oh, my wife’s always complaining that I do, XYZ now. I see why she does says that because she needs this other kind of behavior in order for her to feel like things are normal. So it’s really a starting point.
It’s not like a pigeon holing or a defined thing. But the Enneagram, another reason that I like it is that it also provides a pathway for someone to move past their patterns and get some space between what they typically do and what they spontaneously would like to do. And it can be very different.
You want to get the most creativity and Excitement in that, that you can, and or it feel like you’re living your life. And so that’s one of the things that I work with them on.
Dr. Mike Woo-Ming: We’ve so much we could talk about, the time is just going so quickly. I want to talk about your programs.
Because we discussed this, there’s a lot of coaches, they’ve got, group coaching programs and work for three months. You prefer to. One-on-one it’s fair to say. And for long periods of time, tell me why and what type of a person would work best with you.
Dr. Pam Pappas MD: Okay. So the reason why I prefer to work one-on-one is so that I can individualize the work as much as possible with what a given person needs.
That can vary depending on the level of training at their end, I have, or level of experience that they’re in. Sometimes I’ve worked with people at all ranges from freshly out of residency, and now they’re in a new primary care practice and sweating it to all the way to gee, I’m ready to retire, but I’m scared because I don’t know who I am.
And how can I survive this? So you can’t put both of those individuals in the same pot and expect them to come out with the result that they personally are looking for. So I really want to get very clear with them to start with about what it is that they want. What is the growth that they are looking for know? Decide. Okay. What’s it going to take to get them there and construct something that really I think is going to give them the best running start. I also don’t do just one off. Oh, can I just get a coaching session from you? I just need one migrant. No, we could, but that, but in the scheme of things, in the scheme of the depth of your life, that, That may be like a little dip, a toe in the water.
And I know that’s not going to be in the long run in their best interest because I’ve done both. I, myself, I’ve been coached in a shorter program and then a longer term one-on-one and I could see what happened with me in terms of the person that would be best suited to this is if they really are.
Interested in understanding themselves. I don’t know how many people have started, like on a discovery call or on a, I call them wake up calls with my private practice. Cause, but they say, I feel like I’ve really lost my soul and I’m bumbling around. And I, I don’t even know who I am anymore.
And so if there wasn’t. Find that in and tap into. What’s naturally there with, there’s plenty there, there’s more right with them. It’s wrong with them that I’m clear about that. They’re probably more resilient. I know that they’re more resilient than anybody ever said, but if they’re feeling like that, that they’re being made into a piece of machinery some way, but, and they’ve they’re having that soul.
Or wanting to connect with something that’s larger than themselves that they used to think medicine would provide then working together in a one-on-one way with me, I think is useful because there’s room for tears and all kinds of in, in what my homeopath calls will, Pam, that’s a worthy piss off.
There’s room for all that.
Dr. Mike Woo-Ming: Okay. Can you share maybe one or two success stories of who you’ve transformed?
Dr. Pam Pappas MD: I’m not the one that transforms them. They transform themselves. And that’s the thing. What I do is I think provide space for them to have their own insights and realizations that moving forward.
And sometimes that happens during the conversation. Sometimes it happens a couple of days later when they’re taking a walk with their dog or the taking a shower and they go, oh, wow. That’s what we’re talking about or why I can do this. So one would be. A woman who was an excellent family physician who also had training in obstetrics and C-sections, and she’s in a hospital system that had her on call in various ways, a lot more than any of her colleagues were.
And she’s wondering why she’s tired. Because of that, head down, just do the work kind of attitude. Yeah. That you’ve seen yourself. But what ended up in our work together is her realizing, Hey, this is crazy. I would be, she was reluctant to give up the C-sections because it gave her a certain feeling of.
Credibility validity specialists, which something, humans typically crave, but she realized she would be happier in a direct primary care practice that she owned. And she did. So by golly, that’s what she did and very happy. And there, and then there was this is a little different of a story.
A surgeon who was in a big hospital system who came because he was working all the time and it turned out that he had a history of sexual trauma himself and needed specific help with. So I helped him find a therapist that could work with him while we were doing coaching. And he ended up balancing out a whole lot of what was going on, but he said, Pam, what, if I hadn’t started with you, I would have never, ever reached out for specific help with this trauma.
So I, they talked to me about this stuff. And then we work out together, okay. So what can, what do you think can help with that? He came up with, do I need therapy? And I said that’s really a good idea. I wonder, so what makes you say that as well? I’ve thought about it and cause he was drinking and doing a whole of other things that were, he was trying to distract himself.
Like you were talking earlier, he was trying to distract himself from the. Sure. So he made huge progress in he renovated his life.
Dr. Mike Woo-Ming: That’s wonderful. Pam, this has been amazing. Get we’d love to have you on another call. We have links where you can reach her. If this sounds like someone that you would like to work with.
Again, Pam, as far as I know, you’re still taking in clients.
Dr. Pam Pappas MD: Glad to have them glad to talk with people and have a wake up call and see what their Mo I’ve been through wake-up calls of my own. So I’m having to talk to,
Dr. Mike Woo-Ming: We’re at the time of the year where it’s it’s it’s we often reflect.
So if you feel like you’re sleeping throughout the day, maybe it’s called time to call Dr. Pam for a wake-up call. Dr. Pam, thank you so much. And thank you again for everything that you’re doing out there.
Dr. Pam Pappas MD: Thank you, Mike. I appreciate it.
Dr. Mike Woo-Ming: Thanks everyone. And it’s always, don’t just, if you have these issues, don’t try to bottle it up.
Sometimes you need to speak to somebody about these issues, research fund, somebody that you connect with and keep moving forward.