Chrissie Ep 28 (Kara)
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Kara: [00:00:00] work has always been my drug of choice because it can just totally immerse you and I can totally avoid the real recognition of like what if this is not it that little like niggling voice that was there getting louder and louder that I wanted to ignore because it was easier to feel the pain of what I knew than the uncertainty of something new.
Chrissie: I want to be the physician that I would want to be seeing. I Most of us aren't doing medicine the way we would want it to be done for us as patients. We're just trying to survive.
Kara: before you know it, like, you start building this confidence. Because confidence is not something you wait for and then decide. It's retroactive. So you have to start doing the things and then building the confidence that you can actually do it. So that you keep moving forward.
Chrissie: You're listening to Solving for Joy. I'm your host, Dr. Chrissie Ott.
[00:01:00]
Hello, everyone, and welcome to today's episode of the Solving for Joy podcast. I get the distinct honor and pleasure today of introducing you to my friend, Dr. Kara Pepper. Dr. Pepper, which is just fun to say, Is a board certified internal medicine physician and executive coach based in Atlanta, Georgia. She specializes in caring for adults with a particular focus on those with eating disorders. She blends in person and telemedicine care, emphasizes patient autonomy, clinical excellence, compassion, and connection. She is a powerhouse in clinician wellness and offers coaching to individuals, organizations, leads retreats, and speaks nationally on many of these wellness topics.
She also has her own podcast. It's Not Just You, diving into stories of survival, humanism, and heroics in medicine. Another thing we have in common is the [00:02:00] world of micro practices. So Dr. Kara Pepper is a micro practice Maven and currently leads a micro practice mastermind for physicians in or thinking of starting ideal micropractices. So I am so excited to welcome you to the podcast, Kara. Thank you for being here.
Kara: Thank you for having me.
Chrissie: Absolutely. So on the Solving for Joy podcast, we often start with a little bit of backstory, and I would love to invite you to share what you find, um, share worthy about how you got where you are today. What, what parts of this hero's journey, um, would you like to share with the solving for joy audience?
Kara: Uh, I appreciate the very open ended introduction. Thank you. Yes. There's so much to talk about in, in that way. I mean, uh, I think it's really interesting when we look in the rear [00:03:00] view mirror at our lives because you can add up all the little cobblestones and milestones that got you to this place. Um, you and I were talking about how we had a background in, in dance, so I was a professional ballet dancer, um, left home at 13 to move to Russia and train. Thought that I was going to be a ballet dancer, never thought I was going to be, uh, go to college, but eating disorder injuries derailed my career.
Chrissie: Same, except not the Russia part. I just moved to Florida yeah.
Kara: Well, I've been going to Florida after all that. Yep. So. danced and then, um, you know, of course didn't want to like feel any feelings of grief around that. So I just obviously went to med school because you can totally submerge yourself in work and not ever have to think or feel. And so I was really, really good at med school because I was really good at working hard and avoiding my own needs. And so I looked great on paper. And joined a really high performing practice and just kept kind of [00:04:00] sprinting forward until about seven years into my career just could not get out of bed anymore because I was so burned out.
So I was profoundly ashamed and thought that there was something wrong with me, um, because I had physical body needs like, you know, sleep and food. Um, and so I took a sabbatical and in that window of time the best thing happened is that I had, all these people come to me, like I had the answers. I mean, I was clueless. I had no idea what I was doing, but it showed me that so many people are struggling and no one's talking about it. And so it started me on this kind of journey on like, how, how do I figure this out? There's got to be a solution, right? Like I'm a problem solver.
So I kind of rearranged deck chairs on the Titanic of my career for a long time until it finally came to me that I actually don't have to work like this anymore. I can actually just be happy. Um, and I'm worthy of not feeling totally exhausted at the end of every day. And the pandemic came along and really showed me that I would regret the way I was [00:05:00] spending my life, which is, looks great on paper and feels absolutely terrible. And so if you ever want to know what drives your behavior, You should quit the self medicating behaviors you have.
So I quit my job and I quit drinking alcohol within six months of each other. And wow, I learned a lot. And ultimately that led me to saying, I want to do life differently and I still want to serve patients. And I want to build something that feels good for me and my patients. And so that's what led me here. I'm three years into solo practice and I'm helping other physicians do the same. And I feel the best, most connected, most grounded, most purposeful that I've ever felt in my life. So that's the short version.
