Life Changing Moments: Weathering the Med-Life Crisis

Transcript

[0:00] For me, it’s like, okay, the path in front of me is a huge, obtuse angle.
And it’s not that I was off path, it’s just that my, you know, the path is somewhere in there and it just gets narrower as I get to more towards purpose.
There are times in our lives that change the way we see the world.
Navigating these challenges can take insight, trusted confidants, or even a coach.
Let’s explore those moments.
In this companion podcast to Rx for Success, we will discover ways to learn and write our own success stories together.
I’m Dr. Dale Waxman, a physician coach with MD Coaches, and this is Life Changing Moments.

[0:48] My guest today is Dr. Scott Paviole. Scott is a dermatologist in private practice in Charlotte, North Carolina.
Due to a long-held career mantra of being involved in physician-led changes in healthcare, he is also the president of his county medical society.
As you’ll hear, he is passionate about centering healthcare on the fundamental relationship between clinician and patient.
His Path into Medicine story is chronicled in Rx for Success podcast number 143.
I invited Scott back to deconstruct a comment that he made during that conversation, and we’ll get into that in just a few minutes. So Scott, welcome to Life-Changing Moments.
Thanks for having me, Dale. Great to have you and to talk with you once again.
So first, can you just tell us a little bit about what you’re up to professionally right now?
What’s your current professional situation?

[1:48] I have my own dermatology practice in Charlotte, North Carolina, that we started about three years ago.
And in the middle of the pandemic, we took over for an older dermatologist.
And it’s kind of a startup slash career pivot that is growing right now.
It occupies a lot of our time, my wife and I. Great. Thank you for that.
So what I want to do is take us back prior to that situation.
And it was back to your first job in our region here with a multi-specialty group.
And you had been in that practice for about six years and then you had this realization.
I’m going to play a little clip from the Rx for Success podcast with Dr. Randy Cook.
It all started with what I called my med life crisis, which was about two years into private practice when I kind of had an oh, oh, crap moment where I paid off my student loans.
I was very busy at work and I was like, oh, is this all there is, you know, which is not that bad.
You know, I was taking good care of patients, but I was searching for, it was kind of like the learning of residency had, you know, I kind of taken off from reading journals because I was really fresh out of school. So I was up to date on everything.

[3:11] And then I was like, okay, I paid my loans off. This is all there is?

[3:23] Med life crisis and I have to admit I’ve not ever heard that term before Let’s talk about what it was. What was it like to experience that? What did you mean by med life crisis?

[3:35] Well, you know one thing that always comes up for me It is these moments are usually named in retrospect or at least for me and sometimes, Listening to that. I’m like I’ve had four med life crisis is since then crises since then seemingly, you know And each one seems like a bigger hill.
And then when you look back, you’re like, oh, that was nothing compared to current.
So I like to think a bit about getting, you know, clearer on true purpose maybe and getting closer to the center and peeling back the onion, whatever metaphor you want.
But, you know, I think, yeah, getting closer to true purpose.
And a lot of times it is, again, when you look back and you go, whoa, A lot of times, it’s the small events that lead you to that.
But for me, yeah, it’s just repaving and repaving, sorry, paving new paths going forward and pivoting off of a trajectory that you were on.
Yeah. You know, my frame on that for people is that you have somewhat of a unique professional path or personal path, if you will.
And sometimes you get off that path and there’s these moments where you realize, I want to get back on my path. And so for you, it was this, there’s these moments of realization that I’m off the path.
Do you have a recollection of back then, what those moments were that led you to realize, as you said in this recording, you know, is this all there is?

[5:04] Yeah, I think I was in breakdown on multiple levels. I felt some discord at work internally where I just, it didn’t feel as rewarding.
I felt the success career wise didn’t feel like I wanted it to feel.
It was obviously, you know, that trap of you got there and then it doesn’t feel as good as you thought it was going to feel when you were working towards it.
And so I just felt like, okay, here I am.

[5:38] It’s not what I thought it would be. Where do I go from here?
And what tools do I have to get re-centered and choose my next step?

[5:49] Yeah, if you could recall, do you have a sense of what was missing for you right then?
I think agency, so control over my next steps. I just felt like I was trapped and there was one way out and I just didn’t have the mental space to see the opportunity.
And then for me, I like creativity.
You know, I just wasn’t open to the creativity that was all around me, I’m sure.
It’s just, you know, I had the blinders on and I wasn’t seeing it.
So the things that I went to were meditation, relying on my wife’s read on things, my good friend’s reads on things, you know, getting perspective that everything actually was pretty darn good, but it wasn’t where I wanted to be or go.
And so I had to, you know, pick next steps that made sense for me, not maybe what other people would pick, which gave more strength in my purpose.
And yeah, I would say I really, I really like dug into the healthy habits when I could and, you know, doing the things that made me successful or got me in the right mind space to have the vision.
I’m a very visual person, so like, what do I see? You know, for me, it’s like, okay, the path in front of me is a huge, obtuse angle.

