Episode 14: How We Can Avoid the Sunk Cost Fallacy and Have the Courage to Pivot to What We Love to Do? with Dr. Rami Wehbi

EPISODE 14

[INTRODUCTION]

00:06

ANNOUNCER: If you’re struggling with your vitality, energy, mood, focus, or sleep, this podcast is for you. Your host, Dr. Ann Tsung, ER doctor, and aerospace flight surgeon, will help you reach for the stars and remove the barriers or blockades that have been holding you back from living your best life. If you’ve been challenged by your health, relationships, or productivity, then it’s time for a breakthrough. So, here’s your host, Dr. Ann Tsung.

[INTERVIEW]

00:02

Ann Tsung (AT): Hello, welcome to It’s Not Rocket Science Show. And this is your show host, Doctor Ann Tsung. Today, we have the honor of having Dr. Rami Wehbi here. And he is a physician-entrepreneur, who is amazing who started his own media company, and is also a podcast show host of Beyond Medicine. His passion truly is to create a community and to be on the edge of science and technology to explore all those topics. So welcome. Thank you for being here,

00:38

Rami Wehbi (RW): Doctor Ann, thank you so much for having me on the podcasts. I’m excited to be here.

00:42

AT: Yeah. And the reason why I wanted to bring you on, it’s because you have really changed your mindset and pivoted into something, what we call like sunk cost fallacy. So, a lot of times somebody in the professional world they feel stuck in where they are, their circumstances, and they don’t feel like they can branch out and do what they want to do, because they put in so much investment, time, money, energy in their current education profession. And you have been able to pivot, change your mindset from that, and created media company, and also a podcast show host who has done multiple episodes now. So that’s why I really wanted to bring you on because I think you have the mindset shift that this community really needs.

02:09

RW: Thank you so much. It’s honestly really flattering. So yes, sunk cost and the sunk cost fallacy I think we all know is when you continue a behavior or an endeavor, as a result of previously invested resources, whether that’d be time, whether that’d be money, or effort. And regardless of whether or not that current cost outweighs the potential benefit. So, I think in medicine, there’s an enormous amount of sunk cost that plays into the career, right, because you have to dedicate four years of pre-med, four years of medical school, $300,000 worth of debt, another three to five years of residency to become a physician. And throughout that entire process, the further along you get, the more sunk cost you have, because you’ve invested more time, more money, more effort, more resources. And the further along you get, the more kind of trapped you actually become. And it’s not a topic that’s actually really been talked about in our careers in medicine. And I think it leads to a lot of burnout, a lot of feeling stuck, a lot of anxiety, and depression for our community. And so, it’s something that I had to face really head-on as a physician. 

So, I did my medical school at Michigan State, I went on to do my family medicine residency, of which I did at UMass, and after two years of residency, about two and a quarter years, I left residency. And so, I had a big choice at that time, whether I continue or don’t continue, regardless of whether, you know, all the time, effort, and money that I had spent up until that point. And, it’s something I’ve thought about a lot, as a physician, you know, I’ve spent all this time all this money, all this effort, and I’ve made it to almost the end of my residency training, and I was almost there, as a lot of people have told me, and you could have just toughed it out, you could have just finished. A lot of comments that I’ve gotten from people. 

And what I think is, for me, what’s allowed me to just do what I’ve done and kind of just go on my own path is that I took a look at things objectively, and separated myself from what I’ve invested and said, okay, you know, I’ve spent a lot of money a lot of time. I’m not happy in what I’m doing. I don’t want to do this in the future. I don’t see my life going in this direction permanently. Do I continue despite it being something that’s causing me a lot of harm, emotional, mental, physical health just deteriorating, burned out. And in residency, I couldn’t see a light at the end of the tunnel. You know, I was in my last year and I just was like, this is pretty grim, I don’t really want to do this. And I got to a point where I just really didn’t feel like I wanted to finish.  And it was partially because I knew as soon as I was done, I was going to go out and do this other thing that I had planned. And so, once I had, you know, put all that into perspective and analyzed things objectively, of what makes sense for my life and my life’s purpose, I was able to kind of come to a realization of, you know, it doesn’t really matter if I finish or not. I kind of wait, I didn’t make a rash, irrational decision, I weighed the risks, I weighed the pros and the cons. And the pros for me were, you know, I’m a physician, and I’ve earned my medical license. So, I think what a lot of people don’t know is that after one year of residency, and in some states in two years, in most states, you get your unrestricted medical license. And that basically, for me, was like, okay, you know, it’s not all for nothing, I have a medical degree, I have a license that I can actually use to see patients, so, you know, that gave me the security to then realize, okay, I don’t need to finish now, I can get a head start on what I want to do anyways. And that’s exactly what I did. And in the nine months that I would have actually finished residency, I actually got a head start on my career and on my passions and was able to build a business now that operates and runs with a full team and has actually done quite well. Whereas had I not done that I would probably just still be starting off my journey, rather than being already nine months in.