Chrissie: That is such a tightly encapsulated version and so much to unpack. Dang. Um, I mean I could just start with 13 year old moving to Russia. We, oh my gosh, there might be a few feelings to unpack. [00:06:00] I love the description that you're great at working hard and not feeling feelings. I think that, um, so many people in medicine and in other high achieving lanes, um, would identify, right? We're so good at working hard and working on top of whatever feelings are trying to be felt. And yeah, there's a lot of self medication, whether it's numbing with you know, watching, uh, I'm laughing because I just finished watching, like, totally binged all the seasons of The Equalizer with Queen Latifah. And if you do need some time to rest your brain, I'm just gonna highly recommend it. Yeah. Little vigilante action. Plus, she's just amazing in everything that she does. [00:07:00] And rearranging deck chairs on the Titanic, how did you do that in your, in your medical career? What did that look like for you?
Kara: Yeah, I just thought I was the problem, not the system, not the social construct, not the expectations, not the culture. I just thought it was me. So I thought like, okay, great. I'm going to get certified to be a coach so that I can help my patients and that will make this feel better. They will be healthier and less burdensome, perhaps. Or, because patients are a burden when you're burned out, right? It's not the patients, it's you, but I didn't know that at the time.
Um, I, like, got certified to do, like, menopause care, which is a big part of my practice now. But I thought, okay, if I can just, like, find this new academic interest, I'll be more engaged in work. I took on leadership responsibilities. If I can just, like, be a leader, then I can, like, fix the problem from within. I end up doing more, which I think is a real problem in solving for joy. Often we need to do a heck of a lot less, but I kept thinking, okay, if I go to the wellness retreats [00:08:00] and I do yoga and I practice mindfulness and I like, you know, generate more RVUs, if I do all of these things, I can feel really good. And that didn't work either. I was doing way too much.
So I, about every one to two years, I'd like tweak is an understatement, but I'd, I'd do something else to try to pivot and figure this out. And at the end of the day, my core needs were not being met. And it, the practice that was right for me at 30 was not right for me at 45. And the grief of that recognition and the, the joy of that recognition to be like, Oh, there's nothing wrong with me. I'm just like a square peg in a round hole. It's time for me to like build something new. It took a pretty big shift to get there, yeah.
Chrissie: The power of recognizing that you weren't wrong at 30, it just was no longer a fit at 45. I think so many people need that model to potentially follow because they [00:09:00] feel like something has gone wrong with them because they've grown apart from their practice, um, they've fallen out of love. It is kind of like a long term relationship and that there can be no fault divorce where you just took different growth routes and you're no longer an energetic match. Um, that's so insightful. And I heard you adding, adding, adding, yes. You added coaching, you added leadership, you added menopause care. Um, so many people are looking for the missing piece instead of noticing that some of the pieces that are crammed into the puzzle right now actually need to be loosened and taken out.
Kara: Totally. Yeah, but I wouldn't have been able to tolerate the white space. You asked me about if I went to less FTEs, like yeah, I went from a five day week, four and a half day week, four day week. I shifted the schedule around so [00:10:00] many times, but I couldn't tolerate being and just settling. And so that's when all this addition, like I bought out my time, but then I just rapidly filled it back up with something. So, I joke about my drug of choice But like work has always been my drug of choice because it can just totally immerse you and I can totally avoid the real recognition of like what if this is not it that little like niggling voice that was there getting louder and louder that I wanted to ignore because it was easier to feel the pain of what I knew than the uncertainty of something new.
Chrissie: For some people, parenting is their drug of choice. you know, for some people it's, it's about that identity that props us up and like helps us again to not feel the things that are needing to rise to the surface and be integrated.
Kara: That's right. Exactly.
Chrissie: Was there a moment of clarity for you that [00:11:00] brought you to that realization?
Kara: Yes. I had been trying to fix myself for a long time. If I did enough therapy, did enough yoga, did enough mindfulness, changed my schedule, added all the things in. If I could just do those things, I could feel okay. And we were in this after hours meeting, your physician listeners will appreciate this, where we were like relearning how to put in smoking cessation into the chart, because every EMR is different and whatever. So great. And we were like two hours into the meeting and they were talking about, you know, should it be free text or not? Whatever.
Anyway, and I literally have this moment where that, that little voice that had been getting louder and louder finally just said, I can't do this anymore. And not, I can't, I won't do this anymore. And it's not like the next day I quit my job. It was just a knowing that I couldn't unknow. Like, this is not it. If I were on [00:12:00] my deathbed, looking back at this season of my life, if I kept doing the thing, thinking that it was the right thing, like if I could just make it work, it's okay, I couldn't unknow that this was not what I was supposed to be doing. As my parents are aging, my kids are growing up, and this is my life. I mean, this happened during the pandemic and the background of me recognizing that I could have shown up at work and died of COVID, like, is this what I wanted it to look like? Like, this is not the way I wanted the story to end. So I couldn't unknow that. And it was in finally recognizing that, that I started to actually make meaningful change.
Chrissie: It's like the dissonance became intolerable.
