EP325: What If Wiping Out Was the Key to Rising Stronger in Medicine?

Transcript
YouTube English auto-captions.

========================================================================

Hey guys, this is Dr. Michael Wing. Welcome to another edition of Bootstrap MD, the podcast for physician health care and entrepreneurs. From time to time, I love to highlight physicians who are out there in the trenches making a difference and especially those who may be going off the beaten path.

You know, there are many of us who are employed physicians, but from circumstances or something that's happened, they go towards a different direction on there. And my guest here is no exception to that. He's a former general surgeon turned healthc care executive. He's a leadership strategist and now an author who builds who brings a rare inside out perspective on modern medicine.

After more than 25 years on the front lines, including a personal mental health crisis that reshaped his understanding of purpose of resilience, he transitioned from the operating room into executive leadership. And he now serves as a president of Integress Health and Medical Group in Oklahoma City. He draws on lessons from surgery, surfing, we got to talk about that, and leading large physician organizations through constant disruption. Dr.

Dr. Elner helps physicians and healthcare leaders navigate burnout, build sustainable careers, and lead effectively in times of chaos. He's the author of a book that just came out, we're going to get into called Wipe Out, Rise Up, a practical and deeply human guide to leadership, grit, and redefining success in medicine. I want to welcome to the program Dr.

Scott Elner. Thank you for sharing your time with us today. >> Great to be here, Mike. Thanks for having me.

Thank you. We're going to talk about how much surfing you do in Oklahoma City in one moment. That's probably my most critical question. No, if you guys have a chance, you got 15 minutes.

I highly encourage you to search his TED talk. Was it one TED talk or you done a number of TED talks? >> Yeah, it was actually a TEDex talk. They're really particular about how we monitor and protect those.

It was a TEDex Mountain Avenue talk about anti-fragility and lessons learned from surgery and Grey's Anatomy. >> Yes. So, go reach out to that. I think it was very inspiring in terms of transparency.

I mean, the first minute as physicians, we're invincible. And you talked about something that happened with a patient that most physicians don't want to bring up and how it shaped you. So maybe we can discuss this. Maybe that's the best start.

Maybe we'll talk about your upbringing. I know you're a California guy or you've been in California. I'm not sure if you were from here. Talk about your path to becoming a physician.

And yeah, we'll just take it from there. >> Yeah. So I am a California guy. Grew up in a place called Calabasas, which is right outside LA.

And grew up surfing Malibu a lot. Particularly a place called Zuma Beach. So I loved the environment. I love that culture.

I was at UCLA for my undergrad and my father being an attorney, I was on this path to become an environmental lawyer. I wanted to save the planet. At 21, you have those kind of ideals and medicine wasn't really on my radar. Part of this story is in my book.

I had a pivotal moment in my life that really changed my perspective at a young age where you're just trying to figure things out. I was surfing in a very nice summer day at the beach, crowded Pacific Coast Highway was just brimming with, you know, people cruising up and down. As I was walking back from my surf session, my truck, I heard this awful screeching sound of metal, and then this presence roll up onto the back of my legs, pinning me against my truck.

I looked down, it was a man who had unfortunately been hit head-on by a car that crossed over the double yellow lines. He was in bad shape. Really bad shape. Clearly in hemorrhagic shock, which I didn't know at the time.

He had tattoos and they were fading in the sunlight, greenish tinted blood coming from his ears, traumatic brain injury. And I didn't know what to do. I just paused, kneelled down, and held his hand, which was awkwardly up, pointed up to the sky, and he was unconscious. Next thing I know, this car pulls over on the side of the road and this woman comes out very calm, composed, and she had grabbed a lifeguard's tray and intubated him right there in the middle of the highway.

Saved his life. Turns out she was a trauma surgeon. And that just seeing that, seeing how this person was able to manage the frailty of life in such a dire situation really inspired me to change course, go to medical school, and eventually I went on to become a trauma surgeon. >> Wow, that's amazing.

