Stop Calling It Physician “Burnout” With Oncologist Hardeep Phull

“I had a professor who once told me physicians are like the best employees you can have. They'll whine and complain a little, but in general, they'll do anything to get the job done. Even if it means staying up late at night to get their notes done, calling patients after hours or during lunch, or sacrificing lunch and not taking breaks.”

Dr. Hardeep Phull is an oncologist at the Palomar Health Medical Group and an alumni specialty director at the Cleveland Clinic. Known for his outspoken views on physician burnout, particularly in oncology, Hardeep is a forceful advocate for doctors getting paid what they’re worth. He’s also emerged as a leading voice on LinkedIn, where his honest insights about the good and bad of practicing medicine reliably spark conversation. 

In this episode of How I Doctor, Offcall co-founder Dr. Graham Walker talks with Hardeep about his journey in medicine, why "burnout" should be reframed as "moral injury," and why this is such an exciting time in oncology. Hardeep also shares tips for how physicians can maintain their purpose while still making money in their careers. Their interview is dynamic, contains practical advice and big ideas, and useful career reflections — here are five key takeaways:

1. Billing requirements have ruined oncology notes

“I've recently had some doctors complain and tell me, "Where the heck is your actual plan, because all this stuff you're writing — do you get paid by the word or something?" I say, "No, it's that it helps to make sure it's compliant." And I'm just thinking, "Who am I serving here?"

Hardeep believes notes on chemotherapy patients should be short and simple — something like: “Patient is back again today for cycle number three. Had a little bit of neutropenia and nausea on the last ones. Doing well, PET scan in two months, continue treatment." Unfortunately, the notes Hardeep actually writes are long and stuffed with jargon — because that’s how oncologists bill for their work. Billers have told Hardeep to make sure visits and problems sound “complex” and “high risk.”

2. Burnout should be called “moral injury”

“At some point your mind just recognizes you're not being present; you're just kind of going through the motions to get work done. That, over and over, is what I think is moral injury. It's disconnecting from purpose.”

Burnout is a problematic concept in Hardeep’s view because it places blame on individual doctors who can’t handle their workloads rather than a system that stretches them beyond their capacity. He makes the case that using the phrase “moral injury,” a wartime term, is a better framing. It captures the psychological toll of witnessing or perpetuating atrocities, as well as the loss of passion or purpose that can happen as a result.

3. COVID made doctors rethink their priorities

“I think it gave us the freedom to actually speak out because it was finally almost recognized — ‘Oh my gosh, doctors are important and look at them on the front lines showing up to work.’ It's crazy to think back, but many of us thought we wouldn't make it out.”

COVID forced Hardeep to reconnect with a different sense of purpose. During the pandemic, doctors gained acknowledgement for their tireless efforts, but they were also risking their lives and drowning under unsustainable workloads. Hardeep’s realization that he “could be gone in a week” — and also that his decision to moonlight at an urgent care ER could have health consequences for his cancer patients — caused him to take a step back and reflect.

4. Targeted drugs are revolutionizing cancer treatment

“We have so many [drugs] in our repertoire — five, six, up to a dozen for every cancer, for which at one point we had one or two, which were 50 years old. And there's new ones every day. So, it's a very exciting time.”

Twenty years ago, a metastatic cancer diagnosis was often a death sentence. But innovations in germline testing and an influx of new targeted drugs are helping patients with advanced cancer live for years, managing the disease like a chronic illness. In fact, there are so many new drugs that the biggest hurdle is figuring out how to use them — i.e., do you combine therapies together as a first line or use them sequentially one by one? There’s an ongoing debate, but Hardeep says most doctors and trials are starting with a combo of immunotherapy and a targeted drug or chemo and then continuing with a maintenance protocol.

5. Doctors should start accumulating wealth as early as possible

“Be humble enough to realize that you could lose it all, and protect your assets.”

Though it’s hard to put money away during internship and residency, side gigs are the best way to do it. Hardeep picked up extra shifts at nursing homes and an urgent care ER. Another financial tip Hardeep offers is to protect yourself against the various liabilities that come with being a physician. That means getting every form of recommended insurance plus a really good umbrella policy.

Connect further with Hardeep on LinkedIn here.

To make sure you don’t miss an episode of How I Doctor, subscribe to the show wherever you listen to podcasts. You can also read the full transcript of the episode below.