06:37

AT: I congratulate you for the courage to share that story. And to take the action step to actually say no to something. So, you can say yes to something you’re passionate about. So that is huge. Because we have that fear. Usually, we want that stability and safety and the sunk cost fallacy, like you said, we invested so much, very few of us can objectively weigh the pros and cons. And actually, you know, think of it as actually I’m just getting a head start, this is my passion. And you know, that actually is a good segue because I usually like to frame you know, the interview, like, you know, start with why, because if you don’t know your why, then how do you know, like, if you don’t have a strong enough drive to get there, and then you envision your end goal, the what? And then the how is the process to get there. Would you be able to tell me a little bit of your why at that time, you know, back when you were younger, when you went to medical school, and how your why has morphed throughout this process until now.

07:38

RW: So, for me, I, you know, I’m Middle Eastern background, I grew up in a Lebanese home, my parents were both immigrants. And I watched my family struggle a lot growing up. So, my dad worked as a civil engineer, and he was, you know, out of work for a lot of my younger life, and I watched him go from job to job, you know, without a lot of job security. And, money was a real struggle for my family early on, growing up. And me being the oldest of four, I felt a lot of responsibility growing up to help my family, and be there to kind of be the one that like, you know, I’m going to fix everything, I’m going to be taking care of everybody, nobody’s got to worry, I got this. And that was my mentality. And I put a lot of pressure on myself to be the provider, and be someone that’s going to help my family and be someone that’s going to make a difference. And, in our culture, you know, there really aren’t a lot of pathways to success. It’s like you, really, you know, have the choice of becoming a doctor or a lawyer or an engineer, or some kind of professional. And that’s what our community saw as being a success. 

And so early on, you know, maybe around high school where things actually got a little bit hard after 2008 I realized, okay, you know, my family is really struggling, I gotta figure out something because I got to be able to support everybody. So, I’m going to go and become a doctor. And at the time, I had an uncle that was a dentist, and I saw that he was, well often successful, and I had a few mentors at the time, who were also doing well. And, you know, I naturally had a liking to science. I was really good at science. I love science. I love learning about the pathophysiology of the human body. And, you know, even growing up I was pretty good at that. And so, my why at the time, you know, as a pre-med was I want to take care of my family. It wasn’t, I didn’t have a calling to become a doctor from a young age and then know from a young age, I want to be a doctor, I just knew that I needed to do something to take care of people. 

09:48

RW: And so I then worked really hard to get to medical school. And when I got into medical school, I, then I was like, wow, like, this is different than what I thought it was going to be. And then I started meeting doctors and getting into the scene of medicine and realizing, I think I might have made a mistake. And, you know, I was like, it’s gonna get better and things are gonna get better. Everybody kept telling me there’s a light at the end of the tunnel, you just got to make it through past step one, and then past step two, and then into residency, and then you know, it’s all going to always get better, right? So, I just like, okay, I’m just gonna keep doing it. And you know, the farther along you get, the more debt you have and the more stuck you are. And so, I was just always getting to the next step, and doing the bare minimum to get to the next step while also doing things that I actually was interested in. 

10:38

RW: So even in my first year of medical school, I started a community blog. It was a few classmates of mine and I, you know, I started a website, learned how to make a WordPress website and started doing posts for my medical school classes. At the time, I also started an Instagram account, and I became like, one of the first medical influencers on Instagram. And I had one of at the time, one of the biggest audiences on Instagram, as like a quote-unquote influencer, sharing my story and sharing my journey through medical school. So, you know, three years into that, I put aside the blog, and I say, okay, I want to do podcasting now. 

11:13

RW: So, you know, in my fourth year of medical school, right before I’m getting ready to graduate, I take all my student loan money that I would have otherwise used to go on vacation and invested in starting a podcast. So, I bought a bunch of T-shirts, I bought some mics, I bought like a logo. And I started my own website and started recording conversations with people. And you know, 2018, still wasn’t really common to have a podcast, a lot of people still didn’t know what that was. So being early allowed me to grow a little bit faster. And I built out some systems, I had a team around me of some interns that I would mentor. And throughout my first year of residency, I put out content almost every week. 

11:56

RW: And so, yeah, so I did all that. Kept getting to the next step and in my intern year, I really was like, I really don’t like doing this. I don’t like being a doctor. And it’s not that I didn’t like helping people. But it’s like, I didn’t like that I had no life to do anything else that I wanted to do. And it made me build a lot of resentment towards the training system and towards medicine. And it really just really sucked the life out of me. Up until you know, I really just had enough.

12:25

AT: Was there one move? Typically, there’s one moment, decision, I’m curious, was there one incidence that you finally said it’s enough? Because you probably have thought about, you know, your other ventures versus continuing all the time all the time, but there must have been that one moment, I don’t know if you remember, when you realized that you had a different why. And you decided to go ahead and quit.

12:48

RW: Yeah, I had noticed I have other multiple moments like that. I think I had an almost, I think in my third year, I just wanted to check off all the boxes and that I was going to go do my own thing. Fourth year, I was like, thinking about okay, I’m just gonna do a year of residency and get out and then go and do my own thing. Do what I really want to do. You know, and residency after my first year, I actually quit residency. So, I was like, I talked to my program director at the time and I was like, hey, after this year, I’m not going to continue and I’m just going to hang it up. And I actually decided not to do that after, after a few months of weighing all the pros and the cons I chickened out. So, I had planned to do it after my first year, but I chickened out, and so I didn’t go through with it. But then after my second year, I was like, okay, this is really it. Like I’m really, I’m really done. And I just don’t want to do this. At that point, I had more of a plan. And I had more of a little bit more security to know what I was going to do. So, I didn’t feel I was afraid to do it at that point. And so, I think, but definitely by the time I was a second year, I knew, like, I wasn’t going to keep doing this. And I knew that I didn’t want to do it, I knew it wasn’t going to be what I was going to spend my career doing. And so yeah, I think I definitely think like, early in residency, I knew right away, but I just kept just saying, whatever, you know, just keep going, just you’re almost done, just, you know, tough it out. And I really let my health deteriorate throughout that process. My soul was just sucked out of me. And I think when you’re doing something you really don’t want to be doing, it’s even more hard, especially in residency, it’s hard enough as it is. But if your heart’s not in it, it’s nearly impossible.

