Roger Kapoor, MD 00:00:00 Not all stress is bad. Stress okay. Really? Stress is kind of like a double edged sword.

Keith Reynolds 00:00:14 Welcome to Off the Chart with Medical Economics, a podcast featuring lively and informative conversations with healthcare experts, opinion leaders and practicing physicians about the challenges facing doctors and medical practices. I'm your host, Keith Reynolds, and today we feature a conversation between Medical Economics managing editor Todd Shryock and doctor Roger Kapoor, author of the book Working Happy. They're digging deep into both the causes and solutions for that perennial issue for physicians burnout.

Todd Shryock 00:00:52 I'm here with doctor Roger Kapoor, author of the new book Working Happy to Talk About Burnout. Doctor, thanks for joining me.

Roger Kapoor, MD 00:01:00 Well, hey, thank you for having me. And, compliments to you, medical economics, for your continued attention to this important matter. with all of your activities, such as your annual burnout survey and your articles, your webinars, your conferences, special reports, I can tell you on behalf of physicians that I'm aware of, we appreciate you and all the work you're putting into this.

Roger Kapoor, MD 00:01:18 It's an honor to be with you.

Todd Shryock 00:01:19 Well, thank you for that. So so, doc, from from your perspective, what are the biggest causes of burnout for physicians today?

Roger Kapoor, MD 00:01:29 Well, I think the list is long. let me start by just briefly defining burnout, which, as you know, was officially recognized by the World Health Organization as a syndrome. And it's got its own ICD ten code, 73.0. it's described as being caused by chronic workplace stress that hasn't been properly managed. And, you know, some unfamiliar with this issue point to the Covid 19 pandemic as the cause. But many of us know that burnout has been persistent challenge for decades and was only magnified by the pandemic. So, to answer your question, an easy way to look at the causes of burnout for me is to simply put them into two large buckets. It's either your workplace and or yourself. So the workplace causes, I think, are very obvious. Maybe you're working for a private equity where you feel money is valued over mission.

Roger Kapoor, MD 00:02:28 Maybe you're finding that you're being compensated to do things to people instead of doing things for people. Maybe you're depressed, but you're scared to talk about it because it has to be disclosed on certain license renewal forms. Maybe you're dealing with burdensome and repetitive administrative tasks, like prior authorizations or feeling a lack of control over your work environment. Or maybe you're spending more time staring at a computer screen instead of your patients. One thing though, I'm purposely not mentioning is maybe you're working long hours because surprisingly, burnout is actually unrelated to whether the work is hard or if somebody spends long hours at work. You know, one of the interesting things about people who love their work is that they often work harder and longer at their jobs than people who are disengaged. nevertheless, the list of workplace related causes for burnout, obviously, are long. The second bucket of burnout, which is often overlooked, is our own lifestyle choices, our own attitudes. It's easy, of course, to just focus solely on the external factors.

Roger Kapoor, MD 00:03:41 But the truth is, the way we manage our personal lives, it plays a crucial role. and can either mitigate or exacerbate burnout. for example, simple mistakes, like depriving yourself of adequate sleep or chasing the elusive goal of work life balance so that can actually contribute to burnout. And these behaviors not only heightened stress, but they can also diminish your ability to thrive, both professionally and personally, ultimately degrading your overall quality of life.

Todd Shryock 00:04:19 Doctors work long hours. It could be a very stressful job. How do you tell the difference between I'm burned out and I just need a vacation or I'm just overly tired? How do you differentiate what is truly burnout and what is just kind of normal work stress?

Roger Kapoor, MD 00:04:38 That's a that's a great question. in general, there are three key signs that you might be dealing with burnout. Number one is what's called emotional exhaustion. You're feeling drained. and again, this is going beyond what you mentioned, going beyond being tired after a long day. It's a little deeper. It's this ongoing sense of fatigue doesn't go away with rest.

Roger Kapoor, MD 00:05:04 And now your body is in a constant state of stress. The second is what's called depersonalization. Growing distant. Okay. Or even cynical about your job. And this is when you start to feel detached from your work. You might, for example, catch yourself thinking, I don't care anymore, or you're feeling like your job is meaningless. It's that you take this job and shove it mentality. and the third point is personal ineffectiveness. It's feeling less effective at work. And this could take the form of somebody, starting to doubt your own abilities, or you feel like you're not making a difference anymore. And that negative Self-Assessment that affects your confidence. It affects your job performance. And and as you mentioned, not all stress is bad stress. Okay. Really? stress is kind of like a double edged sword if you think of a bodybuilder, good stress, okay. When it's managed properly with adequate rest recovery and build strength. But let's say the load is too heavy, or maybe the length of time, you're going to hold that weight up gets a little prolonged.

