Episode Summary Dr. Stacey Ishman is a pediatric ENT surgeon, a sleep physician, a chief medical officer, an author, and a coach, and she wants every physician to know a secret: you can actually do whatever you want. Her book, The Physician's Guide to Owning Your Time, grew out of a stretch in her own career when she felt overwhelmed, lost, and spending her days on things she did not want to do. More than 20 years into an academic career, Dr. Ishman was laid off from an administrative role. It had never occurred to her that a surgeon could be laid off. It turned out to be the best thing that ever happened to her, though the hit to her identity was significant. With time to think, she asked what she loved most about academic medicine, and the answer was teaching, coaching, and mentoring. She built a coaching practice, then wrote the book by speaking it aloud in her car, answering 99 prompts with stories from her own career. In this conversation with Dr. Amy Vertrees, she explains why you cannot find time but can align your calendar with your values, how to build a yes/no filter, why busyness became a currency of perceived competence, and how to set boundaries that stick, from turning off EMR notifications to letting your system and your leaders hold the line. Along the way, the two compare notes on deep work, on the roles surgeons play, and on the pauses in a career (deployments, maternity leaves, COVID) that reveal what really matters. Detailed Episode Notes Part 1: Who She Is and Why She Wrote the Book Pediatric ENT surgeon and sleep physician; founder of the Academic Medicine Strategy Group, which helps academic physicians find the job they love Also CMO of a Medicaid insurance company, a landlord of 12 rental units, and active in real estate syndication Mission: save academic medicine, because academic physicians drive discovery, teach the next generation, and take on the most complicated cases Wrote the book because she could not find what she needed when she felt overwhelmed and lost; has coached more than 100 people in the last couple of years Core insight: everyone says they don't have time or can't find it. You cannot find time, but you can align what you do with what you want to be doing Mid-career moral injury: spending your time on things you don't want to do, while being taught that you are not in control Part 2: The Layoff and the Book Loved her academic job until she didn't, 20-something years in, and did not know what to do next Laid off from an at-will administrative role, something she never imagined could happen to a surgeon; the hit to her identity was gigantic Used the time to ask what she loved most about academic medicine: teaching, coaching, and mentoring Coaching moved her from unconscious to conscious competence, since explaining how she got there meant understanding it herself Wrote the book using the Talk Your Book approach: 99 prompts read aloud by ChatGPT while she drove, answered with spoken stories The car is a place for silence and a conversation with yourself; ideas often arrive when things are quiet (in the car, in the shower) Part 3: What the Book Promises and Where to Start Goal: be intentional about your career, know your yeses and nos and be at peace with both, understand your values, build a filter, protect the work that matters most, put systems in place for documentation, know when to delegate or delete, and hold boundaries without guilt She acknowledges it is an overwhelming list: you don't have to do everything at once, and one thing that brings more peace and clarity is the goal First step in her Reset and Refocus program: values clarification (she couldn't name 20 values the first time she tried) Narrow to your top three or four values and use them as a filter: does this build my leadership, my visibility, my priorities? Values shift by season: family, research, or building a business can each be number one at different times Amy's complementary method: start with roles, reviewed every six months, and recognize that some roles can be phoned in for a season Surgeon in the business (the hamster wheel of clinic and cases) vs. surgeon on the business (the strategic work) Part 4: Busyness and What It Hides Busyness became a currency of perceived competence and a sign of allegiance Wake-up call: she realized she had every symptom her sick child had, and it had never occurred to her to prioritize herself Some people are great at getting things done in a short time; being amazing does not require being busy Email is a list of everyone else's agenda; she keeps 9,000 open emails and doesn't feel bad about it Amy: busyness can be a way to avoid what we are worried about, and it makes us look important Pauses reveal what matters: after deployments, maternity leaves, and COVID, Amy noticed that requests stop after about two weeks The painful recognition many physicians reach: we are not honoring the things we said mattered most Part 5: Rebuilding the Life You Want She deliberately took a remote role so she could be present at home for the unplanned moments, like short conversations and making a meal Left clinical medicine for 18 months, then returned to surgery one week a month, with no EMR the other three weeks The lesson: it's often not medicine itself that is the problem, but how we practice it Part 6: Boundaries in Practice Early-career strategy: closed door and lights off in the morning for focused writing time, with snacks for residents as the exception Started clinic and the OR late for a couple of years to get her kids to school, and the world did not end First, recognize that you deserve time at home; then turn off EMR notifications, because nobody needs to answer those messages at 8:00 at night Tell people when you are available and when you are not, as a former chair did with his Thursday bike ride Batch EMR messages instead of reading throughout the day; if something is urgent, people can text or page Amy: email triggers urges to respond; if you take a breath and close it, nothing happens Amy: someone can only violate a boundary if they know it exists; there is no fence, sign, or alert Try one boundary and see what happens; both choices are uncomfortable, and you can pick the one that serves you Don't give away admin time to fix a system problem; you can't fix it by giving away your peace of mind The best boundaries are ones you don't have to keep putting up; let leaders, schedulers, and systems (including ambient AI) hold them Her version: she asked her office manager to block two random days a month without writing them on the calendar, because she did not trust herself; it became every Wednesday Part 7: Deep Work Three categories: reactive work (about 99% of what physicians do), collaborative work, and deep work Ideal: 10 to 20% of your time for deep work, in two- to four-hour blocks; if that's not possible, start with 30 to 60 minutes at your best energy time Find your best time: she writes better in the morning; a colleague does her best work from midnight to 5:00 a.m. Deep work is the work of the surgeon on the business; ask whether it is missing from your week on purpose or by oversight Urgent cases cannot be booked a month out; if you gave away your deep-work time to a case two weeks from now, it was not urgent Part 8: Coaching, Vision, and Community Academic Medicine Strategy Group has a team of coaches; Reset and Refocus is a one-on-one program (three or six months) built on the book's framework The course is also used for early-career faculty; a device company grant supports 85 residents starting the course this year Department-wide coaching is underway in five departments, with workshops and a bank of coaching hours leaders can use Vision: expand from individuals to departments to institutions and help build a movement that saves academic medicine We need many people attacking the problems of medicine from different angles; more surgeons coaching is a good thing Community makes it easier and more fun, like walking into a national meeting that feels like a reunion Key Takeaways For Overwhelmed Surgeons and Physicians • You can't find time. You can only align your calendar with your values. • Pick your top three or four values and use them as a yes/no filter so the decisions are made in advance. • Turn off EMR notifications after hours and batch your messages during the day. • Start with one boundary. Nothing bad will probably happen. For Leaders and Program Directors • Help your team protect their time: ask schedulers and office managers to hold boundaries so physicians don't have to renegotiate daily. • Don't fix system problems by asking people to give away admin time and peace of mind. • System-level fixes, including ambient AI, reinforce boundaries. For Early-Career and Academic Physicians • Build a promotion plan from day one so your work is intentional and counts toward where you want to end up. • Protect deep work, even 30 to 60 minutes at your best energy time. • Remember that a layoff, a pause, or a leave can be the moment that shows you what you actually want. Book (Amazon): https://a.co/d/0ha3GUtPPodcast: Academic Medicine Strategy Podcast, https://podcasts.apple.com/us/podcast/id1744860399Blog: http://amedsg.com/blogLinkedIn: http://linkedin.com/in/stacey-ishman-md-mphInstagram: @sishmancoachWebsite: http://amedsg.comFor the BOSS career clarity audit, head to https://www.bosssurgery.com/
