Nobody Knew I Was Drowning | Dr. Corey Fish

Dr. Sue: [00:00:00] Hey, all. Welcome to Still Practicing. Today, we talk to Dr. Corey Fish. He is the network medical director of Optum Care Network, and titles don't matter so much to me. I've known him for a really long time, since he was a little baby doctor, uh, coming out of residency, and he is a delight to talk to today.

He brought a lot of vulnerability, um, talked really openly about some deep risk-taking in his career and how those things did or didn't pay off, and how he maintained a, a certain positivity about it. He's not jaded and, um, is on the other side of those difficulties, and I think, uh, it's gonna be a great lesson Dr.

Corey Fish 

Dr. Corey: Hi 

Dr. Sue: It is [00:01:00] absolutely so awesome to see your shiny face this morning. Thanks to you. Thanks for coming on. 

Dr. Corey: Thanks for having me. This is great. Yeah. This is super fun. I, I think this is, uh, this is my second podcast appearance ever, and by far the most, like, professional, so we're off to a great start already.

Dr. Sue: Thanks. I appreciate that, for sure. 

Dr. Corey: It's really cool to see this come together. It's something that we've talked about for a while, and- 

Dr. Sue: We have ... here we are. Yeah. You and Annalisa have both been, um, major boosters of the whole idea, so, uh, I appreciate that too. And, um, all of Annalisa's past experience was excellent encouragement to move forward, for sure.

A little softball warm-up question: when you knew you wanted to be a pediatrician? 

Dr. Corey: Yes. Um, this is a good story. You've maybe heard this before, but I'm gonna tell it anyway. So, um, I was a third-year, uh, med student, and in your third year you have to go through all of your, you know, [00:02:00] rotations, uh, family medicine, internal medicine, psychiatry, and all this other stuff.

My pediatrics was the very last one, and I think there were maybe eight rotations that year. And first rotation comes and goes, and, uh, you know, it was great. Got a fine evaluation, but there was this note in my evaluation that I, um, lacked a certain professionalism, apparently, uh, that is needed to, to be a, to be a real doctor.

And I was like, "All right. Well, that's weird." And then the next one came, and sure enough, I got another comment about my lack of professionalism. And, and this recurred in every single rotation until pediatrics, where, uh, I got my evaluation back, and they were like, "This guy's great. He should be a pediatrician."

It turns out I wasn't acting unprofessionally. I was just acting like a pediatrician. So to me, that was like, I gotta do this thing, 'cause everyone else thinks I gotta be serious, and I don't wanna be serious, so- 

Dr. Sue: Aw ... 

Dr. Corey: let's go. 

Dr. Sue: Perfect sign. Perfect sign. Yeah. We're so [00:03:00] lucky that, uh, it unfolded that way, and we, uh, got to have you in our, in our specialty, so excellent.

Dr. Corey: Thank you. Yeah, it was good. It was definitely the right decision. 

Dr. Sue: I know that you went to medical school at the University of Washington. Go Huskies. Mm-hmm. 

Dr. Corey: Go Huskies. 

Dr. Sue: And then you went to the University of Texas Southwestern in Austin- Mm-hmm, mm-hmm ... for your residency training. 

Dr. Corey: Yep. 

Dr. Sue: I wonder if you would give us a little overview of your career since your training.

Dr. Corey: Yes. So, uh, in my residency, um, I was exposed to, you know, kind of big city resource-heavy medicine. I mean, there was a lot of specialists in Austin, and it just seemed like invariably when we were on our inpatient rotations, we would be admitting kids who, um, either didn't need to be there or who were so sick that they just needed to go to the ICU, like, immediately.

These were admits from the community that hadn't gone through the ER. [00:04:00] And I was like, "You know, this is ridiculous. There's gotta be a better way." And my answer, uh, to basically everything at the time was, "I'm just gonna do everything myself, and then that way I will always know what's going on, and my patients will always have good care, and no one else will be in the kitchen mucking things up."

