“I Don’t Have the Bandwidth”: How Physicians Can Slow Down and Create Space in Their Career with Dr. Moe | Ep36

Michael Hersh, MD

[00:00:00] 

A few years into practice, most physicians start to notice a shift. We're still showing up, still doing great work, and still being the doctors we were trained to be. But there's kind of a tired that also starts to show up, and it's one that doesn't really go away with a weekend off or better sleep. The way we practice starts to cost us in small ways.

We feel shorter at home. We don't think as far ahead as we used to. Even while we catch ourselves dreaming about retirement. And without really saying it out loud, we tell ourselves, well, this is just how it is right now. Most of the time, no one tells us it doesn't have to stay that way. Today I'm speaking with a physician who recognized that toll, took it seriously, and built a different path forward without walking away from medicine.

Well, hey everyone, and welcome back to another episode of the Better [00:01:00] Physician Life Podcast. Thank you so much for being here. Now I talk with a lot of physicians who reach a point in their careers, usually a few years into practice, where nothing is technically wrong, they're functioning, they're reliable, they're doing what they're trained to do. But the pace, the schedule, and the constant cognitive loads start to take more than they give back. And over time, the way they're practicing no longer feels sustainable. 

That's what we're talking about today. So I am joined by Dr. Maureen Gibbons, and most people know her as Dr. Moe. She spent years working as a full-time emergency medicine nocturnist, and eventually recognized that even though she loved medicine, the way she was practicing wasn't something she wanted to keep doing, especially the way she was doing it.

What makes her story interesting is that she didn't look for an escape hatch. She noticed the cost, took it seriously, and intentionally built a different practice model and one that preserved [00:02:00] both her clinical identity and her life outside work. Today, she runs a multi-state virtual lifestyle medicine practice, teaches other clinicians how to use telemedicine intentionally, and recently released a new book called Freedom to Shift.

Dr. Moe, welcome to the show. How are you? 

Thank you so much, Michael. It's been a fantastic journey knowing you, watching you, and just being around you in all the ways that have affected my entrepreneurship journey as a physician. 

I love that. Thank you so much. And yeah, it's been great getting to know you.

We were chatting a bunch about all of the changes that we both kind of had in our careers and in entrepreneurship over the last couple of years. You know, I’d love to start early in your story. When you think back to those years working nights in emergency medicine, were there any signs that the way you were practicing was starting to cost you more than you wanted it to?

[00:03:00] Yes. Did I see them? No, because one of the things that you said is a few years out, and the way I usually phrase it is your shoe just feels a little too small. Like it's still the same comfy shoes, but they feel different. They feel too small. And I was on the ground post-residency for 15 years before I started to notice something, and I had told one of my colleagues when he came in to relieve me in the morning, talked about our cases, difficult things and I said, I know I could be a better doctor if I just had more bandwidth. And little did I know when you say things to the universe, the universe listens and usually hits you with something pretty good or bad, depending.

And he looked at me, and he said, the only way to stay in emergency medicine long term is to go part-time. And I said, yes, that's absolutely my goal. I thought I would retire from that department. Like that very [00:04:00] department was so much of my identity, and I thought I would retire from that department, working four to six shifts a month.

Doing my other things, and because I've been a serial entrepreneur, I've been coaching for over 30 years, and that part was starting to bubble up again, that I wanted to do things a little differently. And so the way I formed my practice, I incorporated a lot of my coaching into the practice because that's where I love to be.

And so. You were talking about being a serial entrepreneur and wanting to incorporate more coaching. What was the timeline for that work? How did that work for you? 

I wanted to be a life coach since before life coaching was a thing.

I used to be an athletic trainer. I used to work in high schools, and the last high school I went to before we went back to medical school. I was the person that the kids would go to instead of the guidance counselor to talk to and figure out what they were going to do. And I always wanted to be a life coach.

It's so funny. So [00:05:00] I didn't go to life coach school. I went to medical school instead. No, I mean, I love emergency medicine. I've loved it from before. I was an emergency medicine physician. I loved it every day of my career. Sad as it is. I wasn't burned out when I left. I was doing the right things. I had sleep, I had the activity planned.

I had a very regimented schedule. I mean, not super regimented. I do have a family and life, but that coaching thread goes all the way through. But I didn't realize it until I had enough bandwidth and margin, like that's the second stage. I didn't even know what margin was. Like I heard people talk about it, but I didn't know what it was until I felt it, and one day I was like, oh, that's what they mean.

