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Hey guys, this is Dr. Mike Wuang. Welcome to another edition of Bootstrap MD, the podcast for physician and healthcare entrepreneurs. We just wrapped up PIMD con just a few days ago and I'm still thinking about one moment from the conference that really hit me harder than anything else.

My name is Dr. Mike Mumang. I'm a physician entrepreneur. Been doing this for over two decades.

Yeah, I do apologize beforehand a little bit under the weather here. It was just amazing. We had our PMD con. We had our mastermind retreat as soon after that.

Just amazing insights. Got to meet some amazing new people and reconnect with some of my old friends. And I want to set the stage for this demonstration that my partner Peter Kim did who was the founder of PMDCon. And he brought out a glass jar, some rocks, pebbles, and sand.

And he watched him fill that jar in a way that made everybody in the room go quiet. And I still think it was one of the most effective things that occurred at the entire conference. So if you missed it at all, I'll give you kind of the playbyplay because people are still talking about it. Here's the thing.

This simple demonstration might explain why so many of us are finishing another 50 to 60 plus hour work week and we feel like we still didn't get anything accomplished that actually mattered. So, you know, why do we chart until midnight and but we can't remember the last real conversation we had with our spouse? Why do we ace every quality metric but it feels like we're just failing at life?

So, I want to share with you what Peter showed us at PMCON and why it matters for all of us, every single one of us who are trying to build a life in medicine that doesn't consume us. So, go ahead, you know, get your favorite drink. Let's sell that pager. I still know why we use pagers and let's talk about rocks.

Okay, ready? Let's get started. So, at PM and Decon, we talk about lots of different issues about building your own dream practice, your dream career, physician burnout, building sustainable careers. And then for his keynote, Peter decided to do this demonstration.

He brings out a glass jar, empty, clear, and simple. Then he pulls out these fistsized rocks, maybe seven or eight of them, and he starts placing them in the jar one by one. They settle to the bottom, you know, with a satisfying thumb. When he can't fit anymore, he holds up the jar to the audience.

Is the jar full? A few people nod. Yeah, it looks pretty full. Then he puts in smaller rocks, pebbles, smaller stones, maybe the size of marbles.

He starts pouring them in the jar. Now, as they're cascading down, they're filling in the crevices, the spaces between the big rocks. And a gentle shakes, and he's able to put in more pebbles in now. Is it full?

I think people are starting to catch on. He smiles, maybe some head shakes. Next, he's pouring into the sand. He's pouring it and he's filling all the gaps, all the tiny spaces between the rocks and the petals till the jar looks completely packed.

No. Before anybody can answer, he pulls out a small thermos of water and pours it in. The sand absorbs it. The jar is truly full now.

The room is completely silent at this point because we all know where this is going. He sets that in the jar and asks the question, "So, what happens if I put the sand in first?" And we all kind of knew what the answer was cuz we were all living the answer. If you put in the sand first, the big rocks don't fit. And so basically it just tells us that the life is that jar.

It's what are you putting in first and we're looking in the room and they're physicians. They built successful practices. They work for big hospitals. They're hitting every metric.

They're trying to to do whatever they can to look great on paper. But and I I saw in everybody's face, we're filling our jars with sand first. So I started thinking about my own jar. What are my big rocks?

Well, the big rocks are the things that are most important to us, the things that we need to keep uported. This isn't our health. This is time with your kids. That isn't just doing covert patrol or bedtime logistics.

It's being present with your spouse, having actual conversations, not just coordinating calendars, your health, as I mentioned, your exercise, your sleep, that physical exam that you put been putting off for 3 years. It's your friendship, those deep friendships that recharge you. That's what that matter, you know, and the calling that brought you to medicine in the first place, you know, your career. So, the smaller rocks represents things that are important, but may not be first and foremost.

Certainly, don't compare to your own health, to your family and friends. They should be getting your CMEs done or scheduling staff issues or prayer authorizations or committee meetings. Yes, they're important. Or are they more important to the big rocks?

