Interested in the Cabo retreat? Learn more about it here. And interview for a spot here. Join us inside Empowered Surgeons Group here. Gopi Shah and Ashley Agan met when Ashley was a PGY-3 and Gopi was a fellow. They’ve been friends ever since. Both went on to spend about eight years in academic medicine. Ashley made associate professor at UT Southwestern and was the first physician in her family. Gopi built her own academic career. And eventually, they both hit a wall. They describe that wall differently. For Gopi, it was the realization that what she thought her career would feel like was not what it actually felt like. For Ashley, it looked more like a seven-year itch, coupled with a vision she’d carried for years of running a small practice of her own. What I love about their story is that they didn’t leave in the same direction. Gopi and her family moved to Paris on what she calls a pipe dream: the chance to live abroad. She put her professional life completely on hold. She needed the reset, not just professionally, but for her mind, body, and overall wellbeing. At one point, she genuinely wasn’t sure she wanted to keep practicing medicine. Eventually, she tried locums. It was supposed to be a try-it-and-see experiment. Instead, she found a way of practicing that she loves. Every new institution requires her to read the room, understand the system, and figure out how to work within it. She loves the variety, the call, and the hospital medicine. And as a pediatric ENT, she has a pretty good explanation for why she likes working with kids: they keep you honest. They see right through the ego. Ashley watched Gopi do all of this and describes her, in some ways, as a vision board. Two years ago, Ashley left her salaried academic position and opened a direct-care, cash-pay practice, despite being told it wouldn’t work. Her take on cash pay is refreshingly nuanced: it’s harder in some ways and easier in others. Building the practice is harder. Actually practicing medicine without the insurance model hanging over every decision is much simpler. She figured insurance would always be there if she needed it. She hasn’t needed it. What Ashley really wanted was control of her time. Her old life had become two daily frenzies, one in the morning and one in the evening, with a packed clinical day sandwiched between them. Somewhere along the way, she started to feel like she was missing the point of her own life. She understood why the system was built the way it was. She also understood that she could not build the life she wanted inside it. And then there’s BackTable ENT. That started almost by accident. Gopi’s husband had launched BackTable IR as part of a startup building an app that allowed proceduralists to rate devices. The app needed physician engagement, so they started a podcast to drive people toward it. The podcast ended up being the thing of value. Gopi and Ashley first shared a microphone while talking about nosebleeds. In 2020, they decided to make an ENT podcast together. They recorded five episodes, mostly with people they already knew. Ashley’s summary of those early days is basically perfect: it was so fun, even if nobody listened. They weren’t initially thinking about it as education. That came later, when they started talking about all the things that weren’t making it onto the academic agenda. Their first episode in that series was about the idea that you can’t pour from an empty cup. From there, the conversations expanded into practice building, professionalism, personal development, mentorship, coaching, and all of the other things they wish someone had taught them when they were younger. Some of those topics, like the difference between mentorship and coaching, were still genuinely unfamiliar territory when they recorded them. And doing it together mattered. There’s something about having another person beside you that makes it much less terrifying to ask the question that might sound stupid, hear your own voice coming out of a microphone, get in front of a camera, or put an opinion into the world where someone might judge you for it. Their goal is honest conversation. Even with sponsorships, they want to be able to say what they actually think. If there’s something their colleagues should know about a device, they want to say it. These are the conversations that happen on the sidelines at conferences. The conversations that don’t always make it onto the Academy podium. And underneath so much of what they do is a challenge to one of the most deeply ingrained ideas in medicine: that there is only one right way to be a surgeon. Both Gopi and Ashley have learned what happens when you’re willing to fail forward, especially when the risk is one you chose for yourself. That, to me, is the real story here. Not that they left academic medicine. Not that one built a locums career and the other built a cash-pay practice. It’s that they stopped assuming the career they had been handed was the only career available to them. Learn more about Back Table ENT podcast here. Learn more about Ashley's practice, Scottie ENT, here.