Offcall exists to help restore balance in medicine and improve the wealth and wellbeing of physicians. Sign up for Offcall here to bring about more physician compensation transparency and join our physician movement.

Transcript

HP:

Seeing people at their most vulnerable moment in life and providing hope and help, there's not very many feelings in the world better than that. It's a journey. It's a marathon, not a sprint. And the other thing I tell my patients is that go through all the stages as you're supposed to for your grieving, let's just call it, the shock.

Graham Walker:

Welcome to How I Doctor, where we're bringing joy back to medicine. Today I'm talking with Hardeep Phull, an oncologist at the Palomar Health Medical Group and Alumni Specialty Director at the Cleveland Clinic. Hardeep is a prominent voice on the subject of moral injury and physician burnout, particularly for those in oncology. He's extremely outspoken and a really passionate advocate for physicians, and I think personally it's critical that all physicians, we learn how to talk about this openly and honestly and as well-spoken as Hardeep is about the subject, so we can advocate for ourselves and for our patients. Welcome to the show, Hardeep. Thanks for joining us.

HP:

Oh, Graham, I mean I'm really flattered. I would say exactly the same about you.

GW:

Thanks, Hardeep. Yeah, I think it's important that we represent ourselves, whether it's on social media or in the mainstream media, to let people know what's going on in medicine and advocate for our patients and good care for our profession as well.

Maximizing your worth isn't "gaming the system"

HP:

Physicians don't have unions. Every other labor group tends to have unions, and we've never done that. In a way, social media has now turned into this way, especially like professional networks where we met, Graham, like LinkedIn, where you can have professional discussions and leave out a lot of the, let's say, side discussions or the funny cat videos. Those are fun too, but you can have really, really good conversations on different topics.

GW:

I totally agree, and I think traditionally medicine is a bit tribal, especially by specialty. Part of what we're doing with How I Doctor is we're really trying to help doctors, I think, see that we are stronger together and that we have an ability to control our destiny a little bit more if we are all rowing in the same direction and working together too.

HP:

I love what you're doing with Offcall. You know what I think physicians are very bad at, it's negotiating for themselves. I mean, I had a lawyer for most of my positions where they did a contract law, but even then with big health systems, you have literally no negotiating power. Independents who own these private practices, they're being bought out by private equity left and right which then conglomerates to the hospitals. So I'm sure you see these trends up in the Bay Area. I think this is nationwide at this point.

GW:

Yeah. It feels like there's no one representing our voice, but ultimately it trickles down to the amount or the quality and the quantity of the care that we can actually deliver to our patients. If we're being asked to see more complex patients in the same amount of time or see more patients in the same amount of time, that has to come from somewhere.

HP:

I had a wonderful professor who once told me, "Physicians are like the best employee you can have. They'll whine and complain a little, but in general they'll do anything to get the job done even if it means staying up late at night to get their notes done, calling patients after hours, before hours, during lunch, sacrificing lunch, not taking breaks."

GW:

It doesn't actually serve the greater good or serve our patients or serve ourselves to burn out or get sick or develop medical or mental health problems.

HP:

What's interesting, Graham, is I learned most about this topic in training, not because I was burnt out, but because I saw ER physicians start this FIRE Movement, the financial independence retire early. And I always thought to myself, "You guys just started. Why are you retiring so early?" And then they would show me. Then I even moonlighted in the ER at one point, and I realized was, "Wow, that's a whole lot of excitement to pack in one day, and that's what you do in one day and how many shifts do you have?"

But what they showed me was that's not everything in life, and we're not greedy. We're not trying to game the system or make money, but here's what you can do outside of medicine, have side gigs, have passive income. All of them owned real estate or had companies on the side or side gigs, and I was like, "This is incredible. How come no other doctors are teaching me this? Why aren't oncologists doing this?" I remember during residency saying to my director, who didn't like this, I said, "Residents should get 15% of work RVU so that they work harder, and they get some back."

GW:

Interesting. That's interesting. Yeah.

HP:

I was just like, "Why can't I also bill? Why can't I learn how to bill?" The other thing is learning how to bill, how do you bill high and get what you're worth for what you did? Once I mastered that and learned, unfortunately learned, that it's all about how you write your note and what words and jargon and all this that you write, which are arbitrary phases to be honest. These types of things make a difference at the end of the year when you generate way more RVUs for example. It's interesting how you learn that over time, but you learn it by being on the front line, not necessarily protected in a training program or in a clinic. You don't always see that type of attitude, that work hard, but capture what you're worth and think about an exit plan to be free. Work because you want to work not because you have to get a salary.