Kara: It was easier to ignore that for a long time, but finally saying like, there just has to be a better way and being accepting of that. I didn't know what to do with that information. I didn't know where I was going. I certainly had no idea [00:13:00] I'd be doing what I'm doing now, but just to say like, I've gotta start getting curious in a way that I've, I've not allowed myself to do before because that felt so scary to acknowledge that something might change. That house of cards that I had built might have to crumble and so, um, yeah, that's it.
Chrissie: There's a real, um, It's such an important acknowledgement of moving into the unknown, knowing that you're moving into the unknown with no guarantees of like, what's going to be my foothold or handhold when I take this next step, but I can't stay here. And so here I go. It's, um, it's exhilarating and it's terrifying. And I am sure that, you know, like me, you probably also, um, Like, just had no capacity to envision the future that you're living now at all.
Kara: No. Zero. Because I had no space to do it at [00:14:00] all. Like, I had no time for creativity, for imagining, for intuition, because every second of my day was packed with work. And then on the weekends, on Friday and Saturday, I'd open a bottle of wine and just check out, you know? And it's not like I had, you know, this grey drinking I've talked a lot about, but this grey drinking or high risk drinking behavior. You know, you don't have to meet criteria for alcohol use disorder to just recognize that alcohol is checking you out of the things that really matter to you.
And so it was obvious to me that I would work obsessively like Sunday through Friday and then drink Friday and Saturday nights and just keep repeating that cycle over and over again. And it just was sucking my joy. I mean, truly that's what got me to finally say I have to leave this job and I have to quit drinking. Was that, it may have helped numb the things I was trying to avoid, but you can't selectively numb only unpleasant feelings. Like, I recognize, like, my whole world is [00:15:00] grayed out right now. Like, the things that really matter to me, my joy is not there anymore, and it was just time to, to go pick that up again.
Chrissie: And we don't have very many models for leaving what looks like a stable job that, you know, society thinks that we should be, uh, excited to stay in forever. There are so many social constructs to keep us in places that don't work just because there's momentum there.
I am fascinated, um, and, and I think that there's so much for people to learn about gray drinking and how addressing gray drinking can be a potent way to solve for joy. You know, we think that social drinking is a constant and if we're not doing, uh, you know, binge drinking or drinking to the point of blacking out, et cetera, then we don't have a problem. But I think that, you know, well [00:16:00] over half of the people listening could probably identify with that, you know, after work drink that maybe became a, um, automatic habit, especially during the pandemic. Um, And how, how does one recognize that? What, what do you, what wisdom have you found to share with people who are interested in learning more about that?
Kara: Yeah. It's not a binary. So we often think of alcohol on the spectrum of like total sobriety, teetotaling all the way up through chemical addiction, but it's a gray zone up to that diagnosis. So hence the term gray area drinking. You know, it's that same niggling voice that was telling me that something needed to change with my work situation. It's the same with drinking. So it's like worrying about drinking or negotiating around drinking. Like I'll just have one or I'll have one and then a glass of water and then another one.
It's like looking [00:17:00] around and like seeing that everyone else is doing it and thinking like. I just live a little, you know, like stop worrying so much about it. It's, I don't, I don't have a drinking problem, but I have a problem with my drinking. There may be like more blackouts or more hangovers, but you're able to kind of overcome them but there's no rock bottom. There's no DUI. There's no car crash. There's no, you know, losing your job. It's just this high risk kind of accelerating drinking. And I would find myself as an actual physician who treats this disorder for a living like googling like what is the criteria for alcohol use disorder as if I don't know so I could like check to like make sure I didn't meet criteria. Like pro tip if you are worried you meet criteria like you should probably reconcile your drinking like you don't have to wait until you have a diagnosis.
Chrissie: Right your inner voice has a problem with your drinking even if you're not doing quote unquote drinking.
Kara: Correct. Yeah, I mean the cognitive dissonance. Let's just name this for what it is. Like alcohol is a carcinogen that [00:18:00] causes every type of cancer I spend my day job trying to prevent. Breast cancer, colon cancer, head and neck cancer, whatever. So it's a known carcinogen and yet like there's breast cancer fundraisers that serve wine. Like I don't get it, but that's what we just accept as normal. It causes heart disease, which I work on preventing from preventing in my day job. It worsens anxiety and depression. Uh, there's real problems that I spend my entire career trying to prevent for my patients, and yet I was consuming this thing that was causing all those same things for me.
And so really getting honest. I mean, all of this is about me finally getting honest with myself and saying like, this is not working for me. And so, Uh, yeah, I mean it felt scary to stop, but it has profoundly changed my relationships, my joy, my interest, I feel like I'm caring for myself in a way that I didn't know was possible. Um, it's really, really amazing.
