Podcaster discusses debt, burnout and people skills with fellow physicians

Host Amber Smith: Upstate Medical University in Syracuse, New York invites you to be The Informed Patient with the podcast that features experts from Central New York's only academic medical center. I'm your host, Amber Smith. Today I'm speaking with a fellow podcaster. Dr. Andrew Tisser has a podcast aimed at early career physicians. It's called "Talk 2 Me, Doc." Welcome to "The Informed Patient," Dr. Tisser..

Andrew Tisser, DO: Hey, Amber. Thanks so much for having me.

Host Amber Smith: You majored in psychology at SUNY Geneseo, and then you attended the New York Institute of Technology to obtain your Doctor of Osteopathic Medicine. What attracted you to the field of medicine?

Andrew Tisser, DO: Yeah, that's a great question. I, unlike many, did not come into college knowing I wanted to be a doctor. I know a lot of people were like that where that was their childhood dream, and they had doctor sets as kids and things. That was never my path. So I came into college, just enjoying psychology, and that's why I majored in it. And I got involved with the local fire department, doing some EMS work and working as a fireman, actually, in college. And I got more and more involved with that and I realized that it wasn't quite enough for me. When I would drop off the patient in the ER, I wanted to know what was going on after I was done. And I had a paramedic actually, that was very influential in my career. His name was Gordon, an older guy. I don't know how old he was . Back then he seemed ancient, but I don't know, I don't think he was that old. And, I told him, "you know, Gordon, I think I'm going to try and get into med school." And, he said, "Andrew, we don't try things in life. We just do them. So you're either going to go to medical school, or you're not." And I said, "OK, well, you know, if you're gonna put a fire under me like that." So that's kind of how it ended up, and I applied and got in and here we are.

Host Amber Smith: So you liked the emergency medicine stuff, just from your volunteer work with the fire department, and then you stuck with emergency medicine, once you kind of found your way through in medical school?

Andrew Tisser, DO: Yeah. I tried to like everything else. I really did. Because with the inherent some of the challenges that come with emergency medicine, I tried to really like something more reasonable, to some degree, but I just didn't. I didn't like anything as much as emergency medicine. I got bored easily. And so, that kept me in the field that I knew.

Host Amber Smith: So what do you remember about your time at Upstate, because you were an emergency medicine resident from 2014 to 2017. What was residency training like?

Andrew Tisser, DO: Tough. You know, I don't know that many practicing physicians who look back on their residency as being cheerful and full of, rainbows and unicorns and such, because you have a short window of time to train a proper physician, right? And to learn the vast specialty of emergency medicine in general, where we got to know a little bit about everything. You only have so much time. And so we work really hard. But Upstate was a nice place. It really was. What was really cool about Upstate, the hospital, is that we had such a large catchment area, so we got to see, really, just the spectrum of disease from really local urban type people all the way up into like the hill country and Amish and Mennonite populations, and really just a very interesting patient population.

The other thing I really remember a lot about my time in residency is just the pediatric emergency medicine training I received was amazing. And, with Dr. Richard Cantor, who I believe has retired since, but he was one of the greatest pediatric emergency medicine people in our field, one of the creators of the field. And so being out there and after I left Upstate, we went to Chicago for a few years. Just seeing the disparity in training that I received to some of my peers was fantastic. And, Syracuse is a fun city, you know?

Host Amber Smith: Well, what, what has kept you in emergency medicine?

Andrew Tisser, DO: You know, it's interesting. I've worked in pretty much every practice setting possible at this point. I followed my wife out to Chicago where she did a fellowship, and in my time there, I worked at six or seven different hospitals in the two years we were there doing some part-time work in a lot of different places because I really didn't know what kind of setting I wanted to work in. And so I worked in these tiny little hospitals, all the way up to these giant medical centers, and everything inbetween. Again, my training was fantastic to the point where I was able to adapt really quickly to any of those settings. And so I've learned over time, what keeps me happy, and it's doing a lot of these other things, doing the podcast. I do a lot of administrative work nowadays. I'm the associate chair of emergency medicine for my hospital, so I do a lot of that and a lot of side projects and I have an 11-month-old that keeps me happy, too. And busy.