So, you're a trauma surgeon and where did you primarily practice? After I finished my training at UC San Diego, I went out to University of Connecticut and there's a consortium of hospitals out there. And so I practice out in the Hartford area of Connecticut, so New England, which was awesome for a California guy like me getting exposed to a way different culture plus cold winters but beautiful fall leaves.

It was a great time and I really enjoyed my experience out in New England. >> Now, you've been open about facing a mental health crisis earlier in your career. If you want to get into it or just looking back, how did that experience shape the kind of leader that you are today? >> I'll just say first off, we need to talk about mental health like we do physical health.

It's really important that we ensure that we're caring for how we view things. You know, every day brings us stressors, especially in healthcare. We deal with stressors probably more than anyone else in any other industry. And so what you're referring to, I had one of those nights where you just feel like, why am I doing this?

What's my purpose? Feeling a sense of loss, frustration, cynicism. You know, a lot of the feelings many of us have felt when we deal with burnout. And I was on call dealing with a difficult patient.

I had to go to the O for something I felt was completely preventable. But this patient did what they did. And then I get a call from my fiance right before I'm about to go to the O and says, you know, it's not working out. You don't have time for me.

And you know, it just felt like things were just crashing around me. And it's life. It's adversity. But I didn't realize that at the time.

All I could feel was just this weight. And I had real feelings of maybe I should just end it. What's the point? And fortunately, I had someone reach out to me at the right time, who cared about me, who got me excited about something totally different from what I was focusing on at that moment in that dark place, and it brought me out of it.

But knowing that there's always that potential, I've worked very hard on managing through these emotions. if they ever feel like they're creeping up. I really practice a lot of meditation and mindfulness, which has been very helpful for me. >> Yeah, I do the same every morning.

Even when I don't want to or I'm busy and I know like I'm trying to put out 10 fires, by the time 8:00 turns around and we're getting these calls, I run a practice and nurses call, etc. At least at 5 or 5:30 in the morning, I'm an early bird. That's my time to just feel have gratitude. What is my purpose on here?

Thank you for being transparent and thank you for sharing. I know you go a lot of this into the book which I think would be very helpful for other physicians who may be having similar challenges. How did that reflect on your career as a surgeon? >> A lot of empathy.

There are going to be times when things don't go right in your career. You may have an outcome that leads to a complication. I have had moments where you start to question are you good enough? What if you get called to peer review or you know you're called out at morbidity and mortality conference?

How do you manage through those feelings of shame, guilt? You know, historically, I don't know if this happens as much in residency anymore, but it was pretty rough back when we trained when, you know, you were pimped in front of your peers. You were sometimes made to look stupid, yelled at. And so, I really worked on becoming a better person, a better leader, a better physician.

And that's my goal. My purpose is not just to be a good surgeon, not to be just a good leader, but a good person. And so that's always leading with empathy, presuming good intent. If somebody does something harmful or wrong to me, I ask questions first or if they act badly, maybe something's going on in their life that I don't know and that's why they're acting the way they do.

It's hard, right? Because a lot of times we want to respond or we want to react not respond but I really try to take that time to just think first >> right often times for a lot of us the buck stops with us right so if there is an issue or complication we have to be accountable and you discuss about anti-fragility and we can delve into this especially you know I assume you're kind of similar with me the resources that they have now like burnout wasn't a word it was just like you just suck it up. You just put more work into it.

You just take more call and more demands in there. And if burnout means you are less of a physician, right? I mean, that was the mentality or at least that's I perceive the mentality that most of us had, I guess, back in the day. I don't know if you've had something similar to that, but that's what unfortunately my training was a lot of that was that you weren't working as hard as the others.

>> Yeah. I didn't really know about the term burnout until after I was already practicing as an attending physician. And you know, it makes sense. It's how our culture was developed through the social transformation of healthcare in America.

It wasn't until recently, even before CO, the notion of resilience, and I'll call it resilience 2.0 really came to my mind. Resilience 2.0 know is another term for anti-fragility which I give the description resilience is you get knocked down you get right back at it anti-fragility or resilience 2.0 I know is when you get knocked down, we experience adversity and then we step back, we say, "Wait a minute, what can I learn from this? How can I be better?" And then you get back at it.