And I think there is a movement right now for people to, they call it like sober [00:19:00] curious or to consider cutting back. And we know that 20 percent of physician women truly meet criteria for alcohol use disorder. Like there's so many of us. And when I started, and just like when I got burned out and took a sabbatical and people came to me like I knew what I was doing for burnout. When I started publicly talking about quitting drinking, I had hundreds of healthcare workers reach out and say, me too, me too, me too. Like people are struggling silently. So why not talk about it and just normalize that like, we don't have to live like this.
Chrissie: Thank you so much for sharing your journey with that, um, publicly. Cause I think it is. It is inspiring. It does actually, you know, it's not possible for somebody to think about it until it is. And when somebody else does so in front of them, it really hastens the process.
Now, I certainly am one of the health care workers that got into a habit of having a nightly drink or two during the pandemic. Um, and it lasted fair while after the pandemic, and I'll tell you when I have [00:20:00] two drinks at night, um, I get a little bit less, uh, you know, acutely agitated, I guess, with whatever feelings I'm not giving my time to, but I'm also a whole lot more likely to do the next buffering thing, watch a show. I'm also likely to not do the meaningful thing, read to my child, you know, um, or like be deeply present with my family.
It takes us out of the good and the bad, as you articulated. And I think Sober Curious is really interesting, or even like part time Sober Curious. We had an anniversary this week and, um, we found a, uh, a wine shop across from the Mathnasium where our kiddo is getting support. And we went there and bought this beautiful bottle of a, it's like a tonic. It's like a non alcoholic tonic. But it's made with these Szechuan peppercorns. It's called DROM, D [00:21:00] R O M M E. And I think that the, um, this particular bottle is called a wink and it's just like the most delicious little sipping tonic with all kinds of healthful ingredients and it feels like you're having a special drink, you know, your, your brain is looking for that dopamine reward of like, I need a treat. I need something special at the end of the day, but it turns out it does not have to be always a carcinogen, a socially sanctioned carcinogen and, um, yeah, totally neurologically harmful substance. Yeah.
Kara: You're right. You're right. It doesn't have to be.
Chrissie: It can be. I mean, beer is delicious, but It doesn't have to be every day.
It doesn't have to be.
Kara: It doesn't. And, you know, there's people with brains like my husband's who could, like, have a drink and, like, not think about it for weeks or, like, have a couple at a, you know, sports, sporting event and, like, have the foresight to take an Uber home and it's, like, not a thing for him, like, but for people with brains like mine that tend to get a little [00:22:00] compulsive little, like, all encompassing, who like to numb, particularly for people who are looking for that kind of, like, efficient, effective way to turn your brain off for high functioning anxiety people, like, just something that you gotta, you know, just be aware of, right?
So I guess I would just offer that if anyone who's listening is just worried about their drinking, even if it's quote not a problem, like, you don't need any more validation to be like, what would it be like to just go four weeks without drinking? Um, you know, we talk about dry January. But, uh, even, I think this past year they were talking about wet January, damp January, was that, was that the term? Which is basically like, if you can't quit entirely, then just cut back. Like, all of that is information about your relationship with the substance, so. And for it being the third most addictive chemical on the planet, like, if it feels hard to control, there's a good reason for that. It's designed to be hard to control.
Chrissie: Yeah, so there's smoke, there may well be fire.
Kara: Mm hmm. Totally. [00:23:00]
Chrissie: Speaking of stages of change. Um, we, uh, I really, really enjoyed this email that you sent out last week about the stages of change that many physicians or others go through, uh, transitioning from a traditional employed overworked, exhausted model to a more purposeful autonomous career. So. Thank you. whatever that looks like for them. Um, you shared these stages and I would love for you to walk us through the highlights. of that in, into the time that we have left, if you would, I think there's just so much gold in naming these stages and sort of talking through them.
Kara: Yeah, absolutely. I think after coaching physicians for years and helping patients with [00:24:00] behavioral change towards their health, there's just very predictable stages of change that Um, we talk about and everyone's got their own stint on it, but this is mine, which is in the beginning It's like how I described just feeling really burned out and stuck like this is how it is, That's stage one. And so it just the possibility that things could be different is not even accessible to you. You're just kind of stuck in misery, whether that's, this is just what adulting is. Of course we're exhausted every day. This is, of course, how marriage is. It's always really hard. Of course this is how my job is. It's always really toxic. It's not any better anywhere else. This idea of being stuck. It's like the, the idea with change, if you desire it, is to kind of move yourself along.
So, if you find yourself there, in this place where there's friction and you don't even want to change yet, but you're like, I just need to acknowledge, like the first step is just noticing. So maybe you just need some space in your life to actually just heal when we're in the fight or flight place, like our intuition is [00:25:00] not working. So maybe your first step is just to edit out some things that are no longer serving you. Get off the committees that you've been on for a while. Scale back and take a break if that's accessible through your work. Get some support. Tell someone that you're not feeling well. It's a great time for a therapist or a coach.