Host Amber Smith: Well, tell me how you got started as a podcaster.

Andrew Tisser, DO: Sure. So, initially, the podcast was to be focused on communication in health care. When I was leaving Chicago, one of the security guards bought me a bottle of champagne and I said, "oh wow, you didn't have to do that. That's nice." And he's like, "well, you talk to me, like I'm a person, Doc." And I was like, "Oh gosh, that's terrible. Don't most people talk to you like you're a person?" And he said, "No, you'd be surprised." And so I sought to really get some information about communication in healthcare and how we talk to each other. And so thus, "Talk 2 Me, Doc," right? And after about a season of that, it grew a little stale. And the only reason that is is because a lot of people were saying the same thing, that we're all the same team; some of the hierarchy in medicine is really not as much as it used to be: and everyone has a voice. And while all true, I didn't think that continuing in that topic was really that interesting for my listeners. After a while, after I had interviewed people from pretty much every part of medicine, and my interest became more aligned with the issues relating to the early career physician. And then I pivoted the show, and that's where we've been ever since.

Host Amber Smith: This is Upstate's "The Informed Patient" podcast. I'm your host, Amber Smith. I'm talking with Dr. Andrew Tisser. He's a doctor who has a podcast aimed at early career physicians, and he did some of his training in Syracuse, in the emergency department at Upstate University Hospital.

So now that you changed sort of your focus, or refined it to aim at the early career physician, what are some of the issues that you find important to these people?

Andrew Tisser, DO: I think fundamentally a lot of the issues are the same across the spectrum of medicine, right? But the early career physician -- and I arbitrarily say up to like seven to 10 years out of residency, and I just made it up -- but I think that demographic is faced with a lot more different issues than than the previous generations.

The biggest one, you know, the elephant in the room is student loans, right? We're looking at people coming out of medical school, you see all these things like, oh, the average indebtedness is $200,000. Most of the people I know would die if they had $200,000 in debt because we're talking $400,000 or $500,000, $600,000 in student debt. So that is a big issue in and of itself. That leads to a lot of downstream issues, something we refer to as golden handcuffs, right? People that are staying in medicine either full-time that would like to go to part-time, or working ungodly amount of hours per month, per week, in order to afford a lifestyle that's inherent with their hard work and their training. So, we see a lot of burnout because of that, right? And a lot of physicians would really do better if they cut down clinically. You know, instead of working 180 hours a month in the emergency department, if they are working 130, they probably would have a lot better life. But a lot of that is tied together with finances.

The other issue we're seeing, again, is, actually the greatest exodus of 30- to 50-year- old physicians from the profession in the history of time, which is really concerning, right? Because I want someone to take care of me when I'm older, right? This is multifactorial, and this was happening before the pandemic, but the pandemic has certainly made things a lot worse.

We also see more of a focus on health and wellness initiatives and burnout in residency curriculum, but we're still not seeing a ton of work on like just the practical side of medicine: how to negotiate a contract, how to buy a house, what is a physician mortgage? What should you look for in a potential employer? Why higher salaries don't necessarily lead to better happiness, what to do with your marriage. How are relationships in the early career? There are a lot of things that are different nowadays because of the focus on metrics, because of the focus on increased documentation standards and burden, because of the increased amount of patients we got to see per hour, and on, and on, and on we go.

So I feel that this demographic is different than the previous one, and so that I focused on a lot of those things. Certainly older physicians can listen to my show and get a lot of value as well. But, I talk to what I know about.

Host Amber Smith: Medical school, you're learning medicine and how to heal the sick, but I don't think you get as much, or any, training in how to run a practice or understanding how the health insurance system works or Medicare, Medicaid. I mean, those are huge things that I guess you're just supposed to know through osmosis?

Andrew Tisser, DO: It's very much true. Or even alternative careers. You know, I had a colleague once that said she would cry in her car before every shift. That's how bad it had become. And she said, there's just, there's just nothing else I could do. Well, that's not true, right? There's a lot of viable careers for physicians if they want to leave the bedside. So some of that stuff as well. And recently I've been having a learner series on, so we've had medical students and residents and fellows coming on as well to talk about some of the challenges that even this generation which isn't that far from me, right? I graduated residency in 2017. I'm not that far out. But there are new challenges, that I didn't even face that are coming up now. There's a never ending amount of stuff to talk about. I've met some really cool people. I bring in guests from the spectrum of life and not just medicine, from every industry. And, and so, you know, it's been fun. It's been a fun project.