Roger Kapoor, MD 00:06:22 It can become damaging, like a muscle tear that occurs when the strain is too great. So in health care. But simply that bad stress, when it's chronic, it manifests as burnout, leading to potentially, of course, devastating consequences for both the provider and the patient. And just as that bodybuilder needs proper recovery time to grow stronger, health care providers need space. They need resources to manage the immense pressures they face on a daily basis. And of course, there are some tools like the Matlock Burnout Inventory MBI, that can help assess burnout and recognise these symptoms early. But definitely the quicker you find it, is probably the best way to prevent burnout from taking over your professional and personal life and really taking root.

Keith Reynolds 00:07:23 Oh, you say you're a practice leader or administrator. We've got just the thing our sister site, Physicians Practice. Com your one stop shop for all the expert tips and tricks that will get your practice really humming again. That's physicians practice.com.

Todd Shryock 00:07:44 Those feeling burned out mean you have to get another job or look for another position.

Todd Shryock 00:07:48 Is that the only solution?

Roger Kapoor, MD 00:07:53 That's a that's a tough question. because,

Roger Kapoor, MD 00:07:57 There's really no, there's really no clear cut answer. Okay. I think it really comes down to some type of honest soul searching about where you are in life and what you truly want. It's not something you can figure out overnight, but it is crucial to think about if you're feeling unfulfilled. or if you're feeling out of sync with your current career. I think my advice is if you're in a job that doesn't align with your sense of purpose, it's probably time to start thinking about making a change. And that naturally leads to the next question. Well, how do I figure out what my purpose actually is? and one concept that I think might help is called ikigai, which I talk about in the book, ikigai is a Japanese term, from Okinawa, a region famous for having the highest number of centenarians per capita in the world. It's fascinating. the word itself, when you break it down, Ichi means life, and gae means worth or purpose.

Roger Kapoor, MD 00:08:59 So it's essentially, you know, finding your life's purpose. discovering your ikigai, involves basically asking yourself four simple questions. What do you love to do? And that's really reflecting your passion. What makes you feel alive? What makes you get up in the morning? what are you good at? here. You know, you're doing a self-assessment of your skills, your talents. What are you excelling at? Naturally. number three is what can you get rewarded for? Okay. Because that's going to ground your purpose and practicality. What can you do that will either allow you to get paid or, get you a sense of accomplishment. And then the last question in this, tool is what is the world need? And that's about finding a way to contribute meaningfully to the world around you. And when you find the intersection of those four things, you have found your ikigai, your reason for being really cool example that comes to mind is a guy named Joe Addis. Don't know if you've heard this guy, but, he was known as the Gentleman Peeler.

Roger Kapoor, MD 00:10:07 Okay. And he immigrated to the US in 1993. He started selling $5 vegetable peelers on the streets of Manhattan. And he didn't sell. You know, he didn't just go out there and sell peelers. He he literally put on a show. He dressed up in a suit and a tie every day. He was seated on a stool just above the ground. And he brought an immense passion to his pitch, and his ikigai was essentially to sell. And he lived it. He became a legend, really. And even though he was just selling, a product as is humble as a vegetable peeler. Would you believe that he end up living in a Park Avenue apartment? He had a Rolls-Royce, all from $5 peelers. the lesson here is, you know, if you find your, ikigai, it might require some effort, might require some exploration. But I think it's worth it when you're living in alignment with your purpose, the work no longer feels like a burden or a drag. It feels more natural, more natural expression of who you are.

Roger Kapoor, MD 00:11:14 And while we're talking about fruits and vegetables, when I'm thinking about this question, it's sort of like going apple picking, which I'd love to do with my family. And if you're going to go pick out some apples, you know, you need to find a healthy apple tree to get those apples from. And, in order to have that tree, it's got to have really strong roots. And for that to take place, somebody's got to nurture an exceptionally tiny seed. It starts there. And here's the thing. Many of us, we want the apple, but we're not always willing to put in the effort to fully understand what it takes to nurture that seed. We focus on things like wealth, social status, possessions, and other things. The apples. In other words, the apples. Okay. But we're going to overlook the importance of pursuing our passion, cultivating our competency generating goals with clarity. That's the seed. So the idea here is if you focus on the seed, the rest will take care of itself.