By the way, can we swear on this podcast? Is this a swearable podcast? 

Dr. Sue: Yeah, I think so. It's for grownups. 

Dr. Corey: Oh, okay. Cool. All right. Awesome. I just- I meant to ask that earlier, so now I know. Perfect. I figured out pretty quickly that the only way to really practice that way was to go to some place rural, and I knew I liked the mountains, and so I started looking around.

Uh, and I found this great pediatric practice in Bozeman, Montana, um, which was called Acorn Pediatrics at the time. Now it's called Hatch Pediatrics, of course, your practice. And you were kind enough to take me on as a resident, and went and totally fell in love with the work, and it was just exactly what I was looking for [00:05:00] at the time.

Um, and so after, uh, residency was over, I, I came to work for you in Bozeman, kind of getting to, getting to do all the things. 

Dr. Sue: It was surely that, a place to do all the things yourself. 

Dr. Corey: Yes. Yes. 

Dr. Sue: Um, but yeah, that is great for having a sense of control of the patient's experience and knowing that you're cultivating a safe experience for them.

Um, maybe has a downside, but, uh, yeah, was, uh, gratifying for sure in its way. 

Dr. Corey: Yeah. Yeah, absolutely. So yeah, did that, and then, you know, after a couple of years there, um, you know, kind of some family fit and looking for, you know, different opportunities for, for my wife and I, moved to Portland and practiced primary pediatrics in Portland, which was exactly the opposite, um, which we can get into, uh, some examples of why [00:06:00] that was the case later.

We could certainly do that if you want. Um, but, uh, and then, you know, after a couple of years of doing that, uh, kind of started my own, my own thing. Um, ended up opening a pediatric urgent care, which kind of took on a life of its own, and then made another hard pivot, yes ag- uh, yet again to the world of, um, managed Medicare and working with no longer pediatrics anymore, um, and have been in that world, um, doing some medical director stuff, uh, for the last couple of years.

So I think that's the, that's the 10,000-foot overview. 

Dr. Sue: Yeah. Perfect. Perfect. That's exactly what I was looking for. And yeah, let's, uh, let's get into some of that stuff in the middle of that story. Um- I'm curious to start, if you can remember early in your career if you ever had any thought about burnout, if you ever had the thought that that was a problem of other people, or if it just was not even, not even [00:07:00] conceptualized by you in that part of your life.

Dr. Corey: I think I w- I felt like most young people in their careers probably, which is that you're sort of a superhero and you can kinda do everything, and if people burn out, that's gotta be a problem with them or something they did or didn't do, and, and that's certainly never gonna happen to me. Um, so I would say somewhere between that and not even on my radar screen.

Mm-hmm. You know, I was just focused on from getting to that post-graduate year one to year two to year three to out the door and making a real paycheck, and, uh, there didn't leave a lot of time for reflection on most other things, as it turns out. Yeah, 

Dr. Sue: I imagine that is fairly typical. Um, certainly sounds familiar to me, too.

Yeah, it just, uh, wasn't even, wasn't even much of a thought. And I don't think, uh, I don't think I knew any pediatricians who had burned out, or if they had, they weren't talking about it to me, so, um, that makes sense to me. [00:08:00] Um, in the arc of your career, was there a point where you thought, uh, "This is not working for me"?

Dr. Corey: Yeah, totally. I mean, I, I think that has come up a couple of different ways. I'm not sure, you know, I, I guess, I don't know. I don't know what burnout is supposed to feel like or what typical burnout is supposed to feel like. Maybe it's different for all of us. But I think for me, that kind of manifested as, you know, this sense of, um, just being sort of bogged down and kind of bored a little bit.

Um, and you know, that, that came up for me at practicing in Portland, um, you know, as a general pediatrician especially, you know, on the heels of what I, what I had been up to in Montana before that. And it also came up, um, you know, during my time at, at BraveCare, which, you know, as I s- sort of alluded to earlier, kind of evolved into something that I had never really planned on or anticipated, but, um, the grind sure felt heavy, [00:09:00] uh, in the middle of that, too.