So the first step is just noticing and carving out time and space for you, because you never know what you might find. Second stage is the noticing part, which is like I now recognize things are not going okay, but something's gotta change. This is often where people get stuck. Like I said, like, it feels so scary. I don't want to make any change because uncertainty feels totally big and overwhelming and I'd rather just be miserable here. I'm just going to keep fixing. So like, I knew I wasn't aligned with my practice, but I wasn't willing to leave, even though everyone outside of my clinical world was like, what are you doing?
Like, you just got to go. Anyway, so, so I recommend two things. One is, uh, they're, One is the question, which is, [00:26:00] outside of what you do for a living and who you are relationally, who are you? Not what do you do, not what fills your time, but like, who are you? What makes you you? What are your core values? What are the things that set your soul on fire? What breaks your heart? Like, who are you? Because a lot of us have just kind of forgotten, probably 90 percent of the people I ask this question to can't even answer it.
And then the second thing is to lean into resentment. When I was drowning at work I would, um, there are women in my neighborhood who would invite me to like play tennis at the local tennis club at like 10 in the morning and I would get so angry. Like, I have a job. Like, I can't just like cancel my patient. I can't just play tennis at 10 in the morning. And I, I really like was resentful towards these women and felt disrespected in a way like don't you know I have this job. But the truth is it's not about them It was that I felt so trapped. I I just wanted the flexibility to say [00:27:00] yes I mean, it's not that I want to play tennis. I just want to have control over my schedule so when you're starting to feel real resentment about people who may have like a privilege that you want, lean in. Like that really is a compass to point you towards the thing that you're lacking or the thing that you really desire um
And so those two things are helpful because it helps us start to like recognize like what actually needs to change for me. And then once you kind of figure, start, you know, figuring some of that stuff out, the next stage is just discovery. Like, um, you know, there has to be a better way. Uh, I don't have to live like this. I don't know what it is, but I'm going to figure it out. So getting curious about things, talking to people, meeting with mentors, listening to podcasts like this, like, just, it's like an information kind of stage where you start to just acknowledge, like, there may be something else that's out there. And then once you gather that information, this data collection, you may actually find that you have options.
This is the next place where people get stuck, which is they're [00:28:00] like, well, this just feels too big and scary. I mean, I know I could quit my job, but like that feels overwhelming. Like maybe you just need to try something. It doesn't have to be for forever, but like maybe you could volunteer. Maybe you could, you know, go up for a promotion. Maybe you can adjust your job. Maybe you could like. Just start financially planning for the option that you might leave your job. I mean, it's just about like starting to take some tiny steps with no commitment. We're not gonna spook you here, but just like some tiny commitment to get you moving.
And then before you know it, like, you start building this confidence. Because confidence is not something you wait for and then decide. It's retroactive. So you have to start doing the things and then building the confidence that you can actually do it. So that you keep moving forward. So that's like stage five, which is action. Like I'm finally actually doing these things. Um, I, I really do think it's because I built a coaching practice and I've been coaching alongside my clinical practice that when I was ready to step out on my own, I was like, it's not that hard. Like I've made a business. [00:29:00] I like have scheduling software. Everything is figureoutable. It's really not that hard.
So, so it's kind of the five stages. It's like totally numb and checked out, stuck. There's the noticing that something's got to change, discovery, like there has to be a better way, data collection, figuring out what your options are, and then just taking action. Like what are those steps? And so no matter what you're trying to do, you don't have to quit your job. If you want to build a practice, I'm happy to support you, but that's, not everyone wants to do that. Not everyone's meant to do that. Whatever that thing is that's like awaiting you, like this is the predictable way that people get moving.
Chrissie: I'm having little flashbacks to 2008, 2007, 8, when I decided to um, leave a practice that I was not aligned with and I'm just tracking how I went through these options in like quick succession. Um, from, I'm just not happy. This isn't what I thought I was going to have when I finished [00:30:00] residency. This is kind of anticlimactic. This is a little bit of a letdown. This is not how I envisioned it. You know, this is not using all of my skills. This is not using all of me. And in fact, it feels kind of oppressive, even though I have these golden handcuffs and I'm getting paid finally, this six figure salary.
I am not happy during those first 18 months of professional out of residency life. The feeling I remember the most was dissatisfaction. It was not relief. You know, it was not, um, relaxation. It was, it was like, this is it. This can't be it. I didn't climb all the way up here to, to like experience what feels like low level mediocrity.