I have space to think, create, build, and enjoy. It just felt very different. But no, I'm a very slow learner. I need lots of repetition, and obviously, I was out [00:06:00] for 15 years. I'll be outta med school for 20 years this year. When did that happen? 

Yeah. You know, it's interesting when you say this, right?

So the thing that I notice when I start talking about my bandwidth it's usually that I don't have enough of it. So it's coming from a place of lack. And if I'm telling somebody that I don't have enough bandwidth, I am kind of at the end of my rope already as it is. And that's something that I've needed to notice in me.

And then the other piece that you were just. Talking about is kind of that white space. So if you don't have any bandwidth, then there's no white space, and there's no way to reflect back on kind of your life and how things are going. And it's really hard to live on the edge of just constantly doing everything and not giving yourself any opportunity to reflect or consider, like, do I even wanna keep doing things this way?

I love the way you phrased that because you didn't say, do I want to keep [00:07:00] doing this? You said, do I want to keep doing this this way? 

And that's a huge difference. And you know, if I could still do emergency medicine, well I would do it now, but I don't feel that I'm the best at that job. I'm not the best for that job.

And, I'm sure those of you listening will argue not necessarily for me, but for yourself in that same vein. I mean, my husband told me two years ago, we were talking about career paths, and he's full-time emergency medicine, and he said, emergency medicine's a young man's game. And then, recently, I read Arthur Brooks’s From Strength to Strength.

I wish I would've read that two years ago, because the farther those curves get apart, the distance between that gets more painful to hop onto that other curve, to go from the hustle to the wisdom curve, the farther apart they get, the harder that is. So like you said, if you keep someone, if you grab someone between three and five years out of residency, [00:08:00] when it first starts to feel like, 

I know I can do this better. It's like that's what I would go into every shift with shift goals and trying to do systems and all the things, and there just becomes a point where I couldn't do anything better. I didn't know why. Now I know why. 

Well, and so just to clarify, for any listeners that haven't read From Strength to Strength by Arthur C. Brooks, it talks about the inevitable career decline. We all have a trajectory in our careers, and eventually, there is a decline, and most people recognize their career decline, their professional decline. Too late. They wait too long. And so the premise behind From Strength to Strength is we have different strengths at different stages in our life.

When we are young, we learn differently than we do as we get older as we become mid-career physicians, like both you and I are. And so, how do you successfully make the leap [00:09:00] from the career that you currently exist in to the quote-unquote next career? Before you reach that point of professional decline.

And it's a challenge, I think, for all physicians who hold so tightly to our physician identity. Right? It is one of the singular things that I saw the eye roll. Translate your face. Go ahead. 

Yeah. I love that. I'm using that at home. Please hold. I need to translate my face because. That's exactly it.

I mean, it took me a year and a half to get through that identity shift. It should have taken me three months tops because, I mean, I worked out, I slept, I was a mom, I was a wife. I did other things. I had a very rich life outside of medicine. So why was my identity still so entrenched there? Because part of it was that I do love emergency medicine.

I will always love emergency medicine. Now I just try to give back to the [00:10:00] emergency medicine physicians instead of me treating a patient, which is different, I mean, I do have a lifestyle medicine practice. My coaching is giving back to the high achievers that I was, now that I'm not still a high achiever, but like that second curve, I do things differently now.

I can't just pound knowledge all the time. And I don't know how to convince, for lack of a better word, the old me that would've been three to five years out. Because I see all of the old mes that I talk to now three to five years out, showing them this is the time to take a look at your, I don't like the word passion because sometimes I think those are more fleeting, but your interests, your skills, where you go.

Instinctively, what you do, what you talk about at dinner, that everyone else is like, could you please stop those things? I tell people, find three of them. It's one of the exercises I do in [00:11:00] workshops. Find three of them. Bring me the one that you wanna try first, because guess what? It might not be the first that succeeds.

You might decide, Ooh, I don't like this very much. But we do have the freedom to shift. We do have the ability to change without anyone else's permission and to grow into that second half of life, for lack of a better way to put it, to grow into those skills, grow into that wisdom. Finally, take what you've done, translate that knowledge, that experience those skills, and send the elevator back down to the people who need it.