Um, so I, I haven't been in that place, I don't think, for a while, uh, which, which feels good. But, um, but yeah, it's come up a couple of times, uh, over the arc of my career. 

Dr. Sue: Can you talk a little bit more about Brave Care? 

Dr. Corey: Mm-hmm. Yeah. Yeah, so after a couple of years in Portland, um, I decided that, you know, I, uh, the- what I was up to currently was kind of untenable.

I, I couldn't continue to practice primary care pediatrics in the way that I had been, and so, uh, I remember having several conversations with my wife, Annalisa. Uh, you know, do I go back to school and specialize in pediatrics? Do I-- Do we move somewhere else? Do I change clinics? Do I work in the hospital as a hospitalist pediatrician?

Or, you know, should I kinda do my own thing? And, and one thing I always had gravitated to in pediatric medicine was that, um, real acute, kind of [00:10:00] urgent, you know, we gotta do something for an intervention for this kid soon or bad things might happen. That was always a point where I kinda found my flow state.

I th- joke in another life, I think I was probably a pediatric ER physician. Mm-hmm. Mm-hmm. Um, but have always kinda gravitated to that, and so thought, hey, you know, I, I could do pediatric urgent care, and maybe I should just open my own thing. Um, so after a couple of years of practicing primary care in Portland, I decided to do that, and was this-- I joke that it was the right combination of confidence and naivety, right?

Like, how hard could it be? Just, like, open a practice. Yeah. I mean, what... Yeah, and then you realize pretty quickly that the hard part is not getting the doors open. Uh, you know, you're, like, patting yourself on the back, "We did it," you know? Uh-huh. But then what you realize is that the, the hard part is what happens, like, every day after the doors are open.

Dr. Sue: Mm-hmm. 

Dr. Corey: Um, and, uh, turns out I knew next to nothing about how to market that particular set of [00:11:00] services. And you could be the greatest thing in the world, but if nobody knows about you, um, it's a, it's a real tough, tough sled. 

Dr. Sue: Yeah. Yeah. I wonder if you might have heard from a mentor along the way that running your own practice is not rocket science.

Dr. Corey: Yeah. 

Dr. Sue: Just go do it. 

Dr. Corey: Yeah. Yeah. Maybe, maybe so. Well, here's the thing, is you did it, and you just made it look so effortless- ... most of the time. 

Dr. Sue: Yeah. 

Dr. Corey: Mm. Yeah, most of the time. Um, and, uh, I was like, "Yeah, you know, I could totally do that." Uh, but, you know, there's a whole bunch of factors outside your cont- immediate sphere of control that can really conspire against you, I think.

And, you know, the nature of, you know, episodic care is people don't need it all the time, thankfully. Mm-hmm. Mm-hmm. And so that's another sort of tricky thing to, to manage and figure out how that's gonna go. 

Dr. Sue: Yeah. And so then you did what with that? 

Dr. Corey: Yeah. So, oh, got the doors open. Um, [00:12:00] and, uh, there was a lot of suffering.

You know, it got pretty dark in there. Um, you know, when you do things like, uh, put your house up as collateral for a loan to open this thing, and then the thing doesn't go well, like, that's a pretty heavy time, pretty stressful time. And, um- Yeah, no 

Dr. Sue: doubt ... 

Dr. Corey: was, was not great there for, for a year or a year and a half, and then, uh, ended up meeting my business partner, um, who comes from a world of venture-backed, um, tech startups, venture-backed startup companies.

Had had some success in a couple of previous endeavors. Brought his kids to see me and was like, "Hey, this is great. This should exist everywhere. You know, how would you like to work together? We could turn this into a whole venture-backed thing." And I said, "I don't know what that means or how that looks, but I'm miserable doing what I'm doing now, so, you know, let's do it.