So stress, volatility, chaos, the things that are going to impact us that through change, how can you become more hearty? And that's anti-fragility. So, I really like that term or resilience 2.0 and that's really helped me. And when I talk to the younger generation of physicians coming through, I want them to know that, you know, if anything, embrace the chaos.

You're going to be better for it because it's always going to be there no matter what. Health care is going to be difficult. It's going to be hard. and you chose this path and you got to figure out is there another path maybe within healthcare or outside of healthcare but embrace it.

So you chose an interesting path. You went from being a general surgeon now you're the president of a very large physician group. Was there a moment you realized that maybe staying purely clinical was not the right path for you or you wanted to do something different? What kind of led you to that destination?

I never really understood leadership and the importance of leadership. Nor did I understand how difficult leadership really can be. I was thrust into my interest of leadership because of my passion for patient safety and then quality. I was getting really involved with looking at outcomes and from there I realized that to change behavior to modify or influence people's actions you needed leadership.

You can't just tell people hey you got to do this differently. You got to go on the RAS protocol. You got to use this medication. Now, especially physicians, the interaction with working with physicians who are very intelligent, top 1% achievers, you've got to be able to influence differently.

And so that led me into leadership. Ultimately, I went back, got more training, and you can become a better leader. You're not born that way, just like you can become better at emotional intelligence. And eventually I was asked to do more and more get involved with committees running our surgery service line, running the medical group.

And then at some point I said, "Okay, I've done about 10,000 operations. I love operating, but I can't be two places at once. It's not fair to the patient." And so I made that decision and ultimately flipped over. Now, I do go to the O and hang out and watch and observe because I do miss the clinical part, but I love what I do as a leader and the impact I can make.

>> So, for physicians who are considering leadership roles, you said we're not born to be leaders, but we can become leaders. What capabilities do you think they should start building now? Maybe that we didn't get in medical school. Let me preface that by saying don't go into leadership because you're burnt out because you'll be burnt out in leadership.

The capabilities from leadership are to be an effective communicator. And one of the best ways to gain influence is to be an active listener. Ask questions. You know, we talked a little bit about reacting versus responding.

When a situation happens, you want to give people the benefit of the doubt. And if you ask the appropriate questions and give them a chance to explain what's going on, you'll usually find that it wasn't necessarily their fault alone. It was a systems issue. And I think a very powerful way to gain influence is to build that trust.

So, you've got to be able to effectively communicate, build trust, show empathy, and be humble. I I love that. I want to change gears just a bit because before we came on the call, we discussed my audience and many of them are investors, entrepreneurs, and you said you've had some experiences in the VC route. Want to tell me more about that?

>> Yeah, you know what's really exciting about healthcare is there's always the innovation that's out there. And it was very clear to me as a leader, I was actually the CEO of a health system at the time. And I was exposed to opportunities through strategic partnerships with venture capital firms. And you know, you kind of I don't want to say impostor, but I was pretending like I knew what was going on, right?

It's a totally different world. And as physicians, you know, we're not really taught the business acumen in to understand things like startups or, you know, if you do have a great idea, how do you get funding? And I made the decision because I had this gap in my knowledge to spend about six months as an executive in residence. And it wasn't like residency as we know it.

It was a little more involved with the VC side of things. learning how to do a pitch, going to pitches, seeing other companies bring their ideas and try to secure funding, which is incredibly difficult. Probably of the hundreds of pitches I saw, maybe one or two would get funding. And that experience gave me insight from the other side from the VC world of okay, what are people looking for if they really want to get into a health system and make an impact with their new AI product?

How can you give an effective pitch? And I will tell you, it's all about exit strategy with venture capital. >> They want to get in, get out. >> Get in, get out, and make profit.

>> Make a lot of money. >> Yeah. Yeah. But you know in health care you know what I had also shared being part of that was our health systems they're always going to be somewhat apprehensive about this new thing coming on and so I also was able to provide guidance on well you probably want to approach this person or you want to get buyin from maybe the chief medical officer who's going to influence the physicians.