[7:12] And it’s not that I was off path, it’s just that my, you know, the path is somewhere in there and it just gets narrower as I get to more towards purpose.
So, you know, I don’t know if I was a great visual for everybody, but I just feel like I’m in, I’m walking forward and it’s just fine tuning pruning the path. Got it. And it sounds to me like, you know, going back to that idea of it didn’t feel quite right. You’re talking to friends and your wife and And there is this realization that, you know, maybe you have it.
Some things are better than you think that they are, but it still didn’t quite fit for you.
And so it sounds like having these conversations with close connections enables you to even go deeper.

[7:59] In your own self-exploration. Did I get that right?
Oh yeah, I mean, I just try to stay open even to patient stories.
Sometimes they’ll inspire me or say, oh man, I didn’t think about that.
But yeah, I think finding friends and people to talk about stuff.
A lot of times, people see you better than you see yourself.
It’s a lot easier, and for them too. It’s easy for them to give me advice, which is great.
I appreciate that, but it’s hard for me to see it because I’m the fish in the water.
So I think that can be a really reliable choice. But you’ve got to have people that care about your best interests over theirs.
They’ve got to have your best interests in mind. Right, yeah, I just want to distinguish those two because one is some other people saw things in you and said, hey, what’s the big deal? You got it great.
And then the other part of it is people who are willing to listen to you and say this doesn’t quite feel right and to have your interest in front of their own interest. So I think there’s two different things.
Sometimes we have people who aren’t really good listeners to us and they’ll say things like, what are you complaining about? You’ve got X, Y, and Z, even though it doesn’t quite fit.

[9:06] Yeah, and if, you know, let’s say you’ve got a friend that really wants you, you know, as an example, but doesn’t want, wants you to live near you.
And you have a job opportunity in San Francisco and they say, I think you should stay here because they want you to stay here because they don’t want you to move far away.
I mean, that’s not someone, they just say, you know, we’ll figure it out.
But you’ve got to have your spidey senses tuned into that and also know who to talk to at the right times.

[9:33] Hi, I’m Rhonda Crowe, founder and CEO for MD Coaches. Here on Rx for Success, we interview a lot of great medical professionals on how they grew their careers, how they overcame challenges, and how they handle day-to-day work.
I really hope you’re getting a lot of great information. But if you’re looking for an answer to a specific problem, management or administration challenge, or if you’re feeling just a bit burnt out, like maybe you chose the wrong career, well, then there’s a faster way to get the help you need.
No, it’s not counseling, it’s coaching.
RX for Success is produced by MD Coaches, a team of physicians who have been where you are.
I know you’re used to going it alone, but you don’t have to.
Get the support you need today. Visit us at mymdcoaches.com to schedule your complimentary consultation.
Again, that’s mymdcoaches.com because you’re not in this alone.

[10:35] We’ll get back to our interview in just a moment, but right now I want to tell you a little bit about Physician Outlook.
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And now let’s get back to today’s interview. So Scott, you’re in this situation where you realize.

[11:47] That is this all there is and looking for something that is more creative, something that gives you some more agency.
What did you open yourself up to at that point?
But I wanted to also say this. I felt at that time, I was almost resentful to my career.

[12:09] At that point, because I viewed it as I could have been doing other things where I should have spent my time and other ways to go somewhere.
And it’s my wife who said, hey, you have a platform.
People will listen to you no matter what because of your training and your experience.
And don’t throw all that away just because it doesn’t feel good right now, it may be something that you can still use to go where it feels better for you.
And so that was actually very helpful to not, because my trap is that I just want to escape when I feel trapped.
And so you don’t have to run away, you can use your power and your knowledge and experience, but maybe just shift how you’re expanding that influence.
Got it, so you were actually thinking about, were you thinking about leaving medicine altogether with that too.
Yeah, and you know, I mean, we talked about midlife crisis, I still have thoughts about how I want to spend my time. I don’t want to leave medicine, but I do want to have the most impact that I can with what I have.
And, you know, that may not look like seeing patients nine to five, five days a week.
I do want to see patients, but I do want to see them on my terms.
And I do want to see them in the way that I think is best for quality health care.