Host Amber Smith: Let me ask you a little bit more about the student loans, bec ause everyone's heard how much money doctors are gonna owe when they get out of medical school. Do you think that deters some people from even going to medical school?

Andrew Tisser, DO: Yes. We're not there yet, but it's getting worse and worse. It's becoming a profession of the children of the wealthy. You go into medical school, right? And you grew up middle-class, so you had to take out loans, right? That is just the nature of it. If you come out with a loan burden of half a million dollars, and you're not on track for any of these PR forgiveness programs, which are very few and far between, you can't take a job as a family physician, almost, right? I mean you can, but you're not going to have the life you maybe imagined. And not to say that physicians aren't the top 1% of earners in the country. I'm not trying to discount that in any way. But if you're looking for a straight return on investment, it's not the best one anymore, right? Because you know, reimbursements are going down. Salaries are going down. Tuition is going up. And that's just where we are right now. And unfortunately we could have a discussion about the unregulated tuition in this country, which is a whole different issue, but that's where we're at. And, and of course, if you wanted to do healthcare, why wouldn't you go to PA school and be done in three years and not have residency and not have the loan burden? It's certainly is becoming a roadblock to becoming a physician, if that's what you want to do.

Host Amber Smith: Is there something you'd like patients to understand about doctors?

Andrew Tisser, DO: We're people, right? I think there's still this vision in people's minds of like the mighty physician that can do no wrong, right? And how many times do I go up to a patient when I don't have a diagnosis for them and just say, "Hey, I don't know. You're going to have to talk to your doctor, or a specialist. We've run all these tests. Everything looks OK. I'm not saying something isn't wrong with you. I'm not discounting your symptoms. I just don't know." And people appreciate that, right? It brings a humanity back to some of this, right? We're just people, people that have a lot of expertise and knowledge, but we make mistakes. As long as we're able to own up to that, I think it makes for a better physician-patient relationship.

Host Amber Smith: How would you advise a young physician who got into the profession because he or she wants to help people, but now they have to decide what specialty to devote their career to? What sorts of things do they need to be thinking about when they choose their specialty area?

Andrew Tisser, DO: It's really tough. If you take your average medical student, graduated college at 22, got to make a decision on what you're gonna do for the rest of your life at 25 years old. That's tough, right? So, the way I advise students always is to make a list of all the specialties and I like to cross things out. And when you cross out a specialty, it's important to note whether or not that was because you didn't like the specialty, or you had a bad experience. Is it, you didn't like Ob/Gyn (obstetrics and gynecology) because you didn't like the OR (operating room), or is it because you didn't find the specialty interesting? If you didn't like the OR, that eliminates a bunch of other ones. And so go through it that way. Everyone says don't pick a specialty based on money, and I agree with that, but I think lifestyle concerns matter. And I think it's something to think about. When you're 23 years old and single, you know, working half the weekends and a bunch of nights per month seems fine. When you're married and have a bunch of kids, maybe you won't feel the same way. So sometimes it's hard to think past the present, but these are concerns, so just think about those things.

Host Amber Smith: So your podcast -- "Talk 2 Me, Doc" -- where can people find it?

Andrew Tisser, DO: Everything I do can be found at my website, AndrewTisserDO.com. And I'm on all socials everywhere. I mostly hang out on Twitter and LinkedIn these days. But any place you find podcasts, Apple podcasts, Spotify, all the big ones. I'm there.

Host Amber Smith: Well, I appreciate you making time for this interview, Dr. Tisser.

Andrew Tisser, DO: Well, thanks for having me. It was a lot of fun.

Host Amber Smith: My guest has been Dr. Andrew Tisser from the "Talk 2 Me, Doc" podcast. "The Informed Patient" is a podcast covering health, science and medicine brought to you by Upstate Medical University in Syracuse, New York. Find our archive of previous episodes at upstate.edu/informed. I'm your host, Amber Smith, thanking you for listening.