14:27

AT: Yeah, I think that’s huge. Because if you are not, like you had talked about before, if you’re not living your authentic self, if you’re not doing what’s true to your passion, and your why, then you do feel like your soul is sucked out of you like you, instead of being energized by it your energy’s being sucked out by it. And so, would you tell us a little bit about what is your why now or at that time, and how that didn’t align? And how medicine didn’t align and how it wasn’t authentic to your Why?

15:00

RW: And so this all goes back to why I actually went into medicine and I went in, because I was trying to provide for my family and to be someone that like, had a secure career and could take care of my family, it wasn’t because I had a calling to become a physician. And, you know, people don’t like to hear that, because it’s not glorifying. And people don’t like to say the truth, they like to make doctors out to be as heroes and saviors and like, this is my life’s calling. And there’s the whole martyrdom of culture around it, which is really unhealthy. And so, for me, that wasn’t the case. It was like, no, this is a career, I’m doing this to provide for my family, and I have the ethics, I have the character, I have the strength to do this. It’s a good fit, like, I’ve always put my patients first, I’ve always done the right thing. And I’ve always been ethical. And so, you know, I could do this, this is a career that I, you know, I felt comfortable with. But at the end of the day, it wasn’t my life’s calling. And I knew that very early on. And medicine is one of those things, if it’s really not your calling, it’s extremely difficult to make it through. And so, I kind of was just dying, slowly dying throughout the process of going through it because my heart wasn’t in it. 

I always sort of knew I had an entrepreneurial spirit, I knew I had an interest in social media and media production and telling stories and building community. I knew I was good at kind of telling stories in some capacity, and connecting with people and networking. And I knew I wanted to own my own company, my own business. And that sort of wasn’t always in alignment with medicine. I think my why has been something that has been developing, and I don’t think I’ve had a concrete answer, what is my Why? It’s sort of been an unfolding for me of, well, it’s not this, but it’s most likely in this direction somewhere. And so, it’s been a constant evolution for me of why do I do what I want to do? And you know, what is it that fires me up? And what I want, what do I want to change in the world? What do I want to help fix? Who do I want to help? And what am I good at doing that I can actually use my natural skills in a way that aligns with the betterment of the world.

17:20

AT: Yeah, I think that’s a perfect segue because I like to know your vision, like what are you envisioning, with your current endeavors? Just like you said, like, it will be good for us to actually get into nitty gritty Like, who do you want to help? What are your strengths? And what are you mentioning with your companies in like five years, 10 years, maybe even like 50 years? What are the some of the legacies that you want to leave, the missions you want to accomplish?

17:45

RW: Yeah, I think, if anything, I do want to create lasting change within the community. Whether that’s a mindset shift, a cultural shift. I think I want to contribute to the freedom of physicians in some capacity. In a way, going through all this really opened up my eyes to a lot of the dysfunction in medicine. And I think, for me, in particular, I’ve been a type to not really hold back my thoughts and be a little bit more vocal, or the person that would probably stand up to some tyranny. I’ve been the person to like, say, hey, this isn’t right. And I don’t like the way this is, and this doesn’t make sense. And we shouldn’t just be okay with this. And regardless of the consequences to my own detriment. I think that’s part of my personality. And it’s just, if I see something as being wrong, I really don’t care if it offends anyone, or if it’s not liked by anyone, it’s just, this is how I feel, this is what I see. And I’m gonna stand up for it. And maybe that is my superpower or maybe that is my kryptonite, I don’t know. But I think that the community would benefit from being able to really come together and have a voice. And I think media is a great way to do that. Along with that, I also found that I’ve, you know, got other passions. And some of them are in alignment with medicine, just not in the way that I’ve thought before. So, the science part, the futuristic part, the part that always is curious and wants to learn, that’s well a part of who I am. And now I think we’re I’m taking a liking to like exploring the cutting edge of science and medicine, whether that be through cutting edge technology, through biotechnology companies, or biopharmaceutical companies, and bridging that gap between the science and between our community and sort of the general public as well.

19:36

AT: And when you say you want to play a part in physician freedom, could you tell me what kind of freedom are we talking about exactly?

19:45

RW: Freedom from the tyranny of the system, and the system everybody seems to be stuck in. I think there are problems on the physician culture side, which is the which the physician community needs to take responsibility for. And then there are problems in the bureaucratic side of things with hospital systems and insurance companies. I think there are two sides of this. So, the systemic problems, I don’t see getting better without the actual physician community problems actually being solved. So, there is actually toxicity within the physician community, you know, physicians do actually lead to some of our own problems. I guess, maybe that’s something else to get into. But really, there are two problems here, internally and externally. And externally, the problems have gotten to the point where they’re really just toxic and unhealthy for our community and for doctors in general. And they’re leading to less doctors entering the field and more doctors leaving the field, which is going to lead to a problem in the future. And internally, the culture of our community needs to change and be more accepting of change and allow for branching out of just clinical medicine and into other areas of the world, including politics, and other things of that sort.