[13:29] Yeah, really important piece there. really glad you said that and I’m glad your wife also helped you realize it.
She’s smarter than I am.
Yeah. You know, there’s quite an investment and just because the model of how to be a dermatologist that is predominant is the one that you may have started with, it doesn’t mean that that’s the only way to do things. And I know that you do some coaching as well.
I certainly hear this in some of my coaching clients that there’s this limiting belief that there’s only one way to do things With all my training so good for you. Good for your wife. Yes.

[14:08] So what did you open yourself up to I think?
Opening up to a new way of health care delivery that was different than I was trained in. Because you get trained in a certain way where the knowledge is the determinant more than anything in my opinion for how we were trained. And I think going forward, knowledge is going to be nearly universal. Meaning if you’re a patient, you can have almost the same access to knowledge as I have. It’s not just in a book in a library somewhere that you studied. You actually can have a subscription and you can get all this information. And now it’s going to be relationship-based with the patient, more of like art slash wisdom with the patient, able to, you know, how do you distill what’s important out of that will be the skill that is nearly irreplaceable as I see it, even with AI technology. And all at the same time remembering that I do not think there’s any substitute for medical training, and I think it’s getting washed out a lot with all these TikTok influencers versus an educator versus a actual deliverer.

[15:26] I don’t think there’s any substitute for the MD. I think we’re entering a very scary time where people don’t fact-check, aren’t interested in nuance, aren’t interested in the scientific method. They’re interested in noise and excitement. And you know, that’s fine, but I don’t think that’s a good way to go about healthcare most of the time. You know, I think there’s a There’s a little, you know, certain things probably fine, but I think devaluation of the MD, I think that’s a systemic move that whether or not it’s conscious on the part of big medicine, where, because physicians are more expensive, and, you know, I think that PAs and MPs are cheaper in the system, they’re more mobile, they’re more interchangeable.
And so I think there’s a de-emphasis on the MD. You see it when people are called providers, instead of calling it by their name.
I think that you should be a doctor, PA, and an MP, whatever you went to school for.

[16:21] And if you have a problem with that, now I’m getting excited, Dale. I’m sorry. I hear you.
If you’ve got a problem with that, go to medical school. And if you want to say, okay, I want to practice independently because of shortages. Well, if you look at the data, people that practice independently don’t go to rural areas where there’s a shortage. They stay right dang where they are. So again, I think there’s no substitute for it. I don’t know if of the public knows to care enough to influence policy around that, but I do think it is the best. I think sometimes we have to tell the public what they need to know and be informed about. Right. So you, in this med life crisis that you had, you got activated as you were kind of revisiting your unique path. What were some of the things that you did concretely to help you explore what else as possible for yourself.
Working in some manual labor jobs, but I also really like creativity. I’m futuristic thinking so that blend for me, I like and I got into I did a couple leadership programs with North Carolina Medical Society, Year-long programs which were really great for networking. I thought of networking as a dirty word for a long time, I’m very merit-based person, but I.

[17:45] Really was refreshing to meet people in that space who are also interested in making change in medicine and I made a lot of really great friends, which also has been very helpful for me that I talk to.
So I took some of those, I got into meditation or mindfulness.
I wrote more, I started a blog. I realized that I always knew I was a good writer, but I enjoy writing, it’s good for my mental space. So it just gets it out, I have a lot of ideas.
So that’s been helpful for me. And then I did the year long coaching program, which you probably know this, But when you coach, it’s more exciting.
Honestly, I love coaching because I get a rush when someone has a breakthrough.
So it’s like so energizing to coach because you get to see, celebrate in other people’s successes.
And I would say assuming some leadership positions. So being president of Mecklenburg County Medical Society and realizing that a lot of times in leadership positions, you don’t really know what you’re doing.

[18:46] But I’m really good at accumulating people around me that I think are difference makers.
So kind of learning your strengths and learning what you’re not good at too.
Yes, I just want to pause and kind of reflect back what I just heard.
So you’re in this practice, you know, a multi-specialty group.
You get, you know, do some contemplation, some reflection, doesn’t quite fit for you.
And then you open yourself up to some other possibilities to explore some other facets of yourself, as well as some other ways that you could be expressing your interest in the profession of medicine by getting involved in state medical society, local medical society, as well as get some added training, both for personal well-being, mindfulness as well as coaching, and all of this.
I mean, boy, when you got activated, you get going, And you’re in practice all this time.
Yeah, yeah, and you know that goes to a little bit of my point is I had to kind of as I, Turned it, you know starting in practice Push the boulder for a while. But now I’m kind of at a point where I.