And this all very much goes back to the conversation we had when we started about bandwidth and white space, right? Because if you don't have any bandwidth, if you don't have any white space, it's very hard to explore the things that you might be interested in. And as we talk about our professions.

It doesn't always mean not doing the thing that you love, and that you know right as a physician, you don't have [00:12:00] to not be a clinically practicing physician. You do need to give yourself an opportunity to figure out, is this genuinely what I love? And is there anything else that I love? Also, and I know you were just speaking to how you invite high achievers to do that.

It's very hard to take that step back. How do you encourage people to say, this is great, you might love what you do. How do you give yourself an opportunity to explore other things? 

Well, the funny part of that is if I would have started this journey 10 years earlier, I would probably still be doing emergency medicine in a way that did not physically hurt me.

I ended up with a diagnosis of cardiovascular disease with a lesion of my LAD a year ago, and I do believe that was nights in stress and my long history with food issues and a very small amount of genetics as it stands. But I think that somehow. [00:13:00] By showing what I've changed my life into is my goal of what to show people, wait, I can do this and that.

Because two things can be true. Well, they still love their job, right? Because my goal is to keep people practicing medicine. We need people practicing medicine in whatever way, shape, or form feeds their souls. And like, you know, it's not all the time, like every shift isn't great, but I would've probably had 10 more years at least working part-time in emergency medicine had I started earlier, and in order to open up the white space. Sometimes it is tactical, One of the exercises I do that I would actually like to give your listeners, and I'll give you the information at the end, is a vital metric review where we look at the things you do for a week it's not, what was productive and what earned you money, it's what restored your energy versus what took it, because that's the vital metric 

One of my clients is one of my favorites. She realized after just doing a super quick one [00:14:00] week exercise, took her 10 minutes, no big deal. She was trying to cram 32 hours of activities into every 24-hour day, and I was like, well, I think we might have found your first problem.

She's like, I had no idea, because she never had the bandwidth or white space to even look at it. But she was at such an extreme point where she had to do something. I don't want to get people at that point. And I don't know the best way. Your question was how do you make them see, how do you invite them?

Right. because there's nobody that can force us. Into this work. And if you put your head down, if you keep working, if you just keep doing the thing, you keep showing up every day and you never take a moment to reflect, then you never get an opportunity to look and decide like, we were talking about, do I want to keep doing things this way? And there's so much to gain from. Being introspective from slowing down, and it's really hard to do as [00:15:00] a, self-proclaimed busy addict, somebody who loves to be productive. You know, I think most physicians could see themselves in that description.

You know, it's really hard for me personally to slow down, and I know if I don't, then I'm sometimes chasing things that I don't even realize I'm chasing. 

That hits hard. You know, and I did this in my practice I've made a lot of mistakes in my practice.

Again, why I coach, because I don't wanna make these mistakes for nothing, and it makes me feel better if I can help other people not make the same ones. We'll help you make all new ones, but when you say that, the slowing down is very hard for me, and it's not because I don't, I could sit and grow moss in this chair.

Let me tell you, but my brain will be going a mile a minute, creating, building, systematizing, tweaking. That needs to calm down as well. And you have to have systems in place to really do that. For me, it's like training for triathlon, or any [00:16:00] endurance event. You have to have rest weeks.

And we've started incorporating in my family actually, rest weeks where we take a trip together as a family, where we do some work in the mornings, but the vast majority of the day is kind of nothing. We bring novels, we read novels, we play on the internet or the web. You know, just do nothing. And that's a very difficult thing for my brain to do.

So knowing that that's uncomfortable, how do you do it? 

It's almost like starting to meditate. I don't do well with meditation. If anyone who knows me, they're like, yeah, really? Never would've guessed. I have to start with guided meditation and get in the habit when I relax to quote-unquote do nothing.

I'm not staring off into space. Usually I'm reading a novel because that'll have half of my brain. Engaged in something that's I don't really have to think about. You barely have to read the words, and I'm not talking Oprah's book [00:17:00] list here. I'm talking fluff, complete garbage, because I don't wanna think, I know I have a happy ending at the end. I don't wanna think I don't want it serious. I don't want it heavy. It's very light reading, but then it lets the other part of my brain just sort of chill. 