And then what's the sand? That sand is checking your inbox for 47 times. Busy work that just filling out time, watching Netflix, doom scrolling, Facebook groups, office gossip, and so it was a very simple presentation, but it was very powerful presentation. What are you putting into your life, into that jar?

Are you prioritizing those big rocks or is the sand is the one that you're putting in first? If you put in the sand first, the small rocks and the big rocks won't fit. You start with the big rocks, you make that's your priority. The small rocks are able to fit into the crevices and then yeah, maybe you can have some sand in there.

So, I learned this lesson early on. You know, when I left medicine at the age of 34, I was off of medicine for about seven years. I made a decision that not a lot of people would do. I said, when I'm going to leave medicine and I've got my work with my different businesses, I want to prioritize picking up my kid.

I got two kids. They're now adults now, but my eldest son, cuz he got home from school at 2 p.m., and I wanted to pick him up from school. And I structured my career around it. So, I worked early in the morning.

I had our meetings, but I said, "I want to focus on able to pick up my kid." Every day at around 1:30, 1:45 p.m., I'd drive and I would pick him up. And what was so cool for me at least was I was the only guy there. And I felt really lucky about it and lucky when I saw my son's face light up when I was there.

Lucky to hear what happened in his day. you know, maybe we would go and then we would spend time, maybe go to the ice cream shop. Those were times that I really cherished. So those afternoon pickups were my big rocks.

So everything else had to fit around them. Now your big rock make look completely different and that's the point. So let me share with you one of the doctors in our mastermind group. I want to make sure he has anonymity, but he had a major health scare.

He's a emergency room doctor, a little bit older than most doctors, but has a lot of vigor, has a lot of spunk, but statistically, if you know about emergency medicine, they don't have a lot of older ER doctors. They statistically have some of the shortest lifespans of medicine. So, high stress, shift work, constant chaos, and one of these times just I'm not feeling good turned out to be an aortic dissection.

Literally his life was saved from helicopter travel and that was his wakeup call and Dr. Face to face nothing but sand and small rocks for years were the priority and his body said enough. Now everything has changed. He's putting in the big rocks into that jar.

He's focused now on getting multiple licenses through tele medicine and he does locoms across multiple states. He's happier. He's healthier. He's invigorated.

These were instructors his entire career around the big rocks that matter most. Staying alive to enjoy it. His big rocks is his hell. My rig rock was picking up my kids.

At the end, it's not grinding yourself into a ground for a system that would probably replace them in a few weeks. And that's why Peter's demonstration really hit home for luck because your rig rocks are yours and you have to protect them because your body, your family, your life will wait for you to find time someday. And I know a lot of it this, oh, I'll do this when I pay off loans when I do that.

Here's the thing is that no patient ever thanked me because they answered their message at 11:00 p.m. instead of 7:00 a.m. the next morning. But my son remembered that I was there for those afternoon.

And my friend, the emergency room doctor, he's alive because he finally chose his health over the sand. So, at Peter's demonstration at PMDC Con, every physician at the room can name their big rocks. Family, health, purpose, the reasons they went into medicine. But when we looked at our calendar, it's sand.

So, why do we fill the jar with sand first? It's because we're trained to put out fires. We're trained in urgency. Every notifications feels life or death, even when it's not because we're rewarded by sand.

RVUs, productivity metrics, chart closure rates, patient satisfaction scores. The big rock, nobody really measures those. There's no dashboard for times you were present this month or quality of your marriage. And let's face this, we're people pleasers.

We're terrified of disappointing people. What if somebody needs me? What if they think I'm not dedicated? But here's what happens when you ignore the big rocks.

Burnout. Not the kind you can fix with a weekend course about resilience. The existential kind where you wake up at 3:00 a.m. wondering what the hell am I doing with my life.

Broken relationships. Kids who stop expecting you to show up. A spouse who becomes a roommate. Friendships and fame because you're always too busy.

Regret. You know, I've never met a doctor who said, "I wish I had bought prior authorizations, but I met plenty who wishes they would be there for their kids childhood, who wishes they protect what matters most." One doctor I mentioned, she says, "Great. At triaging an ER, I know exactly which patients to see first. But in my own life, I'm treating every ankle sprain like a code blue and letting the real emergency bleed out in the waiting room.