20:55

AT: And can you tell me a little bit more how you’re using your podcast Beyond Medicine, and how you’re using the media company to kind of assist in this to the awareness? I want to know, like, where you want to take this down the future?

21:08

RW: I guess I’ll start with Beyond Medicine. So, I started Beyond Medicine in 2018. It started as a podcast, and I would just interview my doctor friends or colleagues or people that are fine on social media to talk about their topics of expertise. So, at the time it was because I felt like doctors didn’t have a platform and I thought I might be able to build one. And so, I did that and evolved into actually focusing on the community problems, and focusing on doctor stories, and trying to bring content through our own community to help solve our community’s problems. And so, I really wanted to bring value to doctors. And help them learn through people like yourself, people, like other leaders we’ve had on and really drive the conversation and get people to feel like they have a community space that is addressing their issues and their concerns. So that was one aspect of things. And then the other aspect was kind of like the global aspect of exploring the cutting edge of science and bridging the gap between what’s evolving in our technology space, in our pharmaceutical space, and our kind of like science, sci fi space and bring that to people in a way that’s entertaining. That’s fun. And, and that’s more like the hobbyist in me, the part that’s really passionate, that comes out when we get to do these kind of productions that we do know.

22:26

AT: Yeah, I mean, if you’re doing something you’re interested in, it’s not work for you. It’s just fun. It’s just like, you know, this podcast interview, I’m just having fun having a discussion with a friend. And I think it’s huge that you want to be, you know, bring the stories of physicians out, because, you know, when we feel stuck, or really any other profession, when you feel stuck, when you hear stories of other people in your similar profession, branching out, pivoting, doing something else, finding the time and energy and money to do all that, it is very inspiring and makes it possible for you, which is huge, because first, you have to believe it’s possible, you have to believe that there is a community there who is also aware of the same issues and the problem in the community and they all wish for change. And, you know, once you bring this community together, then you can bounce ideas off of each other. And then, you know, when you learn about new ideas from different areas, that’s not medicine, like science and technology, that’s when you can make new neural connections and actually have that aha moment and do things better and innovate.

23:37

RW: It’s always inspiring to see someone else who’s done what you want to do. And it gives you hope, and it’s not a scary. I’ve actually been really surprised to find that when I tell people my story, they feel a similar way. Or they say I was so close to quitting residency, I just couldn’t do it, or I just want to leave my job. I can’t imagine doing this forever. And I’ve like really been surprised by like, how many times I talked to doctors, and they’re like, wow, like, that’s so cool. Like, what, I’ve got all this shame and imposter syndrome. And all these things I like, well, you know, if my colleagues think this is inspiring to them, then it made me curious, why is that? 

But, you know, going off of that point, I think there is a lot of shame in our profession, and a lot of people have imposter syndrome about not being a real doctor. And that’s actually one of the things that I really struggled with early on, after leaving residency was am I a real doctor now? And, you know, because I’m not board certified? Or, you know, at least for now, I’m not board certified. What does that mean? Does that make me an imposter? Does that make me a fraud? Does that make me not as good of a doctor? And, you know, I realized all of those things are false eventually. But you know, when you are in a system, and when you’re in a culture that is so heavily prideful on the next achievement or the piece of paper, and they really, you know, use that to kind of to qualify themselves or give themselves value. It’s, it’s kind of reasonable to think you might not be. And I think a lot of doctors face this, that end up leaving clinical medicine, or going on to do another career in politics or do another career that’s not even in medicine. And it’s like, no, you’re still you’re still a doctor, you still are just as valuable as you were before. You’re still as important. You’re still as loved, and all of these things and you can go on and do another career. And what’s really interesting is in medicine, you think that well, in medicine, there’s like a different standard, almost, you know, you think about lawyers, lawyers, go to law school all the time, and then go on and do all sorts of different careers and never practice a day of law in their life. And it’s perfectly normal. It’s like they go into politics, they go into business, they go into entrepreneurship. They go and do whatever, and it’s totally normal. But in medicine, it’s like you become a doctor and you train, why isn’t it normal to go out and do a different career? Why isn’t it normal to just walk away? And Ken John is now a comedian and does comedy and send movies. You know, like, why isn’t that more normal, but there’s something inside, this is what I talked about the internal problems. There’s something in our community of physicians where there’s so much judgment by our own peers, and there’s so much almost dependency on our titles that we lose ourselves and think we are only our titles. And for us, other professions don’t necessarily have that. And I think that’s, that’s unfortunate. And, you know, my hope is people do hear my story. And you know, when my book is finished, Unsinking, that they can read about all the things that lead to a sinking ship and how you can stop sinking and my hope is to inspire more people and not only doctors to kind of look at things objectively and do what is authentic to them, and live all through true life’s purpose.