And this is the difference between active rest and passive rest, right? For those of us that have very busy brains. Passive rest can feel like torture, especially if you are at home and you know that there's like a huge list of things to get done and just sitting around. In theory, it sounds great, but when you know there's so much to do you can feel like you're crawling out of your skin in the process of just trying to rest. And so finding ways to actively rest, whether it is choosing to read or exercise or something like that, that all can still count as rest. So long as it is, like you were describing, restorative, what are the things that give you energy [00:18:00] back?

So rest is anything that can be restorative just is different based on where you're at and where your mind is. 

Yep, a hundred percent. And well, it has morphed over time. I can actually feel my nervous system. Unwinding. I can't think of a better word, and I don't think it's just from emergency medicine.

I had a therapist many years ago who told me we seek the teeth that fit the wound. My personality is emergency medicine. It is not lifestyle medicine. I mean, like, if you know me, you're like, yeah, this isn't you. Now, my journey through being an athletic trainer or triathlon coach, sports nutritionist, like that's lifestyle medicine, is everything I've ever done intellectually rolled up into one, which is fantastic.

But when you think about the way we need to rest in the way the road will get narrower, and the way I figured this out with my nervous system is Guardians of the Galaxy at Disney World. Because when I first went on that ride, a couple years ago, it was. like [00:19:00] I couldn't handle it.

My brain couldn't handle it. I went on it the second time, I was like, okay, now that I know what I'm expecting, this will be a little bit better. Super fun, but still pretty scary literally to my nervous system. Like I'm not scared. I'm not going to die on the ride, but my nervous system was so keyed up, and every year that I've gone on it since it becomes pure fun without fear, and I can literally feel the difference in my nervous system. The longer I've been out of the level two trauma center. I don't wanna admit that. 

Right. I'd love for you to speak a little bit more to kind of the nervous system, because as physicians, it can sound a little woo. Right? Like, when we talk about our nervous systems, there's a lot of skepticism comes up.

Physicians can kind of tune out. Can you talk a little bit more about how you have reconciled that with your current work, and when you talk to physicians about their nervous systems, how that goes? 

Probably the same way it [00:20:00] goes in my head that you're full of crap and I can handle this. I mean, I'll tell you, my brain is likeif my frontal lobe is running the bus, we wouldn't be in this problem, 

I have spent so many years with the same level of internal chaos, wanting to calm the chaos, trying to make sense of the chaos long before emergency medicine. So this is a very different place for me to be. We're all gonna sit around, sing Kumbaya, and meditate. Well, that's not the life I live right now.

I like to be productive, but I have to downshift. When I talk to other people, they say the same thing that I did say, oh, no, I can handle it. I got this. I'm not burned out. I don't need coaching. I don't need meditation. I got this. I've done seven Ironmans completely.

You know, I've done marathons. I wasn't fit. I had a problem with food. But that's another story. That's another nervous system story. Because we soothe, right? We soothe with the way that our brain has wired us to be. So a lot of times what I call the dangerously overeducated [00:21:00] crowd, because we know a lot and we're not afraid to tell you that when I talk about your nervous system, it's not woo woo, it's hormones, it's nerves, it's synapses, it's chemicals that have been paved like a highway. Your brain knows how to get you productive. Your brain knows how to get, you relax, like your brain knows how to get what it wants. Whether that's adaptive or maladaptive is a completely different story, and by the time, like you said, where you're noticing that shift where it's just something's off, something just doesn't fit.

That's what happens where you've paved these highways. Then you realize, like you said, I'm becoming short at home. I don't like myself. Okay, let's not even talk about other people because this is about us. We take on these responsibilities 'cause we like them, but then we just don't fit. We don't wanna be ourselves. At least let me just speak for myself. was uncomfortable and didn't like myself very much.

Yeah. And it comes from always [00:22:00] running so fast from thing to thing, whether that is in the emergency room, at the hospital, in clinic, racing home, getting to the kids' activities, making sure that you are everywhere. That you want and need to be. And when I think of the nervous system, that's exactly what I think of when I think about it being so high and everything being so revved up.

I mean, we are always running from one thing to the next. And so yes, when we talk about it, it can sound woo. And if you think about it, of course all of this makes sense, right? This is how we were trained. We were trained to always be moving to the next thing, and this is why slowing down is so hard, and it is becoming aware that this is kind of the algorithm that's running in the background that we never take the time to notice That can provide the biggest shift of all.