Why not?" And so that kind of took us off into this world where, um, we [00:13:00] got into business incubator and raised a bunch of money and ended up kinda taking the business in a, in a direction, you know... We always used to say, like, we were trying to be like the One Medical for k- for kids, if people are familiar with that sorta tech-enabled healthcare provision.

But, um, did that for a while and, and, you know, we were lucky enough to stick around for about, like, five or six years, and then as a lot of startups do, we imploded pretty spectacularly. Um, but learned a lot along the way, thankfully. 

Dr. Sue: Yeah. Yeah Um, when you were leaving your own urgent care behind, was there anything that was really difficult to let go of in that process?

Or you felt pretty ripe to make change it sounds like? 

Dr. Corey: Um, you're talking about, uh, at the time when I decided to take on a business partner? 

Dr. Sue: Yes. 

Dr. Corey: Um, yeah, I mean, I, I had some people, you know, kinda in my ear, you know, [00:14:00] saying, "Hey, Corey, you built this great thing. You sure you wanna do this?" And, and I think a lot of those folks hadn't really seen behind the curtain- Mm-hmm

and- 

Dr. Sue: Mm-hmm ... 

Dr. Corey: weren't privy to the thoughts in my head around, you know, I wonder what it would be like if I didn't wake up tomorrow, you know? Oh, 

Dr. Sue: yeah. Yeah. 

Dr. Corey: Um, and, and so I, I think that's easy to say from the outside. Yeah. Um, but you know, I was sort of put in the position where I could have pretty, um, close to 100% autonomy over the medical care side of things.

Mm-hmm, 

Dr. Sue: mm-hmm. 

Dr. Corey: And so that, that felt okay. Um, so, so all in all, I think it felt like the right thing. I mean, it certainly... What I was doing was certainly not sustainable, you know, without, without, uh, a couple of pretty major miracles. 

Dr. Sue: What were your supports, um, to make that decision? What... Was it just necessity?

You were obviously, [00:15:00] uh, profoundly uncomfortable with what you had built and gotten yourself into. Mm-hmm. Was that all you needed to drive that? Or did you recruit outside support to decide you wanted to make change? 

Dr. Corey: You know, it, it was interesting. Most, as I kind of alluded to, most of the outside support was coming to me with a, "Oh, you know, you could just kinda, you know, maybe keep doing what you're doing for a little while longer."

Uh, so it was interesting. That was very much the tone of, of the outside support. Mm. You know, I talked to friends and, uh, family of course. But, um, but yeah, I, I did recruit outside support, but I feel like there weren't very many voices saying, "Yeah, no, you should definitely take this different direction that's, that's before you."

Dr. Sue: Were any of those outside sources aware of- The depth of suffering that you were experiencing? 

Dr. Corey: No. 

Dr. Sue: Yeah. 

Dr. Corey: Mm-mm. Not 

Dr. Sue: at all. I appreciate you being willing to [00:16:00] express it here. Mm-hmm. Um, and I, I don't mean to be voyeuristic about it, but, uh, I think that's, uh, real common that when- Mm-hmm ... we get, uh, I think it's fair to call that burned out, when we get that, um, degree of suffering happening, we are not talking to people about it.

And, um, I experienced something similar at a point in my career, and, um, honestly, I think I thought I was the only person that would be experiencing that. So, uh, that contributed to me not, not voicing it to other people. Felt- Yeah ... felt kind of shameful. Especially when you're a pediatrician, you know? And you have all these- Yeah

wonderful patients and wonderful families, and there's so much gratification from the work to say, um, I can't do this anymore. I mean, it's like maybe killing me, um, is pretty hard to put words to. 

Dr. Corey: It is. [00:17:00] Do you, do you think that is unique to people in healthcare, or do you think that that's a pretty universally felt thing?

Dr. Sue: Uh, I imagine it is, um, universal to an extent, but- I suspect that within medicine, it is harder for pediatricians to voice that. I've got a lot of adult medicine friends who, you know, can talk about all the things that they dislike about their job and do so pretty freely and even, um, I think when they are, you know, questioning their career choices, uh, and, and, you know, pretty unhappy, especially through and, and after the COVID pandemic.