27:07

AT: Yeah, I highly resonate with that. I know a lot of people will resonate with that, too. My first two podcast episodes was on imposter syndrome. And my journey of how I got over it, because I thought my image my was based on doing well around how, how much knowledge I knew, and I can’t believe, you know, I realized that my self-worth was based on knowledge. And you will never amass enough knowledge to feel enough if that is how you base your self-worth. And it’s really prevalent in physicians, once you make a mistake with a patient, because you forgot something, or you just made a minor mistake or dose adjustment, or you look dumb during rounds, and it’s almost like you feel like such a fake, like an imposter. Or you’re not as smart as you thought you were. And it’s huge. It’s huge in the community. So, it’s called, Unsinking, the book. Right. Okay, we’re gonna definitely have to get a copy of that.

28:05

RW: Yeah, yeah, definitely. And here’s the thing, you know, it’s such an unrealistic standard in medicine to be so perfect. And to go through an eight-to-12-year process of that, there is no amount of research, there’s no research on this, it’s incredibly toxic, to get programmed in that way. And you really do get programmed, you start off as a little peasant, first year medical students, you know, no fumbling over their words and feeling scared around anybody with a doctor degree. And you go through this entire process of just being scared to say the wrong thing, or do the wrong thing or be judged. And then you get punished. There’s this feel of professionalism, that you have to be a certain way, you have to talk a certain way. And you can’t have any opinions that are different from the community’s opinions or from your superiors’ opinions, you will lose your individuality in this process. And there is a tremendous, tremendous amount of harm in that you, your self-esteem takes a huge plunge. You don’t know who you are anymore, you don’t know what you actually stand for, because you have had to conform to the values of everybody else around you. And that is extremely extremely sad to watch these young students go through this process and feel like you know, if they do the wrong thing around all of a sudden they’re you know, you’re you’re not as smart you’re not as good and you’re not like the you’re not cut out to be a doctor. And that’s just as you said, and it’s a hazing process is what it is is truly hazing.

29:42

AT: It’s like mental, emotional, and what would you say you know, since I want to dig into the how, like, how do we deal with this, how do we take steps against this to a medical student to a current resident or any attending who actually has imposter syndrome now? What is the first thing that they should do or think about to change that mindset? To feel worthwhile?

34:42

RW: I think and systemically the first thing is the power differential. The power differential has to change and the sunk cost has to be minimized. So, power differential, you know, if you are in medical school, and you are already four years in, and you come across something that is morally wrong to you, and unjust and unfair. But you can’t do the right thing you can’t speak up. Because of fear of retribution. You can’t say I don’t believe in this; you can’t say I’m not for this. Because you have the fear of being reprimanded, and you have invested too much, and you’ve got too much to lose. So, there’s too much to lose in medicine at all points. And the further you get along, the more you have to lose. And so, you have to just shut up and do what you’re told and get through it for a very long time. 

So, I think one is, how do we gap that power differential? How do we give students and residents more power so they don’t feel as afraid, so that they can if things aren’t right for them pick up and leave, so that they don’t have to be forced to jump off the building, because they have no other way to get out. We don’t talk about how many people are led to suicide, because they have no escape, because they can’t just leave because they’ve got too much debt, and too much estate. And they can’t continue because it’s just too painful. So, I think that’s one reason that leads to suicide, there’s certainly other reasons. But if people didn’t feel like there was so much to lose, that they could have a safe way of getting out without all of this harm to be done without them ruining their lives, then I think we do a great justice there. And people would be less afraid to speak up if they didn’t feel like it was the end of the world for them. If they didn’t feel like, you know, they’re not going to ever have any other career choice, they’re not going to be able to do anything else. So, removing the sunk cost, removing the power differential, I think those are two steps in the right direction. And how we do that, you know, I don’t know that it could ever be done. But I think that there certainly can be ways that it could be less frightening and less intimidating for doctors. 

32:19

AT: Is there a way or a mindset changer? Like, how did you get over your imposter syndrome? Like, what can an individual do to begin to work on not feeling like an imposter all the time.

32:34

RW: Number one, if you do feel like an imposter, it’s probably like, you probably have some level of humility, and you probably have good traits that make you a good person. I think a lot of people that have imposter syndrome are actually really, really good people. So, it’s usually narcissists that think they’re just the best and can be doing anything and like don’t feel any imposter syndrome. So, some degree may be healthy. 

But for me, for me it’s just realizing I’m on my own path and on my own journey, and it’s just this is my life, like I’m just doing what I’m meant to be doing and I take pride in my ability to speak my truth and do what I’m meant to be doing. And I don’t invest so much of my self-worth in being a doctor anymore, whereas I used to, so you know, I have a new path and a new alignment, something new I’m trying to achieve now. And so, I really, don’t really that title doesn’t bring me a lot of satisfaction or identity as much as it used to. So, I think if you’re suffering with imposter syndrome, I think it’s just recognizing that it’s okay. And I think a lot of people more than you know, are dealing with it and you have to kind of find other areas of your life to really get that self-esteem from and I know doctors like that. And this is really sad and unfortunate that like, you know, feel so much shame that they can’t actually share their truth. They can’t be like wanting to and share that they may not I finished residency or they just didn’t get reboard certified or they don’t practice clinical medicine or full time so they just hide it, you know, like, the most empowering thing you can do is just own your truth. If you want to get over imposter syndrome, just speak your truth and you know, just don’t be afraid of saying what it actually is for what it is because people will end up respecting you more for being honest and open and not hiding or being ashamed of anything. And you know, it’s kind of like counterintuitive, right? Because it’s not the thing you think would get you the relief that you need, but ultimately, it is.