Roger Kapoor, MD 00:12:19 And Joette is, I think, did it the right way. And, you know, no pun intended. look at the fruits of his labor. you could, take the flip, of this as well. You know, imagine you're in a job. You don't know what your ikigai is, but you know that, you're not supposed to be where you're at. You know, you got this nagging feeling, this inner voice that tells you to do something different, do something more. I would refer to that as an unsatisfied affinity. You're not fully aligned with your work. And a great example of that is Vera Wang. You know, before she became a household name in the fashion industry, many people unaware she made several career changes. She started at Vogue, she moved on to Ralph Lauren, and she didn't find her true calling until a little later. and when she did, you know, the rest is history. And her story isn't unique. You know, studies show Americans change careers. Not just jobs, but careers about, four times in their lives.

Roger Kapoor, MD 00:13:25 And what is unique, though, and the reason I bring up Vera Wang, very quickly is because she used the opportunities before she found her true purpose that, that she had to sharpen her skills. She used those opportunities to broaden her expertise while she was patiently waiting for her true passion to be uncovered. So my advice is, if you're feeling stuck, if you're feeling frustrated with where you're at and you think you're in the wrong place at the wrong time, I might go as far as to say that you might actually be exactly where you're supposed to be, and you just don't realize it yet. You know, before you start chasing after the next job, before you start looking for the next title, take a moment and fully immerse yourself unwillingly. Just totally go right into the deep end of what you're doing, right now. Instead of getting frustrated or bitter, focus on getting the most out of your current situation, enhancing your competency again, that seed to its very peak. Think about this. Kind of like you're blooming where you're planted.

Roger Kapoor, MD 00:14:39 And? And that approach really takes some honest self-reflection. You know, we all have areas we need to work on, but none of us are perfect regardless of where we are in life. And you need to start working on those areas right now. think of your competency, your skills, your passions as seeds that you need to fully nurture. Because if you focus on developing them, truly becoming at the top of your game in your current role, you're going to be ready for your breakthrough. And that means you don't let your ambition overshadow the importance of developing your inner competency.

Sydney Jennings 00:15:23 Say, Keith, this is all well and good, but what if someone is looking for more clinical information?

Keith Reynolds 00:15:29 Oh, then they want to check out our sister site, Patient Care Online. Com the leading clinical resource for primary care physicians. Again, that's patient care online.com.

Todd Shryock 00:15:45 Some doctors feel that if they reach that point where they need to leave, they feel like it's a betrayal to their patients. They're leaving them behind, or even their fellow physicians who might be left in a not ideal job situation, which might end up being more work for them.

Todd Shryock 00:16:03 Is that the right mindset to take when when looking at a position that maybe isn't right for you?

Roger Kapoor, MD 00:16:10 Well, I think it's important to recognize that, you know, for doctors, feeling like leaving a job is a betrayal, I would say is completely natural. because this comes from a strong sense of duty toward our patients and colleagues. And think about it. For people who go into medicine. It is largely due and seen as a purpose driven decision. This is purpose driven work. There's a deep commitment that can make the idea of moving on feel like some act of disloyalty. But it's crucial to shift that perspective, because the reality is, burnout actually often stems from the fact that physicians who are frankly accustomed to putting everyone else first, they struggle to prioritize their own well-being. During medical school, during residency. You know, doctors are trained to take on more and more responsibilities, eagerly say yes to every opportunity, and maintain their professionalism despite mounting pressures. And we learn about, you know, diseases, we learn about organs of the body, all these therapeutic options.

Roger Kapoor, MD 00:17:28 But we don't learn much about how to maintain our own well-being during the daily pressures in the medical field, so that ingrained habit of overextending oneself. It's definitely admirable. It makes the people that you work with. incredibly humbling experience to work with them, but it can lead to significant personal and professional tolls as your career advances, because in the long run, your patients and colleagues, they actually benefit more. When you're in a role where you're truly engaged, you're truly energized, and you're able to provide, again, top notch care. So leaving a job doesn't have to be seen as a, you know, some form of betrayal. It actually should be viewed as an act of responsibility if you approach it the right way being honest, being open, maintaining good relationships, you know you and your team can work together to find a role either at the same employer or a different one that better fits your values and interest, because that will help you gain more satisfaction in your own work. But it will also set the stage for, I believe, better outcomes for your patients and likely a smoother transition for your colleagues.

Todd Shryock 00:18:45 If I'm a physician and I'm feeling burned out at work, what should I do? Is there a sequence of events I should follow? What you know, what's what's your advice for someone who's who's feeling burned out?