GW:

What physicians want is they want to be paid for their work that they do, paid fairly for it. It feels like everybody else in healthcare is getting paid for the work that they do, and physicians just want that as well. It seems quite reasonable to me. Do you feel like in oncology there's a lot of little phrases and information you need to include in the chart to kind of prove the work that you're doing to care for your patients?

The problem with medical notes

HP:

In general, yes. You have to show it's a complex visit, especially for a patient on chemo. If you asked me, a note should simply be three or four sentences like, "Patient is back again today for cycle number three. Had a little bit of neutropenia and nausea on the last ones. Doing well, PET scan in two months, continue treatment." That would show everything I need to know and what happened. But what we write in notes are very arbitrary exam. They're not actually healing touch, they're more like, "Clear to auscultation bilaterally." Here, it might be, but how about you write, "Patient was tearful today, very emotional visit, provided reassurance, put my hand on the shoulder, and patient greatly appreciated the empathy." That wouldn't meet the billing requirement, but that would be a more healing touch.

And then as you go to assessment and plan, billers have told me, "Make sure you make it sound complex." So giving chemo, so make sure it's life-threatening chemo. "Okay, I can write that in I guess." "And then at the end, make sure that your problem is a high risk problem." "Okay, it's a cancerous problem." "What stage?" "Okay, it's this stage." Basically you get, I've turned my note template into a bunch of check boxes, and I'm so good at it now that I don't even think what I'm doing, but all of it is, it adds like two pages, and I've recently had some doctors complain and tell me, "Where the heck, man, is your actual plan because all this stuff you're writing, do you get paid by the word or something?" And I said, "No, it's that helps to make sure it's compliant." And I'm just thinking, "Who am I serving here?"

GW:

You said two things. One, you mentioned what a note should be, and I feel like a note used to be. I mean back when I was in med school, we were mostly on paper still, and so the attending note was like five lines. That's all you need.

The other thing that you mentioned is you have to prove, this is insane, right? You have to prove to someone or the system that your patient, who presumably has active cancer, they are getting chemo. Even if they are in remission or have no evidence of disease, they probably, many of them, are complex because you're seeing them again. And so the idea that you have to then prove that, I mean who are you proving it to? Hardeep, tell me a little bit about what are the intangibles that are not monetary compensation that make you enjoy oncology?

The most rewarding parts of oncology

HP:

I think seeing people at their most vulnerable moment in life and providing hope and help, there's not very many feelings in the world better than that. It's a journey, and it's a marathon, not a sprint. And the other thing I tell my patients is that go through all the stages as you're supposed to for your grieving, let's just call it, the shock, the denial, the pity, the slow acceptance. You must be a human being. If you didn't come in emotional, I would wonder what's wrong with you. It's okay to be actually. Be a human. But we can still help defeat some of that fear. And to be honest, it just takes meeting with the oncologist and putting it all into context on that very first visit. Say, "Here's the plan, here's what we're doing next."

And then for patients to realize that most things are curable or very treatable in chronic illness. What a luxury in today's society that even metastatic cancers of certain types could, people could live for a decade or longer, so you can make it a chronic illness like diabetes or hypertension. So once you start explaining that context, show them you got this, and then if you need chemo, most patients under the care of an oncologist, do very well. It's just a matter of starting, and it's not doom and gloom.

GW:

When I tell patients bad news as well, I say a similar thing to them. "Whatever you're feeling right now is totally normal." And I say this exact same thing, "I would be way more worried if you weren't having a reaction. The fact that you're upset, the fact that you're angry, the fact that whatever it is, that's a good thing."

Hardeep, let me ask you a little bit about your work and your thoughts on burnout. How are oncologists specifically thinking about burnout? Is it affecting them more or less?

Going through the motions causes moral injury

HP:

I think COVID brought it out in many professions to be honest. Burnout puts it on the individual. This is your fault, you can't handle the work, this must be a problem of you. And moral injury is actually a bigger issue, a wartime kind of term because soldiers would see atrocities committed on the battlefield, commanded by their leading officers to do this and this, and then they realize the moral dilemma of what they're doing and whose lives they're permanently changing or taking away. And so it's very easy for doctors on the frontline to undergo moral injury and then just lose that sense of passion and purpose.