I agree. And awareness kind of stings, I'm not gonna lie, because once you see, you can't unsee. And once you [00:23:00] realize that your operating system is broken, that you're on Windows 10 when you really should have a Mac. Just kidding. Okay, not really, but you know, once you realize that your operating system is fundamentally flawed, number one, it starts to make you question everything about your education.

Then we start to think, what can I do if I'm not a doctor? Just don't go there because then we get scared and then we're just gonna go right back to doing the same thing in the same ways that aren't serving us. Because it's not a dichotomy. It's not either or, you did not waste any bit of your education.

If you went through your education and you never practiced a day as a physician, it's not wasted and you can still help other people with your knowledge. I want people to have a voice. We feel like, well, if I didn't complete the traditional path, then I'm not worthy to call myself doctor, for me, I mean, obviously I did seven Ironmans, 'cause, you know, three wasn't enough.

No, I need to prove that I can do it. In this situation.I'm not really an Ironman until I've done it in this [00:24:00] situation. that's just the way my brain works. I know the physician personality. I'm probably not alone. 

Yes. Love talking about the physician personality because we all do have so much in common and I think, to your point, you never have to stop being a doctor, right?

This isn't about not doing things that you love. This is about taking enough time to pause and evaluate. Am I doing things the way that I wanna be doing them and giving yourself the opportunity to shift if you want to. Because you don't have to decide not to practice clinical medicine, like you were saying.

It's not either or. you don't have to choose and you get to if you want to. 

Yeah. And you don't need anyone's permission, especially your own. That's the hard part because if you don't need permission, then what's stopping you? What's stopping you from making a change? Whether it's changing and granted admittedly this might be a geographic cure, but changing hospital [00:25:00] systems or changing the number of shifts for me, my immediate supervisor did not like part-time positions. So I didn't fit there any longer because I was notgoing to increase that bandwidth and I had told them flat out, as soon as I can create something that feeds my soul, that also I'm creating enough value to create money in return, I'm going to start dropping a couple shifts.

I didn't sit very well. The easiest thing to do would have go to a different system, because if I still wanted to be in a level two trauma center or a level one trauma center, or teach, you can do whatever you want, like there aren't only two options. Do your current job, or stop working.

There's an infinite number of places for you to be. It's not going to be easy. It's not all sunshine and rainbows, but it's not all sunshine and rainbows outside of medicine either. I hate to tell you that's the thing I wanna impress upon people is just, to create that space, that white space, to just start to [00:26:00] think, I wonder if I could do this a little differently.

Love that and again, sometimes that space, you know, I talk about all the time, one of the things that created an incredible amount of space for me was a 30-minute lunch break on my procedure days, right? So we don't even have to be talking about dropping shifts. We can just be talking about how do you space out your day on the days that you're working to make everything feel a lot more approachable and doable in a way that you know lets you eat and use the bathroom and not feel rushed with either.

Imagine that. 

Imagine that.

This has been amazing. I would love for you to tell the audience a little bit more. I know you, just wrote a book called Freedom to Shift. Tell us more about that and how our audience can listen to you and find more and read more about you.

So the subtitle of the book, I have to say because it's my favorite part. [00:27:00] I mean, freedom of Shift is good enough. I mean, shift Stands for Success Happens in Focus Transitions because a lot of what life throws at us, we didn't plan on. And when we make it our own and create that focus, it becomes a very different event.

It's a proven path to stop trading times, start creating freedom and shape what's next, because I want people to shape what's next really. I mean, that's the goal. You can find it at FreedomtoShiftBook.com. That'll take you to the Amazon link. And the best way to chat with me is to DM me on Instagram at Dr. Moe Gibbons. Moe is with an E, and if you DM me the word podcast. You'll get a link to that vital metric review that I talked about. It's a template easily filled out. It's taking that very first step by looking at your calendar and seeing what serves you and what doesn't. 

Amazing. Love it. Any takeaways that you want to leave the audience with today?

The most important thing is [00:28:00] hope because people will tell you, no one's coming to save you. And that is the truth. But we can throw you a buoy and you can save yourself. 

Most importantly, yeah, if we can save ourselves and we can save each other too, right? Yes. As a community as physicians working together.

I genuinely believe anything is possible . 

Same. 

Amazing. Dr. Moe, thank you so much for being here today. Amazing speaking to you. As always, to the listeners, thank you for listening and we'll see you on the next episode of Better Physician Life. Take care.