What a really crazy and powerful analogy. And that's what we do. We code the sand and our big rocks end up dying waiting. All right, going to be tired of using these medical analogies here, but let's talk treatment plan.

I'll give you one more. And that's what came out of this PM decon and the conversations that happened after Peter's demonstration. The practical stuff that actually works. So let me give you some doctor's orders.

This one's for yourself. Number one, schedule the big rocks first. Not I'm going to my kids game if I finish up my notes. No, we'll take the trip someday when things come down.

Treat your big rocks like or blot kind like a procedure you can't reschedule. put them on the calendar first. Then build everything else around. For me, it was those 2 p.m.

pickups at the school. For you, it may be family dinner every night at 6:00 p.m. or your Saturday morning long run or date night every Friday. Whatever it is, block it.

Make it red in the calendar. Make it sacred. The small rocks and sand will find their way in. They always do.

But if you don't protect the space for big rocks first, they'll never fit. Order number two. Now, let the small rocks fit around them. These are some things that can wait.

I know that might seem like blasphemy to a doctor, but it's true. That message get 7 a.m. the next morning, that committee meeting. Do you really need to be on another meeting?

The charting, can you batch a template yet? Can you get a scribe to help you with it? Sometimes good enough is just actually good enough. I pray ties I had to be there when it's done at 1:30 p.m.

so I could be there for my son at 2 o'clock. And what does mean is you have to say no to things that really don't matter. Delegation is in medicine, too. You don't generally do your own billing.

You don't clean your own exam rooms. So why are you doing everything else? In order number three, sweep out the sand. This is a big topic at Pavity Con.

Learning to identify and eliminate sand. Every yes to sand is a no to rocks. You set boundaries, turn off notifications, leave the Facebook groups that make you angry. You stop attending meetings where you contribute nothing and learn nothing.

One position of the conference, you know, sending practice time for one week every quarter categorizing activities as rocks, pebbles, or sand. I thought that was eye opening. Order number five, reassess. Life shifts.

I love it. My kid still wants me to pick him up at school at 2 p.m. He's in his late 20s now. Kids grow up, priorities evolve, your health changes, things transform, but we do still have those times where we're like, well, let's have that family vacation.

Let's have those family dinners, you know. So, sit down and ask yourself, what are the big rocks right now? Am I truly protecting them? And then order number five, check yourself.

How's your energy, your mood, your relationship, your sense of purpose? Do they feel depleted? Do you feel like you're running on fumes? Do you feel irritable and exhausted and you can't remember the last time you felt joy?

You may be overdosing on the sand. Those are your clinical indicators. Pay attention to them. To wrap up, it's one of those things that you don't forget these rock chart demonstration.

And again, it was probably the most effective moments of the entire conference because it made something that was invisible suddenly visible and we could all see what we've been doing wrong. So, I want you to try something right now. Dr. Dr.

Phil should listen to this. Write down your big rocks, your actual real top priorities, not what you think they should be. Not what looks good to paper. What you know matters most.

Every rock is different for every person. Then look at your calendar this week. Are your big rocks show up there? Are they protected or is this week just wallto-wall sand?

Yeah, I get it. I have to continually prioritize myself. But again, it was just an amazing presentation. And I don't know if I'm doing the description justice, but think about it.

I know medicine is a calling, but it's also just your career. You know what is going to matter most to you. Patients will generally be okay. The practice will survive.

You don't have to see every patient. But guess what? You might be missing your kids' childhood, your marriage, your health, your soul. Those don't get doovers.

Protect your big rocks. the people and passions that make this journey worth it. Because when your jar is full, and someday it will be, you want to look back and see that's what mattered most to you while you still had space. Not because you found time, because you made time.

You chose rocks over sand. So, I want to hear from you. What are your top three big rocks right now? I'd love to hear it.

Send me a message at bootstrapmd. Love to hear what you're sharing and what you can do to continue reanalyzing or determine one of your big rocks. Remember folks, you're going to have your ups and downs as an entrepreneur. Do something a little each day to get you closer to your goals and keep moving forward.