Roger Kapoor, MD 00:18:58 Okay. I think, there are probably several, steps that a physician can take if you find yourself in that position. So first thing I would say is, listen to the advice of Warren Buffett. Okay. He said you really should take a job that even if you were independently wealthy, that would be the job you would take. So what he's saying is that your fulfillment should not hinge on what's happening around you, but rather on what's happening within you. Okay, let me explain that. Okay. We often think of burnout as a result of being overworked, but it can just as easily come from a feeling of being under worked or unfulfilled. Whether you're doing too much or you're too doing too little. If your work doesn't bring you joy, it can lead to burnout. Now, in any profession, obviously take health care as an example.

Roger Kapoor, MD 00:19:56 It's easy to point out to our work and say that there's that's a source of burnout. You know, if only this were fixed, it would be so much easier. And, you know, while there may be some truth to that, we have to remind ourselves that earlier generations of professionals in most careers, especially in health care, they didn't have it any easier than we have it now. every generation faces its own set of challenges, just like we face our own set of challenges through every phase of life. think about it. You know, as toddlers. Almost anything can set us off. I've got a young daughter, for example, and she'll sometimes, you know, urgently cry out for her. Elsa doll from frozen. Her voice is going to be filled with panic, as if the world is ending. And you know, I'll go around the house and frantically search for it, and I'll find it. I'll bring it to her and she'll suddenly change her mind. And you know, she'll still have tears in her eyes and she'll say, she now wants a cookie.

Roger Kapoor, MD 00:20:54 You know, as teenagers, we feel like the adult world is our enemy. We're overwhelmed by these hormonal changes. And if we take a moment to reflect on our teenage years, we had some pretty serious stressors. I think, that we all had to deal with as we move through life. Some people suffer from being single. Find them a spouse, find them their soulmate. They now suffer from being married. in middle age. We desire more money. We lament over, you know, when is it going to happen to me? When am I going to have my breakthrough? But give us more. We'll start complaining about taxes. We get older. We wish we were younger. When we're younger, we wish we were older. Again, what I'm trying to get at is that every phase of life, it's got its challenges. So my question back is when are we going to be happy? And by we, I mean us as a profession, in this case healthcare. but honestly, for whatever profession you're in, are we only going to be happy when everything around us is actually the way we want it to be? Because if that's the answer, we're setting ourselves up for a lifetime of struggle and, frankly, burnout.

Roger Kapoor, MD 00:22:07 The second tip I give you is to prioritize sleep. And this is something that, frankly, doctors are they're not good at because they got the rigors of, you know, the professional career. But it's also an ingrained habit from medical training where sleep is, you know, really thought of as a nice to have not a must have. But this is so important, especially today where you look at, you know, when you get out into the professional world, the lines between work and personal life, they've become increasingly blurred due to digital technology. And there's a constant connectivity, a pressure to always be on. And and it makes it more challenging to to get the rest we need. And as your sleep debt accumulates, the negative impacts on your work performance, your mental health, your overall well-being, it becomes more pronounced. Simply put, you know when your sleep is at its best, you are at your best. And I think doctors know this as a fact, because we are, we study the fact that our bodies perform critical, I mean, real critical maintenance work.

Roger Kapoor, MD 00:23:17 For example, the lymphatic system, It's activated during sleep. It helps to filter out harmful substances like beta amyloid, which are linked to Alzheimer's disease. Sleep deprivation has also been associated with elevated levels of cortisol. ghrelin, the hunger hormone potentially contributing to weight gain and the obesity crisis. Of course, don't get me wrong, there's going to be individual variability for sleep needs. But look at the American Academy of Sleep. Look at the Sleep Research Society. They recommend a minimum of seven hours of sleep per night. But studies are showing that many people fall short of that. In fact, one study estimated it was close to 70% of adults. Don't make that criteria in one form of another, one form or another. So, in the medical field, you know, the consequences of sleep deprivation are going to be concerning. There was a real notable study in Jama. It examined 100 doctors, and it found that 1 in 3 had a positive screen for sleep disturbance. And those that had the sleep disturbance, had higher rates of burnout.