[19:56] Have some support around me where I can back out a little bit I still always want to practice because I think if you’re not attached it’s like when we got a talk at a that a thing for malpractice talk about burnout.
And the guy talking was talking about all these things to help with burnout.
And then I realized that he wasn’t even practicing more probably because he burnt out and then he gives talks about burnout.
So I want to always be in the game, but yeah, can I create these other areas that give me that fill my cup and also conserve our society as I see medicine in a really tough spot right now.
It’s a very dangerous place as I see it for physicians and patients, honestly.
Right, so just want to go back to practically, then you then explored and went into solo practice.
That was kind of one of the ways that you regained some agency and was a way for you to creatively express the things that you and I are talking about right now. Is that right?
Yeah, and I am still part of Piedmont Healthcare, but I have my own practices, kind of like a franchise model, I say.
So I see. So you’re an independent business unit, and I was a shareholder, so I said, hey, I’d like to move my practice here.
Now, I moved it to a place where I had no referrals from them, so they’re doing a lot of back-end stuff, and I had to generate all the new patients, kind of.

[21:17] But I didn’t go 100% on my own, but I also went away from the mothership, and I had no other docs with me.
Yeah, so if you don’t mind, let me just ask a couple questions about that transition.
What hesitation did you have making that transition?
I want to say, I got chills thinking about it, but you kind of get away from, as you get further down the system of where you put it on the line.
And it’s scary, but you know, there’s only a couple of places where you feel it, where I felt that in my life, where I’ve really put it on the line.
Cause a lot of times it’s everything’s safe, especially when you have your MD, it feels pretty safe, but it felt like I was putting it on the line. Like there’s not a guarantee.
And this is, you know, June of 2020. So you could conceivably not do well, right.

[22:05] It was, it felt like, all right, let’s see what you got a little bit, which was scary, But I feel confident in my abilities and it just felt invigorating.
It was like scary, exciting, which I think is where we should aim all the time, kind of the edge, because you see what’s possible.
Yeah, you can mess up, but you just have to know that you have the skills to succeed even if you mess up.
It’s scary, but you did it anyway. Yeah, scary, exciting.
In line with my general purpose, but that was very invigorating, just kind of the knowledge that it’s not safe and.

[22:48] Not that anything ever is, but it just is a little bit more on the edge.
Yeah, sure. So, I asked you what was a sort of hesitation, but, and you mentioned earlier some people that are close to you that were helpful for you during your thinking. Anything else that was helpful for you in making that transition?
Yeah, I think just knowing I was ready for it and I felt my gut on it and it just was a little magical. It was a letter that came in the mail that I don’t normally read. And, you know, sometimes you just have to say, wow, this is really serendipitous. But, you know, I had prepared myself all that time for that. Again, in retrospect, I was open to the possibility of that, and it just came. Yeah, it’s interesting you’re talking about, you know, just in your gut, noticing that. The individual who is in the podcast prior to this one in Life Changing Moments, we had a whole conversation about trusting your gut. That’s with Dr. Sheila Kilbane, for those who hadn’t listened to it. And what that means to her. And how do you really.

[23:56] Know that that’s, what does that mean? What does that mean to trust your gut? And so, I invite people to take a listen back to that. You’re illustrating another great example of that.
But I also think one more thing on that because I feel like I get a lot of opportunities and sometimes I feel like there’s a false gut that is – I have to be aware of bias because right now I have an opportunity and I’m like, is this a fake gut or is this the real deal?
So I have to weigh that a little bit.
So how do you tell the difference between the fake gut and the authentic gut?
I think look at Dale’s coaching me now, and I love it. I think the real gut is.

[24:47] Damn it, I really don’t want to do this. I know I have to, because I can’t not do it.
And the fake gut is, it’s like tasting candy is the fake gut. It’s like, oh, this is delicious and exciting. But it’s not like, it’s like the real gut is like, you can’t you’re actually pissed because you know, you have to do that. And it’s incredibly inconvenient.
That’s great. I love it. That’s how I would say it, it’s like, yeah, you’re upset that you have to do it.
But you also don’t see any other pathway to, you know, really for yourself.
Yeah, that’s awesome. I love that.
I love this concept of the fake gut and the authentic gut. That’s great.
Well, listen, there’s such a wealth of wisdom that you have to impart to others as a result of these experiences. And as you know, you’re not alone in going through what you went through.
And my hope is that some people who are listening to this, who can identify with what you experienced, will be able to also take from this and trust their own gut. So what I want to do is just offer you, are there other lessons learned that you wish to impart to listeners that we haven’t mentioned just yet, as you’ve gone through this process?
I saw a stat that I think one in five physicians will be out of medicine in the next five years or something like that. really hope that.