So yes, I broke into the stage two. Something has to [00:31:00] change real quick. I didn't know what the better way was going to be, but somewhere along the line, I was introduced to, you know, one of the micro practice pioneers, Pamela Weibel in Eugene, Oregon. Hi Pamela. Um, and went down and shadowed her for a day. And like, I left that day going, well if she can do, it can be done it, and if it can be done, I can do it. And got like fast into, I am doing this.
Kara: Yes, I think you're bringing up a really important point, which is like doing this in community, doing this with other people, like when you think that you are the problem and you're trying to figure it out, it's a really lonely process. But seeing what's possible, talking to other people, connecting with other people. I mean, there's a lot of tribalism in medicine. Like this is the way things are done and people were my biggest, you know, cheerleaders when I was leaving [00:32:00] and then once I left and started my own practice and I I love my job and love showing up to work on Mondays. It really is disruptive for people who are in that stuck phase, like they have to then reconcile like, Oh, it is actually possible for me.
And so surrounding yourself with people who are already doing it is huge. So like you saw Pamela do it and you're like, Oh, This is not actually rocket science. Like, I can deal with multi system disease for a living. Like, I can figure out how to open an LLC. It's not that hard, so.
Chrissie: It is not that hard. We've figured out harder things for sure. You know, what you're saying sparks in me this memory of when you are the model, when you're the model that's doing something disruptive and different, people respond in, you know, large groups of two ways. One, they, they're excited and are You know, like supportive, maybe even want to emulate some part of that or it's repulsive to them because they cannot tolerate having the lid [00:33:00] lifted, having reality open.
This is flashing me back to a very close friend in medical school. I left a very unhappy, unhealthy marriage after my first year of medical school. My My close, close friend was in an unhealthy relationship that was turning into an unhealthy marriage. And when I left my unhealthy relationship, it was actually so repulsive to this individual that they could not tolerate staying close in friendship with me. We did come back together after that marriage ended, predictably, but, um, I, I have feelings that are similar to that from sort of being in micro practice and having some of the, what I'll call the old guard, just remind me that this is not a sustainable way for medicine to be practiced at scale because we couldn't meet everyone's needs.
The implication [00:34:00] is if you can't do this at scale then it's not appropriate for you to be doing it. I'm like well I can't see this French patisserie making these incredible gorgeous croissants at scale because they would taste like Costco croissants But that doesn't mean they shouldn't be doing them and I felt like I was just like making this exquisite artisanal medicine experience, It was absolutely beautiful and worthwhile, even if it was not replicable at scale. It was the highest that I had to offer.
Kara: That's right. That's exactly right. So I, I do think community is, I mean, we heal in community. We, you know, our nervous systems are better in community and anytime you're making change, but I will say as physicians who I support in building solar practices, predictably they like launch and then they panic because they're like, what did I get myself into? Because then the, the like, The newness, [00:35:00] the sparkliness wears off and you gotta like do the mundane things like take out the trash and deal with, you know, paperwork and whatever and so predictably people get panicked. And so to have people around you be like, nothing is going wrong. This is exactly what it's supposed to feel like right now as you're building your confidence. It's, it's that way.
Similar to you with your, with your friend, like, I had dear friends who wept when I left my practice. Like, we will miss you, we're going to stay friends, and like, they do not speak to me at all. And that is, I've, I've had to do a lot of my own work to just recognize like, that's okay. Like, it's not actually about me, even though that was painful, and That's okay. Nothing is going wrong. You know, people, people are ready for their own change when they're ready. And, you know, that's just how this goes sometimes.
Chrissie: It is so good to do it in community. Um, and here in Portland, there were a few other micro practices at the time. So there was a total four or five of us. Um, that would meet for a while once a month and we [00:36:00] kind of formed our own mastermind support group kind of thing. It was not highly effective because it did not have you at the helm or somebody with that experience. And we were all figuring it out together at the same time. So nobody was really like looking back from very many steps ahead.
But I swear that if I had found coaching and something like your, you know, micro practice mastermind back then, then nano practice PDX might still be open. And it was such a labor of love. I mean, it was, it was a beautiful practice. But I went through the same process of change then. I feel stuck. There's something here that's not feeding me as much as I'm feeding it. Things are out of balance. I need to be more present with my toddler. Something has to change again. And the practice that I loved in 2018 [00:37:00] needed to go away in 2016. I mean 2008, 2016.
Kara: That's right. I look at it as a sign of growth, right? Like, it was the right decision for you in 2008 and you outgrew it. Like maybe, you know, hindsight is 20 20. Maybe if things had been different you might still be practicing. But it was the best decision with the information and the resources that were available to you at that time. Absolutely. That you had outgrown what that represented for you. And that is okay.