40:00

AT: Yeah, I think it’s huge, I think well, we can sum it up is that first find your current definition of your self-worth right now, and then you change to your definition of self-worth, and you change the two, as long as I’m being fully authentic and speaking my truth and doing things that aligns with who I am, then that basically gives me my self-worth, and it’s so much easier to meet that definition of self-worth than having to rely on other people’s perception for your self-worth, as physicians. So, I think it’s, it’s huge to want to be authentic to yourself, because I worked on the same thing too. And I changed my definition from, you know, knowledge, etc, etc, myself worth to my North Star for that is actually just be, I have it printed on my desk right here. And essentially, it just shows that all I have to do is be myself, and I will be worthy of whatever life offers me. So, I think that is completely aligned with what I’ve learned as well. And I think it’s gonna be huge to the audience that at least the first steps to speak your own truth. That’s it.

41:19

RW:  Yeah. There’s no shame, like just, it’s a really hard obstacle. And I have a lot of compassion for people and empathy for people that just, you know, feel like they have to hide the truth. Because it is a very judgmental climate, and it’s a very scrutinizing field we’re in. And so, people don’t want to be judged. And I don’t, I don’t blame anyone. But if you want to be free, then you have to just be okay with just like owning your truth is so empowering that you don’t have to ever worry about being found out. You don’t have to ever worry about someone calling you a fraud. You don’t worry about, you know, not being or being called out. It’s all out there and you’re being honest with yourself. And guess what? People respect that. People won’t judge you if you can just be honest. What makes people uncomfortable, is when they sense you are being inauthentic about something, and hiding something and trying to play it off as something it’s not. I think that is where people will judge you or lose respect for you. And it’s who cares what people think. But that is the counterintuitive process that is hard to grasp. It’s that when you’re not being authentic people pick up on it. And when you are, they also pick up on it.

36:59

AT: Yeah, I think we can probably remember, there’s probably a one person or two that we knew in our lives who just really didn’t care about what other people thought of what they said or what they did. And sometimes you’re like, I wouldn’t have done that. But it’s because we’re afraid of what other people may think of us. Deep down inside, though, I think we have that respect for that courage. Like, I wish I could do that. Or I wish I could just not, you know, care about what other people think I just did what I want it. So deep down inside, it’s very true. You do respect those people? And you actually feel like they’re very courageous.

37:34

RW:  Yeah, yeah. You know, there’s certainly been moments where, you know, someone has spoken up about something and, you know, something that I also resonated with, and they were not very popular for saying the things we all felt. And we, you know, as you know, residents were like, thank you. Respect, but like, we don’t want to, we don’t want to be the one to get punished for that.

37:58

AT: Yes, yes. Yes. Yes. Similar things have happened before. And what would you say those are all like, amazing first steps, like, you know, just speaking the truth. What would you say if somebody wants to pivot? If somebody is thinking about all the sunk investments, sunk cost fallacy right now, and they want to pivot or they may not want to pivot right now, but they want to start something else, but they’re so fearful, what would you say is the first step for them? Or is there any resource that they can go to that has helped you or any planning process how do you go over that mindset and that fear?

38:33

RW:  Yeah, um, the first step for me is total risk assessment. And that really pulled down frame things into more of reality rather than what your feared mind is telling you. So, if you really look at things for what they are, and let’s say I left my job and went on and did this, this, and this. Alright. I’ve got x amount of dollars in the bank, I’ve got a family that loves me and supports me, I’ve got a loving wife or a husband that supports me, I’ve got this and that, you know, I’ll make a minimum of this amount of money, I won’t ever end up on the street, I’ll probably always have money enough to put food on the table, I will still have the love and support of the people I care about. And worse comes to worst, I can always go back. And when you really just frame things in that way, and you’re like, okay, that’s good, I’m not going to be homeless, I’m gonna have food, people still love me, I can always go back on and you just like realize what the heck, you have to lose other than wasting time. If I want, I can go back to residency and I can go back and get board certified to wave my people around and make everybody happy. But I don’t feel the need to know. I think the greatest injustice is not taking the risks in life to actually live out the life you want to live. Without risk, you can’t live a truly authentic life. Without some degree of risk, you can’t live the life you want. And you and I spoke about this earlier, it’s that that like the deathbed exercise, I’ve probably done that exercise 100 times. And that exercise helps me put into frame what’s important for me in life, and be like, okay, well, if I were to die tomorrow, what is really important? And did I live the way I wanted to live? And would I be happy with the decisions I’ve made? And I think a lot of people, unfortunately will end up on their deathbed, with a lot of regrets. And that’s a shame. Like, I think that’s a great tragedy.