[26:16] Physicians like I did really look in a heart and say this is something that needs us.
Patients need us and is it possible to do both?
Is it possible to change the system that you’re in and continue to provide value to that system and not just go where pharma is or you know the next startup?
I think I really hope that doctors dig in and are part of this solution because I think that is the only way that it works.
I think that coaching, silent plug for Dale, can help you get there.
I think there’s, again, physicians uniquely are very programmed through a lot of school to be people that are good boys and girls and play by the rules because you have to to get through the system.
And I think that has the consequence of us being more silent or not advocating more loudly in the system. And I think that coaching can help you find your true voice that we need.

[27:21] And finally, yeah, I think it’s a time for disruption. And I think that, unfortunately, again, it’s like the good gut here, that we can’t afford to be quiet. And I don’t like unionization. I don’t want to advocate that. But I do think we need to make powerful, powerful statements as physicians about how patients need to be cared for because it’s not right what’s happening right now at all levels. So get some coaching, talk to other doctors. I think it’s been very helpful. Be active locally because that’s very tangible, that’s been refreshing for me. So talk to other docs locally and get some coaching and have fun out there. Try to be the difference that you wish is out there. Yeah, that’s awesome. You know, Scott, one of the things that comes to my mind as you’re sharing what you just shared is, this started with a personal dilemma and you are still resolving, it’s not totally resolved, you’re resolving a personal professional dilemma by involving yourself in the wider system.

[28:30] And leaning into that, we’re all pretty busy and saying, I should get involved in these things outside of my practice can be a another thing to do. But what I’m hearing you say and inviting us is when you do that, you improve yourself, you improve your own lot in life, you open yourself up to some other possibilities for yourself that allow you to return to your unique path. I think you illustrated that very nicely in the story of you.
Yeah, it’s like when you’re really, really, really tired and your best friend calls you and you talk for 10 minutes and you’ve got three times as much energy now.
That’s kind of how it is when you find things. But you’ve got to think, what does that for me? What always gives me more energy, even if I’m tired?
That’s great. That’s a great question to leave our listeners with. Really, so that’s great.
So Scott, thank you so much for taking some time out to come back to the MD Coaches.

[29:33] Podcast family and help us understand more of the steps that you took when you had that your own sort of dilemma. I really appreciate it. And I know that our listeners are going to get a lot out of that. So thank you again for being with us today.
One more, Dale. One more tip for our listeners. It’s like dress for the job you want.
I like talking on podcasts, so I’m going to follow my own advice here.
I’m gonna get a podcast mic and earphones so Dale doesn’t get mad at me for not being prepared.
That’s worked for me many times. Get nice clothes if you want to speak in front of people, get the podcast stuff if you want, and then it opens up.
I mean, it sounds a little woo-woo, but manifestation definitely helps, especially if you’re prepared.
So just for our listeners to know, so Scott is using his computer, mic and speakers, and we try to avoid that when we’re doing podcast recording, but he really didn’t have anything else.
So his lesson from this is to do that for future invitations, which I’m sure there will be many.
It’s been a pleasure, Dale. Always good to talk with you.
Here are my takeaways from this conversation.

[30:49] Number 1.
Dr. Paviol may have created a new term. Med life crisis refers to the sinking feeling that can creep up on us like, here I am and this is not what I thought it would be.
Number two, how to work through it. Having conversations with close connections helps with clarity.
Because trusted others often see you better than you see yourself.
Just a word of caution, these trusted others have to have your best interests at the forefront.
3. Intentionally seek opportunities for self-discovery and be open to what else is possible.
Dr. Paviol got involved in physician leadership programs, enrolled in coaching training, and similar to my last guest, Sheila Kilbane, got quiet through mindfulness.
All of these had a great part in informing him of his next steps.
4. When contemplating another professional chapter, Aim for opportunities that make you feel scared and excited at the same time.

[31:53] When this happens, it is likely a true gut feeling. And as we also learned from Dr. Kilbane on the last podcast, trusting the gut aligns us with our unique path.
Finally, if you find yourself thinking, is this all there is?
Coaching offers a space for you to explore what else is possible with someone who definitely has your interests at the forefront.
As all of the coaches at MDCoaches are physicians, we’ve been there and we’re here to help.
For more information, please contact us at mymdcoaches.com.
Thank you for listening, and be well.
Some life-changing moments of your own. Join the conversation today.