It was a great experience to kind of go back and forth on both sides. >> We're talking with Dr. Scott Elner. He is the author of the book Wipe Out Rise Up Chronicles his journey, the mental health struggles that physicians face, what it actually takes to pivot from clinical work to leadership and the practical strategies he uses to navigate that transition while maintaining a sense of purpose.

Why did you write the book? I really wasn't planning on writing a book until in my last leadership role. I took some time off. It was after COVID, you know, a lot was going on.

Healthc care seemed to be in this chaotic trend and I wanted to reflect on where I was in my life. So I used this time almost like a sbatical if you will to just reflect on oh these are the experiences I've felt and I was journaling and then I started writing for another podcast out there I think many of the physicians go to writing some articles and then I was approached by a publisher and they said hey you know what you might have some content for a book and I'm like well I wasn't really thinking about that And then they said, "No, no, no. Send an outline.

Just send an outline." I did. And then as I was working through it with my editor, they came up with the idea because I talked about surfing. That surfing could be a really great metaphor for the trials and tribulations of doing things that are uncomfortable. Because surfing is a sport, like any sport, but it can be uncomfortable.

Paddling out into cold water. you have to wear a wet suit, the conditions. And so I wrote the book, not so much because I always wanted to write a book, but just to share some of my lessons. >> Now, one thing that kind of resonated with the book, and it's something that I see with my own clients when they're physicians, they may or may not be burnt out, but they're looking to do something different, but then they come to me and says, "I don't know what else to do.

All I know is be a physician." And you talk about the importance of purpose. that it doesn't have to disappear when you're signing to do something nonclinical. Could you expand on that, the importance of purpose and what you felt and how that changed because I'm sure you may have had similar feelings that many other physicians have out there. >> Yeah, I know what you're referring to and why purpose is so important.

Somebody told me recently that they asked me actually what's the number one addiction right now and you know all these things go through my head you know substance abuse and I said I don't know and he said Identity people are obsessed with their identity you see it on social media you see it with likes and influencers I realized that my identity was wrapped up in who I was as a physician or a surgeon. And in order to move away from that, I had to really reflect on well, what is my purpose? My purpose wasn't to necessarily operate on people.

Yes, it was to make an impact and make them better, but it was to be a good person, to find ways to contribute and to do some things that really fulfilled my passion. And my purpose is to what intimidates me motivates me. That's my passion. And so that's how I find purpose.

>> I love it. It's that quote that Elen Roses felt says, you know, do something every single day that you're scared of. And that's easier said than done. So I love that.

This has been really illuminating. I wish we could discuss more. What's the best way if someone wanted to learn more about you and your work? Obviously, you have your book that's come out that you can pick up.

Where can they go out and find more information about what you're doing in terms of leadership? I know you're working with other physicians. What's the best place to go to? >> You have a website, drcott elner.com, two ler.

And then I am also a senior adviser with major futures. It's a company that we work through leadership opportunities. And then of course my book is on Amazon and it is in a Kindle edition. I have not done the audio version.

>> You got to do it. >> That's what I hear. But yeah, wipe out rise up and it's a surf session in pushing past limits leadership lessons and sustaining health. >> Scott, this has been very eye openening and thank you for just sharing your story.

I know it's going to be very beneficial. Yeah, please reach out. Scott, pick up his book, Wipe Out, Rise Up, a practical and deeply human guide to leadership, grit, and redefining success in medicine. Is any last minute thoughts before we end the call today that you'd like to share with our audience?

>> I think just to fall back on the discussion we had with mental health, you know, if you're ever concerned about someone, you know, the best thing to do is just reach out to them if they seem off. I think that's something that really impacted me when I had somebody who cared about me reach out to me. So, it never hurts to just say, "Hey, are you doing okay?" >> Yeah, I love it.

Thank you so much. And Scott, thank you for coming on to the call today and thank you for listening. As always, as physicians, we're going to have our ups and downs. Do something a little each day to get you closer to your goals and keep moving forward.