I think 99.999% of doctors go into this field for the right reasons. I think it's okay to seek compensation for what you're worth. I think it's okay to pick a profession that you're talented in and that you like or even has a good lifestyle because then you'll be more rejuvenated to practice longer, let's say.

For an oncologist, I don't think it's just about doom and gloom and who's dying, and it's your fault. I don't think that's really the burnout. I think it's recognizing, "Oh my gosh, I don't have the capacity to see all these patients with these complex issues. I don't have the time to spend with them that I want to." Maybe a 20-minute visit of which 10 is exam and talking, 5 is formulating a plan, and then hopefully 5 is enough, as you run back to your office to write a note, being disrupted at least four times on the cell phone, text, Teams, nurses or staff asking you questions, pharmacists saying, "Do you want to reduce the dose of this?" "Oh, here's a refill. Sign this." "Sign these forms for this prior auth." "Oh, you're on a call right now with a peer to peer. Can you do that in between?" "Oh, sorry you didn't write your note, but that's not important."

When you do that back to back to back to back and you're not spending time with people, even with a scribe, this doesn't matter. I'm just saying when you're doing that back to back, at some point your mind just recognizes you're not being present, you're just kind of going through the motions to get work done. That, over and over, is what I think is moral injury. It's disconnecting from purpose. I'm not doing what I was meant to do, which is see people, help them provide a healing hand, but I have to do that. I have to review labs in between and take phone calls in between. I'm not going to have a personal assistant necessarily or a second doctor doing that while I do this.

GW:

That disconnection from purpose kind of reminds me of in med school and residency we would talk about scut work, which is like, "Oh, you need to call the family. That's scut work." And it's like, no, actually that's important work that just comes with delivering healthcare, but it's when the administrative tasks become the focus of the majority of the time, and you actually can't spend the majority of your time focusing on the humans you're trying to help I think is when it seems particularly difficult.

Do you have a sense of what did COVID do to oncology or why did COVID make this bubble up to the surface for so many of us?

COVID forced doctors to rethink their priorities

HP:

I think it gave us the freedom to actually speak out because it was finally almost recognized, "Oh my gosh, doctors are important and look at them on the front lines showing up to work." It's crazy to think back, but many of us thought we wouldn't make it out. We thought, "Today I could be on a ventilator. I could die today." It's so crazy we would think about that, about a viral infection, and of course hindsight's 20/20, but who knows how much of that was fear mongering, but you can't argue with what we saw. It's very humbling.

I really think a lot of it was just COVID, beyond just the workplace where my work was actually busier, on weekends, I would actually spend more time being present with my family. You couldn't go anywhere. You couldn't just say, "All right, kids, you go to the neighbor's house, you go to a movie, you go to practice." So if you ask me, it was like reconnection with a sense of a different purpose that, "Oh my God, I'm not here just to work." I think there's just something in us that recognized, "Oh my gosh, we're underappreciated. Oh my gosh, we don't focus on the things that really matter in life, and yet we're great, and we're getting all this recognition, but how is this sustainable?"

GW:

I think you're right. COVID forced myself, a lot of us, to think, "Well, what do I want out of this life? I am going to have to stop just going through the motions of, 'Oh, I got a shift. I'm just going to work, see my patients, work my 12-hour shift, and come back home.'" And I wonder, Hardeep, if it hit on that, the thing where doctors, we don't think we can get sick. We think it's the patients on that side of the table that has the illness, and we can't get it. But COVID proved that to not be true. Well, I don't know. I think it really did hit a nerve of, "Holy crap, I could just be gone in a week."

HP:

I can't believe it's all coming back, but I was working at a urgent, more like an urgent care ER, but not ER like you work in, but more like an urgent care. And when COVID happened, it's like I wanted to be there, I wanted to help, but I was selfish, and I felt selfish because I was thinking to myself the whole time, "You idiot." I mean I was doing it for fun and I enjoyed the skills, but I was just thinking, "You idiot, you're doing this to make extra money as a side gig, and you may give this to every cancer patient you've met and now you're going to give it to your family. So stop moonlighting." And it was a recognition that, "Okay, I can't do that."

But I also remember the gyms closed and I was kind of in the best shape of my life finally. After many years of training and fellowship, I was finally getting ahold of my health, and the gyms closed, and I remember at one point I stopped going because there was a renowned bodybuilder at my gym who was intubated with COVID and was super sick, was on all the news channels, and we thought he was going to die, but he made it, thank God. He was healthier than I was, literally the most healthy and the most kind person I'd met, and he's the one who ends up on a ventilator.