Roger Kapoor, MD 00:24:31 They reported, less professional fulfillment. And, they were more likely to make medical errors. my third tip would be, to understand, I'd say the fascinating science behind our emotions. There is a, just a great book by Carl Sagan. he's the esteemed astrophysicist, and it's called The Dragons of Eden. in it, he describes the brain as having three primary layers, which he terms, the reptilian layer or the reptilian brain, the, the limbic system and the neocortex. the reptilian brain. That's going to be the brainstem. That's going to be the basal ganglia. It's the primary, most primitive layer that we have in our brain. It evolved first. It's responsible for basic survival instincts. it's the part that handles autonomic functions like fight or flight, life sustaining activities such as breathing. Essentially, it's processing these external signals instinctively without you even knowing. those signals from the reptilian brain are sent to the limbic system. That's the second layer, which basically comprises of the hippocampus, the amygdala and the hypothalamus.

Roger Kapoor, MD 00:25:53 And this part of the brain is integral for forming emotions, with forms, memories. It forms social behaviors. It's going to process those signals, translate them into emotions, and social interactions. And so those emotional responses are then sent off to the third layer of the neocortex. and particularly the prefrontal cortex is highlighted there. It's the outer layer of the cerebral hemisphere. It is the most evolved part of our brain. It's responsible for higher order functions like abstract thinking, reasoning. It allows us to make very nuanced decisions and to reflect on our emotions. So why do I go into this, 101 on neuroscience? Because, imagine now you're being chased by a bear. Okay. What happens? The limbic system gets into action, it gets that input, it creates the emotion of fear, and you start running, even if you have no idea what's going on. Okay. that happens actually, in 74 milliseconds. Okay. The stimulus doesn't hit your prefrontal cortex, that third layer, until three seconds later.

Roger Kapoor, MD 00:27:11 The reason I'm going into this is your emotions are running the show for the first few critical seconds, and by the time your prefrontal cortex kicks in, your emotions have amplified, sometimes leaving no room for rational thought. Now, we rarely have to deal with bears chasing us in the workplace. But let's say you have a colleague, okay, that gets under your skin before you let your emotions take over. You should pause. Give your prefrontal cortex some time to catch up. Allow for more of a thoughtful response to the situation you find yourself in. Because burnout. It stems, in many cases, from a buildup of negative emotions that we keep sweeping under the rug about our workplace, about our ability to contribute effectively, about our ability to work in the teams that were put in. So before you let your emotions get the best of you. Stay quiet. Give your prefrontal cortex some time to catch up. Give yourself an ability to think about what's going on around you. Because if you don't, those negative emotions will heap up and it'll lead to more impulsive behavior.

Roger Kapoor, MD 00:28:26 Because those moments of cynicism, those moments of anger, frustration, they don't just get washed away. They get cumulatively built up in our mind, possibly pushing you to the point of no return into burnout. So before you get, you know, out there and just kind of respond to people, one simple trick, I would say, and it's simple. just keep a daily journal. Transfer your emotions onto paper forcefully, allowing your prefrontal cortex to reflect on what you experienced during that encounter. Writing down your thoughts gives your rational brain the opportunity to kind of catch up with your emotions. The last thing I'll say is I'll just end with a really beautiful quote that just came to mind, by the Dalai Lama. And he said, I hope I don't screw it up, but he said, we need to learn how to want what we have, not to have what we want in order to achieve steady and stable happiness. I'll just say that one more time. The Dalai Lama said, we need to learn how to want what we have, not to have what we want in order to achieve steady and stable happiness.

Keith Reynolds 00:29:54 Oh, you say you're a practice leader or administrator. We've got just the thing. Our sister site, Physicians practice.com, your one stop shop for all the expert tips and tricks that will get your practice really humming. Again, that's physicians Dot com.

Todd Shryock 00:30:14 Let's flip the script here for a minute. For doctors who have a staff that they're managing or they own their own practice. How can they make sure they're not burning out their staff, whether it's physicians or, you know, support staff?

Roger Kapoor, MD 00:30:29 Well, I think, you know, first thing is, people in, positions of authority like that need to be real honest. your employees are probably not going to come to you and say, hey, you're burning me out. if they do, I'd say the situation is pretty dire. I mean, it's not likely to happen. but there actually might be some science to that. There is, something called the Stockholm syndrome, and it's a term that originated from a 1973 bank robbery in Stockholm, Sweden, where these criminals held bank employees hostage for about six days.