40:34

AT: Yeah, I think when we contemplate our own mortality is when it speeds everything up, it puts things into perspective. And then I love how the first part, what you’re doing, essentially, fear-setting. I learned this from Tim Ferriss. So essentially, what is the worst-case scenario that could happen? And how do you mitigate that risk, and you realize it’s really not the worst thing ever, because you can always go back to medicine. And if this other venture doesn’t work out, you realize it’s not as bad as your brain thought it to be. And then for those of you who are not familiar with the deathbed exercise, so you can think of it multiple ways, either, you know, on your gravestone, what would you like it to read, like, herein lies your name, and he or she was or has done et cetera, et cetera. Or you can imagine your funeral where your friends or family are coming up to you, and saying, you know, what you have done, what you meant them? And who you’re who you were, what type of person were you about? And I think it’s so profound to do that. And even think about, what if I died tomorrow? Would I be completely content with everything so far I have done? Or would you have regrets, because you never know, when that day is going to come. You never know when accidents are going to happen. And so, if you put that into perspective, a lot of the suffering that we have right now, in our own heads, is not really that big of a deal anymore. It’s not like it just like shrinks, puts everything into perspective. And, you know, instead of like being worried about what other people think of you wasting time energy and doing that you can, you know, spend time and be present with your loved ones or pursue your own passion.

42:20

RW:  Yeah, absolutely. And it’s really like, just getting over that fear of, you know, the human brain just creates this unrealistic idea of what it would mean, to leave a career and it’s like the risk of the unknown. And it’s really not real, like you have to frame it and understand it and look at it from a different perspective to be able to kind of get out of that mindset. And you really have to not care about what people think. Like it has to be like really internally grasped that you can do something and take a risk. You know, a smart risk. You don’t want to do a stupid risk. You want to do a smart risk that’s planned out, and well thought out through and look at, like, you’re not going to be homeless, you’re not going to be able to not put food on the table, you don’t have to live a luxurious lifestyle in that timeframe to actually pursue what you want to pursue. And that goes into a bunch of other things of like, people putting on the golden handcuffs. And not being able to escape their lives because they’ve created a lifestyle that’s not, that’s not maintainable. And a lot makes them stuck in their current job or in their current environment.

43:31

AT: Yeah, yeah, it’s a kind of a limited mindset, like, I feel like, I have to make this amount of money. And I need to spend this amount of time to make that amount of money. And I can’t change jobs because I’ve been here for so long, or that I don’t have the time to pursue something else. Like, we think we don’t have the time. But we can create time out of like, if it’s important to us, we will prioritize the time, we think we don’t have the resources, but we can be resourceful. We can rely on networks, if we just send a text, send an email, reach out, Google information, Facebook groups, community, like it’s all there. So, it’s getting out of like that limited mindset into the growth mindset. And I’m wondering, do you have some resources or any books that you recommend, podcast, books, and websites that you recommend a physician who feel stuck in this want to achieve freedom?

44:25

RW:  Yeah, one point I want to add to let you know, I’ll get to your question, is that let’s say you do make a decision or do something like you’re to lean on your community, to lean on your friends, to lean on people that you can, that support you, and be honest and really transparent about what you’re going through, will make people support you and help you and help you get to where you need to be. I think people run into trouble where they hide or put on a front, or say they’re doing something when they’re not, and then, isolate themselves from people that could potentially help them. If you are taking on risk or doing something new, then it’s best to garner that support from people who can then sort of rally around you and support you in that project. And people that care about you will do that, and they will help you and they will connect you to people. And it’s way better than doing it alone. I’ve had so many opportunities, because I reached out to friends reached out to people that I knew would be able to be supportive. And that was really what made all the difference. I think in terms of resources, and getting resources and ways for people to find the help that they need. I mean, I’m trying to create one of those resources right now, through the Beyond Medicine community, which is a discord that we do, which you can find on beyondmedicinepod.com. It’s just a community group, it’s verified doctors in a group, working almost in like a mastermind way to help each other, make connections, give resources, help each other reach financial independence, help each other find the right CPA, help each other in all ways possible. And that’s really what I set out to do. And in terms of like books or things like that, right now, my book is Rich Dad, Poor Dad. And I think we talked about this earlier, but it’s helped me change my mindset about money, finances, how to make money work for you, where to put your money, how to think about money, and it’s really made me realize more than anything, how much money is a mindset? And how money can either, you know, be a trap, or it can be a source of freedom. And depending on the way you think about money and use money is the difference between both of those things. 

46:43

AT: Yeah, I just finished rereading that book a few weeks ago, and I completely agree. You don’t work for money. Right now, we’re trading time for money as physicians with each shift and we’re working for money. But actually, you learn the mindset of letting money work for you and how to invest. And if you just read that book and can you imagine if you just change your mindset by two millimeters, and then that trajectory in like 20-30 years is going to be huge down the line, it’s going to be exponential difference. So, I highly recommend that book as well. Thank you. And can you tell us a little bit about do you have any sort of habits, tools, tactics that you use any routines that really get you going fired up anything at all, or any like parting words or action items you want to leave for the audience and challenge them to do?

47:23

RW: I will share my like process (inaudible). For me, the main thing was writing down what I’m grateful for every night in a journal, so I always, you know, have a journal, I write down what I’m grateful for. And when I’m making a life-changing decision, I do a risk assessment. I write down all the things that I’m afraid of. And I write down the worst-case scenario. And then I look at it and I say, is this the worst thing that could ever happen to me? And would I be okay? And the answer is usually yes. And then I write out what do I want to do with my life? And I draw it all out, I draw who I want to be in 10 years and 20 years, what I want to be doing, what do I want my legacy to be? What do I want my kids to say about me? What do I want my family to say about me? What do I want my loved ones to say about me? What impact do I want to have on the world? And what do I want my life to look like? When you just draw it all out? And I’ve been doing this for years now. And sometimes I look back at what I’ve written maybe two or three years ago, of where I want to be now. And I’m just like, sometimes just get goosebumps, because I don’t even remember the things that I would say back then. And I’m like, wow, everything that I was saying back then is just true now, like, it’s all come to life, it’s all come to fruition. And I don’t know how it’s gotten there. But it has. It’s really nice to be able to see that you can literally write your life into existence.