And so then I stopped working out. That really eroded at me years after COVID when I was like, "All right. COVID's over, get back in the gym. This is no excuse anymore." And I'm proud to say today, in the last several months I've finally started that and committed to that journey from what I was on four years ago. It took a long time, and to me, that's actually helped me with burnout in a way or moral injury, recognizing that sense of purpose I had and recognizing don't make excuses that don't exist.

GW:

Let me transition a little bit. What are some of the shifts? You mentioned people with stage four metastatic cancer, some of them with some disease subsets can live decades with some treatments, which, I was in med school in the early 2000s, stage four equaled death in some, usually relatively short period of time. What are the changes that are happening just in the past couple of decades are changing cancer therapy?

Targeted drugs are changing cancer treatment

HP:

Really it's important to first define concepts. For every patient who shows up in my clinic, some have just benign hematologic abnormalities, some of which are temporary, some of which are due to inflammation or stress. I'm sure you see leukocytosis in the ER. You don't freak out and say, "That's leukemia." But my patients who have it say, "Could that be leukemia? Because I looked it up on Google." And the idea is we can rule it out, don't worry. Here's some tests we're going to do, and we'll prove it's not that, and we're going to check off what it could and could not be. So we look at that, and I think it melts away people's fear when they realize, "Okay, this is just a benign heme thing."

As far as cancer, that's a very big arching term, but we're really talking about solid cancer, tumors. Not all are palpable. Some are found incidentally. Incidental findings do not prove a diagnosis. Just because I see something in the pancreas does not say that's pancreatic cancer. But one key concept in oncology that I say, it's a rhyme, it's the fact that tissue is the issue. You need to have a pathologic diagnosis, cannot look at a picture and say, "Well, you got that. Here's some chemo for you." Got to prove it.

We talked about coding earlier. You have to actually put the ICD code of a known diagnosis. You can't just say mass in abdomen and get chemotherapy approved by any insurance company. You have to.

Say pancreatic adenocarcinoma, stage four, whatever. But then the next steps, you just said innovations. When I was in high school, the Human Genome Project was being talked about, and they were sequencing the genome like, "Wow, this is going to be game-changing." And when I got to med school at the Cleveland Clinic that was actually entering trials and people doing genomic studies. I remember it used to cost a hundred thousand or more dollars. You had to buy expensive sequencers and do things in-house, and it was all research purpose only. And by the time residency fellowship came around, it was more common, but it was still in the 5 to $10,000 range.

If you look at now, you can now get a full genomic study on a patient, usually with a hotspot of genes like let's say, 500 plus cancer causing genes and mutations from the blood, from the tissue itself, from their saliva to look at germline testing all in a matter of a week to two. I mean insurance is actually the longer time it takes them to test it. To get it authorized takes longer. But that testing then tells you, "Here's what your cancer is doing on a molecular level and here's some mutations that may provide you some targeted treatments or immunotherapy perhaps." And it's all covered by insurance. It's rarely more than a hundred bucks cost to the patient.

That, I think, if I were to think of the single biggest innovation, it's that and then knowing what to do with it. We find new mutations, but what does that mean? Is there a drug? Is there a target for it? So then drug discovery. I speak for several pharmaceutical firms, not because I'm greedy, but because I learned so much from our pharmaceutical partners, how much it takes to get a drug from lab bench top to trial to pass trials to get to phase three and then to market is if you took bets on it, you would lose every time. It's so rare.

So I applaud all these people trying to improve cancer care, and you see that. Every drug we have, we have so many in our repertoire, usually if not five, six, up to a dozen treatments for every cancer for which at one point we had one or two, which were 50 years old, and there's new ones every day. So my point being that it's a very exciting time. We have so many tools, and we can test people in so many ways and then even monitor for recurrence, not just with scans and labs, but then DNA circulating tumor cells as monitoring for relapse.

GW:

So that's fascinating. When I read my colleague's notes, I definitely see more gene mutation-y stuff in there, and I don't know what the hell to do with it, but I'm sure you guys do. Mostly what I hear about in the media, I mostly hear about the therapy improvements, immunotherapy, CAR-T, all that stuff, but it's interesting that you are really saying it's more a focus of improved diagnostics and understanding what the tumor or the body is doing at a cellular level so that you then can figure out what potential therapy options exist.