It's so interesting. My, my husband's an MBA and finished um, grad school a long time ago, 2007, and if he still was working in that first job that he took out, like, people would think there was something wrong with him. They would say like, do you not aspire to anything else? Like, you just want to have this entry level job? And very often, especially in medicine, we take these jobs and we're just expected to stay for 30 years.
And I, the [00:38:00] average length of stay for new grads now is about two years for the people who've graduated in the past six years. They stay in their first job about two years because they experience exactly what you're describing. They join because they want the salary and they are hopeful and then they recognize this is not for me and I really admire their willingness to be brave and leave something that is not serving them when so many physicians in our generation feel stuck and say well I can't leave I've got too much invested here. Um, so I often recommend that people find a mentor who's under the age of 35 because I really do think those folks are going to save health care because they look at it in a very different way.
Chrissie: Yes, they are speeding up their iterative process. Hopefully it's because they're learning PDSA cycles early on benefiting from quality improvement science at a life improvement level Yeah, and and not giving in to the sunk cost fallacy, which I think is so much of what keeps Some of our stuckest people stuck. [00:39:00] Like well, I've already been here this long. I don't want to start over I'll have to meet all new Um, panel of patients and new colleagues and, um, new partners and new system. And it's just like, Oh, that's not the, that's actually not a signal to stop. It's a signal to stop and breathe. Listen to your inner compass.
Kara: Yes. Yeah. Step one, which is like edit out, get some time. Sometimes the answer is do less. My two lessons that the world continues to teach me is do less and ask for help. If I don't know what to do, if I'm feeling overwhelmed, it's always one of those two things that I need to be doing. I
Chrissie: think mine is slow down. I've been thinking about having slow down tattooed on a very obvious part of my body, like the side of my finger. So I'm just seeing it all the time. Slow down, slow down more, [00:40:00] breathe slower. Efficiency does not actually bring you any rewards. There's just more productivity for the machine. So slow down to the speed of connection. I love that. And keep breathing.
In your journey, what has joy been like for you?
Kara: Hmm. Uh, I would say in those dark years where I was feeling super stuck, I was resentful, like, uh, towards joy. It felt inaccessible and unworthy. I was unworthy of it, you know, because if I could just be productive, that's where I would get myself worth. Um, but I have, when I finally had that crack, of light enter and that after hours meeting where I was entering [00:41:00] smoking cessation industry It was an acknowledgement of worth I would not have used those words that I can't do this anymore was really a symbol to say like I deserve to do better or I deserve to have it differently and that's continued to get bigger and bolder and so joy for me today looks like being able to drive my kids to school It looks, even though they're teenagers, it looks like going on planned hiking trips every year with my dearest girlfriends.
It looks like having white space and creativity every day in my life. Often that's around building something for my business, but it feels fun. It doesn't feel heavy. Um, Joy feels like, you know, we were celebrating 20 years of marriage just like you, um, this year. Happy anniversary! Happy to you too. It feels like, uh, we both kind of made it through these dark years and, you know, it's really worth celebrating. It's celebrating my [00:42:00] really amazing kid. I don't know. It's, it's, I feel, I'm not ready for my life to end, but I'm really, really enjoying it. And if, if the chapter closed today, then I would feel really content with that. And that feels like a good thing. Oh,
Chrissie: that is a beautiful thing. It feels so clear and aligned. Um, you're like, yep, I did what I meant. I lived how I meant to live. This is what I meant by that. Um, my ears perked up when you were talking about worthiness.
And I think, um, I may be transposing this, but it was like, I, I deserve worthiness. Um, and there is a little link there to like, I shouldn't have to, this was maybe where I'm inserting my own word thoughts, I shouldn't have to be spending after hours time relearning how to input smoking cessation counseling. It's [00:43:00] actually denigrating and insulting to me, which by the way, I believe that it is. But what I'm interested in is the resentment piece of I shouldn't have to versus I deserve more, because there are two sides of the same coin, perhaps one of them is a stance of complaint, um, maybe even disgruntled entitlement. The other one is self honoring, of like, actually I honor myself enough not to stay in places that, that don't honor me and honor my time. Mm hmm. It's more like boundary and worthiness. What does that provoke for you?
Kara: Yeah. It's the difference between being victimized, but the image that comes to mind [00:44:00] is that there's like a birdcage or a jail and the person's like hanging onto the bars, like picture like a cube shaped room and they're hanging onto the bars, but there's no other walls, you know? So I think that's what that felt like to me. Like, it's so hard. It's so, you know, I'm doing my best. I'm trying my hardest. I'm grinding. I'm doing all these things. Don't you see? And really, I was desperately asking for that validation so I could rest. Um, but finally saying like, actually, it doesn't have to be like this and it could be better. For me, that was a way of saying I deserve for it to be better, but those words were not at all accessible at that point in time. I don't know that I felt that way, but there was something that shifted fundamentally to say like, I would regret living like this, and I have to find a better way.