48:48

AT: Yeah, you set the intentions already for your brain to start picking out the resources you need, and to take the actions that you need, and how often are you reviewing these, revising these?

49:01

RW: I’m writing almost daily. And you know, I have a little journal that I write in every day, sometimes it’s only a little bit sometimes it’s like five pages. When I need like a therapeutic kind of release, I’m journaling, writing my thoughts, writing what I’m thankful for. And it’s just for me become a way for me to kind of do my own therapy. But also, a way for me to write down my visions for the future. And something I can always go back to and look at, like, wow, things have changed. And I may not look at a book for like a year, I may not like go back and read my old stuff for months. But when in those low moments on those really difficult times, is usually when I go back and read through and say, well, you’ve come a long way I really did what I said I was going to do. And that’s what you need to pick you up sometimes in the low moments.

49:44

AT: Yeah. So, you would journal every night, something you’re grateful for. And if you have like a future goal or vision, you basically use definitely handwrite. And then with free thoughts just keep going. And sometimes you will find that the idea roll just keeps rolling. And it’s going to be different when you type. The handwriting portion is huge.

50:05

RW: Yeah. Handwriting is very different. It is. For some reason, it’s just more therapeutic.

50:10

AT: I agree. I do morning and nighttime journal. Like mornings, setting intentions, top three are your priorities. I also tell myself, like, who do I want to be? How do I want to feel? What’s one thing I can do to bring excellence and value some future projects I’m working on that I may not achieve today. But it’s in my head. At nighttime. It’s essentially like what did I learn? How can I make tomorrow better, depending on what I learned, what I’m grateful for, and a celebration list of what I’ve accomplished. So, when you look back at the journals over the past year, you’re like, well, even like a weekly review, we’re like, whoa, this is awesome.

50:50

RW: Yeah, it is really wonderful to be able to do that and reflect on it and go back and see how far you’ve come. I think that people should take more risks. And I say that lightly. Because I think that too many people live a life that is too cookie-cutter, too safe. And eventually, that leads to regrets. And especially if you’re younger, you know, and you still have the ability or the capacity to take on a little bit more risk to do something. And I see not just risk but calculated risk that is going to potentially lead you to a better life. And think about it in terms of an experiment maybe, you know, like I never understood that, you know, people can go and do a two-year fellowship and take a humungous salary cut for two more years to get a little bit more experience and a little bit more, you know, whatever and invest in something, but they’re not willing to do a two-year fellowship on themselves. Like, why won’t you take a two-year fellowship on yourselves, give yourself a pay cut, live on the minimum that you need, and go do something you actually want to do, why won’t you do that, but you’ll do it for an institution or to be recognized as you know, fellowship-trained? And honestly, that’s actually one of the ways I framed kind of my process right now is, I’m in my own fellowship, I’ve created my own fellowship for me to do what I want to do.

52:16

AT: That is really awesome. Yeah, I really like that perspective. Be I have not heard that before. So, it sounds like the main points, the big takeaways is, number one, you want to be authentic to yourself, you want to be able to speak the truth. And if you feel like something is not right, that probably means that you know, if you feel like an imposter, that means that probably you’re not being authentic to yourself. And if you feel like there’s other endeavors you want to pursue, then you would weigh out the pros and cons, do some fear setting, take some calculated risks, or else, well, they’re not really risks, they’re learning experiences right, they’re fellowships of yourself, essentially, if you frame it in a positive way, they’re all learning experiences. And really, you know, journal, goal setting, seeing your end vision, I think those you know, for me, those are the major takeaways, do you have anything else that you’d like to leave for the audience?

53:17

RW: No, I think this was a wonderful conversation. And it’s really even been, in a way therapeutic for me to kind of express some of my feelings and thoughts. And, you know, I guess I’ll kind of just do my little show here and say, you know, check out the podcast, it’s beyondmedicinepod,com. Check out the Discord community, if you’re a doctor, you know, we have all of your verified physicians on there. And we got a little mastermind going on where we help each other out. And we provide each other with resources that we all need. And lastly, I’ll kind of just promote my upcoming book, Unsinking: The Sunk Cost Fallacy and the Path to Living Authentically, it should be coming out sometime in the summer of next year.

53:55

AT: That’s fantastic. And I think I’m very grateful for your time, of course, the audience’s time, you know, you spending this hour with us, you have completely displayed and basically lived what you preached, you were fully authentic, you were fully truthful about your story. And thank you so much for even sharing some of your tricks and tactics and mindset change that you used to kind of overcome your challenges with our audience and contributing to the community and raising awareness through the community as well and through your podcast. So, thank you so much. And again, I want to remind the audience to go to itsnotrocketscienceshow.com. We’re going to have all the show notes and all of the resources there listed for you. And again, thank you Rami. I appreciate it.

54:50

RW: It’s my pleasure. Thank you so much. 

54:51

AT: All right. Thank you and remember, everything we need is within us now. Thank you.

54:56

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