HP:

Everything is targeted. So targeting means you must know what you're dealing with and have that test done soon, ASAP. I think that there's a repertoire of treatments, and there's different lines of treatment. We talked about marathon and journey compared to spread. The idea now is to use everything in sequential order. And now really it's like the biggest catch-twenty-two. Now the biggest hurdle is we have so many drugs. What do you use? Do you use a combination up front? You combine everything and just get the biggest possible chance for remission at first line, or do you save stuff and sequentially use it one by one by one so that you have a longer journey? But will the longer journey mean less deep response and therefore less chance of cure? It's an ongoing debate, but most people now and most studies are moving up immunotherapy and some sort of targeted option or chemo in the first line, and it gets a massive response and usually use some sort of maintenance drug, whether it's targeted oncolytic pills or immunotherapy then as maintenance.

GW:

Hardeep, in our last few minutes, I have some kind of rapid-fire questions for you. What is something that you didn't learn in medical school but is crucial to your daily practice as an oncologist?

HP:

Realizing what you want to do and what the plan is not necessarily what everyone agrees with, and you have to sometimes adapt and pick something that's more in line or compromise or sometimes get on the phone and do an appeal. I now try to think of the other person on that line, and I say to myself, "They probably don't want to do this, and they probably don't have all my records. The better I make it for them, I ask them how their day is. They ask me how my day is." And to be honest, that technique of not being angry, and that's what it takes, and it's unfortunate it takes that, an extra step and me being empathetic to an insurance reviewer. That's something I never learned, and it's a skill to be honest. It's a skill to do that well.

GW:

If you could send yourself one message on your first day of residency, knowing what you know now, what would you tell young Dr. Phull?

HP:

Don't change a thing. You're in the right place at the right time. Nobody knows this. In fact, my program director didn't know until four years later, that I wanted to quit the entire time of my intern year.

GW:

Wow.

HP:

I was going to do urology in med school. I loved it. That's all I talked about. I was the silly, goofy urology, jokester in the back, always snickering about genitourinary jokes. I mean literally so such a different person than now. I mean, I still joke, but not quite in the same ways. But a mentor told me, and what a great mentor, that, "Your skills are in medicine. You're a better medicine doctor than urologist. You could still do it, but try an internship in medicine. You may love it." And I loved it. And my mom is an oncology nurse, so I'm like, "Why didn't I think of this earlier?" And in fact, looking back, everything I've done, if I had written the journey myself, I wouldn't be where I am. It would be a contrived path that won't be as happy as it is now. You have to struggle a little, but you also find opportunities and things to do that work out for the best.

GW:

Hardeep, what's the best financial advice you've ever received?

Financial advice for early-career doctors

HP:

Saving, first of all, is really important. Saving money especially, it's hard to do in residency and internships, but accumulating wealth. And you have to do that with side gigs. And my way of doing it was nursing homes and urgent care ER. And then the other thing is risk mitigation. Someone once told me a financial advisor saying, "You could be as rich as you want, but you don't get to take it to the grave. And second of all, if you don't protect yourself, all the liabilities as a physician, life insurance, disability, really good umbrella policy, et cetera, on top of malpractice, you could lose it all." So being humble enough to realize that you could lose it all and protecting your assets while accumulating wealth. Current residents and fellows coming out, I pity them. I don't know how they can buy an entry level three or $4 million condo. That's what they're going for right now. That is ridiculous. I just don't know how that's sustainable for a doctor to not be able to have housing, much less nurses, assistants, front office staff.

GW:

Hardeep, where can listeners find you and how can they support the work that you're doing?

HP:

Sure. I mean, look me up on LinkedIn. I mean I post a lot about the things we've talked about, and I write a lot of articles and post those. That's the best way, I think, to reach me.

GW:

Perfect. Well, Hardeep, thank you again for taking the time before your busy clinic day away from your practice and your family to spend time with us. I really appreciate it.

Thanks for joining me today. For more strategies on managing burnout in health care, visit offcall.com/podcast. Make an account on Offcall to confidentially share your details about your work and sign up for our newsletter where you can hear more about the latest trends we're seeing in physician pay. You can find How I Doctor on Apple, Spotify, or wherever you listen to podcasts. We'll have new episodes weekly. This has been and continues to be. Dr. Graham Walker. Stay well, stay inspired, and practice with purpose.