Roger Kapoor, MD 00:31:08 And when the hostages were finally released, would you would you know that some of them refused to testify against their captors? They even raised money for their defense. in short, they had developed an affinity for their captors as a coping mechanism, and they couldn't see the situation really objectively. So similarly, a lot of employees, they often can't recognize that they're in a toxic environment when they're in one. Which is why sometimes it takes a friend to kind of hit you over the head or the shoulder and say, hey, you kind of changed a little bit. so when it comes time to preventing burnout, you need to be really proactive, in my opinion, and consciously avoid behaviors that could exacerbate or contribute to that phenomenon. It's a multifaceted approach, but a few, consistent themes that that I've come across is, number one, I would make it a habit to recognize others, you know, acknowledging your team's efforts boost morale. They sustain enthusiasm. On the flip side, micromanagement is, I think, a surefire way to drain energy and creativity.

Roger Kapoor, MD 00:32:19 Steve Jobs, I think, put it really wisely when he said it doesn't make sense to hire smart people and then tell them what to do. We hire smart people so they can tell us what to do. you know, because when you're micromanaging, employees perceive it sometimes as a lack of trust. Giving them autonomy not only fosters creativity, but it gets them more invested in the outcome. another common issue is how we give people feedback. You know, teams deserve clear, constructive feedback and a mutual understanding of expectations. Ambiguity here. I think it can lead to an immense amount of anxiety and burnout. Tough conversations should also include 360 degree feedbacks on whether the employees do they have enough resources and support to meet the goals that are being set. One of the worst things you can do is, you know, in my opinion, set unreasonable expectations just because they look good on paper. Goals need to be really rooted in realistic, and challenging yet achievable arenas to build that long term success rather than trying to put together a short term, you know, House of cards, you know.

Roger Kapoor, MD 00:33:39 Lastly, the thing that I'd probably say is you've heard the saying, hire slow, fire fast. I think there's a lot of wisdom in that. You know, take it. What I would recommend is take a deliberate approach that when you're hiring to build really strong and cohesive teams, look beyond just mere intelligence. Not that that's not very valuable, but what I would prefer people do is focus on insight as opposed to intelligence, such as situational and behavioral awareness, forward thinking mentalities, problem solving, attitudes, intelligence and insight. They're not the same thing. On the flip side, on the flip side, when it's necessary, I would act decisively. You know, this doesn't mean you go around saying you're fired. it means regularly providing feedback, offering support. if somebody is underperforming, initiating performance improvement plans, demonstrating empathy, to your employees, monitoring progress closely. One mistake I see a lot is recycling employees. You know, just moving them around instead of letting them go when that decision has to be made.

Roger Kapoor, MD 00:34:55 That's a great way to cultivate a toxic environment. you know, in short, if you're feeling even a bit burned out as a leader, there's a pretty good chance your employees are feeling it even more.

Todd Shryock 00:35:10 Great.

Todd Shryock 00:35:11 Doc, we have a couple minutes left here. Why don't you tell people where they can find your book and. And quickly. You know what it's about.

Roger Kapoor, MD 00:35:20 Well, the.

Roger Kapoor, MD 00:35:22 Book, right now is available on Amazon. It's available, I think, on Barnes and Nobles and several other outlets. And essentially, the book is born out of my experiences, through the Covid 19 pandemic, where I was, operating as a hospital leader and a physician and, trying to navigate the immense responsibilities like we all were racing to understand the new virus, all the possible treatments to save lives. But I was also making it a point to connect with our staff, rounding, Purposefully on our doctors, our nurses, our receptionists, our maintenance crews. I even stopped some EMS and first responders as they came through the E.R., and what I saw in those conversations is, I could really palpate the exhaustion.

Roger Kapoor, MD 00:36:17 I started to hear this term burnout more and more often, and frankly, it really caught me off guard because up until then, my focus was solely on patient care, solely on trying to save as many lives as I could. But during those small discussions, I found that the pandemic was threatening the actual well-being of those providing patient care, and the book is my humble attempt to find solutions, or at least try to do something that could help not just our profession, but our entire community.

Todd Shryock 00:36:51 Great doctor. Thanks for joining us today.

Roger Kapoor, MD 00:36:54 It's my pleasure. Thank you again for the opportunity.

Keith Reynolds 00:37:03 Again, that was Medical Economics managing editor Todd Shryock and doctor Roger Kapoor, author of the book Working Happy. My name is Keith Reynolds, and on behalf of the whole medical economics team, I'd like to thank you for listening and ask that you please subscribe to the show on Apple Podcasts and Spotify. Also, if you'd like to digest the best stories Medical Economics publishes delivered straight to your email six days a week, subscribe to our newsletter at Medical economics.com, medical economics, Physicians Practice and patient care online are all members of the life sciences family.

Keith Reynolds 00:37:37 Thank you.