Chrissie: All the people we care for, our patients, our communities, they deserve intact [00:45:00] clinicians. Yes. They are so beautifully served when their clinicians are intact people. Who are not having the life squished out of them, their humanity squeezed out by the production machine.
Kara: Yes. I think when, if we're not ready to do it for ourselves, because that really requires some deeper self love, self compassion skills, you can do it for your patients. And when I tell people like, go build your own practice because your patients deserve it, like go build a life of meaning because your family deserves it. I don't mean that you as an individual don't deserve it, but that just means not actually be motivating in the beginning it may take doing it on behalf of someone else that person is like the surrogate for what you really need. So actually my my KPIs my goals for 2025 are right here and the center [00:46:00] of it. It says needs to be great for me and my patients. It's a way of honoring both Right? You can do it for yourself and your patients that
Chrissie: I want to be the physician that I would want to be seeing. I don't want to be the physician that, um, that I wouldn't want to see. And the system sets it up so that that is the setup. Most of us aren't doing medicine the way we would want it to be done for us as patients. We're just trying to survive. That's right.
Kara: And I, I think helping people build their own practices, and certainly as I see, I, as I see the mission of my practice is to close the gap between, in suffering. Our patients are suffering, they are traumatized by our system in which they're trying to access care, and the people working within it. We're talking about physicians, but nurses, pharmacists, everyone is being traumatized [00:47:00] from the inside working out. And so there's this chasm in between. And when you take out all the baloney, all the administrative stuff, all of the systems, and you just build something that works, you close the gap. And everyone deserves that. The patients deserve it. The clinicians deserve it. And that is honestly how we save health care. Because what we're doing right now is not working.
Chrissie: And connection is such a huge part of it. And that brings the joy back into the clinician patient encounter more times than not. Absolutely. Kara tell our listeners where they can find you and the Micropractice Mastermind and your podcast.
Kara: Yeah, uh, I'm Kara with a K. Kara Pepper MD is my handle on all social media. It's my website and the podcast is It's Not Just You with Dr. KAra Pepper. Um, [00:48:00] I would love to hear what your listeners think about this. I hope this like reached some point in them to help them wake up a little bit and recognize that they don't have to stay stuck if they don't want to. Absolutely. But yeah, for having me. We,
Chrissie: of course, have the Solving for Joy podcast Instagram handle for anybody who hasn't discovered that yet. Um, we love to hear from you. We love to hear your ideas for episodes. We love to hear your responses to episodes. Um, and like all of the podcasts out there, we are very happy tailwags when you review and rate us on your podcasting platform because it helps us spread the reach and the ripple of this really worthwhile, really, really inspiring work. Thank you so much, Kara, for being with us today. Thank you listeners for tuning in. May we all keep solving for joy. We'll see you [00:49:00] next time.
Dr. Kara Pepper, y'all, if this conversation didn't shake something loose, I don't know what will. The way she burned it all down and rebuilt without asking for permission. That's courage. That's freedom. Let this be your reminder. You do not have to keep living a life that doesn't fit anymore. And next week we'll keep that fire going with Dr. Jillian Rigert but this isn't just a reinvention story. It is a raw, gut wrenching, beautifully human exploration of what happens when we tie our worth to the past, to achievement, performance, external validation, and lose ourselves in the process. If you've ever felt trapped in the life that you worked so hard to build, this one is for you.
And a little note, this podcast is meant to spark joy and inspiration. As you know, I'm a physician. I'm not your physician, so nothing here is medical advice. The opinions expressed are entirely my own and those of my guests. But if the conversations you [00:50:00] hear light something up in you and you're ready to start choosing yourself, I would love to support you. The Joy Reset is a four session coaching package designed to help you clear the noise, reconnect with yourself, your own creative wisdom, and move forward with clarity, confidence, and joy. You can check it out at joypointsolutions. com. And for my physician coaching friends, if you haven't already, grab your ticket now for the 2025 Physician Coaching Summit, november 6th through 8th at Savannah Wellness Resort and Spa in Carefree, Arizona. It's where we come together to breathe, connect, and reimagine what's possible in medicine. Tickets are on sale at ThePhysicianCoachingSummit. com.
Huge gratitude to our incredible team produced by Kelsey Vaughn, post production by Alyssa Wilkes, operations by Denise Crane, theme music by Denys Kyshchuk, and cover photography by Shelby Brakken. And as always, special love to my Sue number one fan and champion. Thank you so much [00:51:00] for tuning in and spending this time with us today. Keep choosing yourself, keep breaking the rules that were never meant for you. And may we all. Keep solving for joy. See you next time.