Um, but I think there are more barriers to pediatricians doing that, uh, I think because we tend to be, uh, a slightly [00:18:00] unprofessional, uh, group. I'm kidding, but, um, a, a group that is really invested in the innate joy of childhood and trying to reflect that back and trying to bring that every day and, um, and then when you're crumbling on the inside, uh, there's not a lot of place to take that when that's the environment of, of the field, I would say generally.

Dr. Corey: Yeah. I hadn't thought about that in that exact way before, but I suspect you're, you're spot on. It's, it's an emotionally pretty taxing day. You know? There's, there's all kinds of things from super happy kids to kids who are not in a good place and parents who aren't in a good place, and you've really gotta be present for all of that for, like, the entire day, you know- Mm-hmm

day after day. Uh, so, so yeah, I think that, that tracks. That's an interesting spin on that. I hadn't thought about it like that before. 

Dr. Sue: Did going into partnership help [00:19:00] fix the things that were feeling challenging? 

Dr. Corey: It sure helped kick it down the r- kick the can down the road- 

Dr. Sue: Mm-hmm ... 

Dr. Corey: you know, by a few years.

I don't know if it f- what it fixed. Um, you know, I- my own, you know, personal feeling on that is I, I think a lot of that has to do with, you know, who we are and how we cope with things as people. And, um, you know, while the s- immediate stress of that might get removed, um, I'm not sure that that does much for the underlying issue.

But, uh- Mm-hmm ... but yeah, you know, it was... We, we raised a bunch of money, and that relieved a lot of that financial pressure. We were able to clear a lot of that debt off the table that was causing me personal anxiety, which, you know, again, was great. I'm very grateful for that. Um, but, uh, but yeah, ultimately, um, the s- the stress kinda came back in a, you know, in a pretty big way.

Dr. Sue: Yeah. How did you navigate that, and how'd you end up where you are now? 

Dr. Corey: Yeah, I mean, the [00:20:00] thing with, with startups is, um, you know, it's a really interesting culture. You are very much building the plane while you're flying it. Mm-hmm. You get very comfortable with the idea that there is six months worth of operating expenses in the bank, and probably something will happen, you know, with a month or two to go, whatever.

You'll just raise another round and, you know, get another injection of money, uh, from whomever for whatever, you know, reason. It's, it's wild. I mean, the- Yeah ... sums of money that get thrown around and the culture is totally bananas. It was not anything I had ever been exposed to before. Um, that real early-stage mentality is not really something I'm eager to do again ever.

Um- Yeah ... uh, I will happily work for someone else's startup. I will never start my own company again. Um- 

Dr. Sue: Mm. Mm-hmm. 

Dr. Corey: You just get comfortable with this idea of kinda living pretty fast and loose, and- Mm-hmm ... you know, that either [00:21:00] pays off one day, which is what all those investors are hoping for, or things explode.

And whatever, that's tax write-off, you know, onto the next thing, and it's just like- ... 

Dr. Sue: wow. Yeah, that's definitely their culture, right? It's just- Yeah ... a tax write-off, and we move on to the next thing. 

Dr. Corey: Yeah. 

Dr. Sue: How was that experience for you as somebody who had birthed that baby? 

Dr. Corey: Yeah, it was, it was interesting because you end up needing to explain a lot of really basic things about healthcare to people who have no healthcare background or experience.

Mm-hmm. You know? And so, um, I'm trying to th- I, I, I'm... Maybe an example will come to me later, but it's just people ask these questions, and you're like Do, do you know anything about the space, like, at all? Like, it's, it's, it's totally, it's, it's just, it's wild 

Dr. Sue: Through that, was there anything that surprised you [00:22:00] about yourself?

Dr. Corey: Just the degree to which I was able to kind of get comfortable with that mentality. Um, you know, and I look back on it now, and it's like, you know, you're talking about, like, checks in the millions of dollars, and the f- and the fact that you're speaking just casually about, you know, seven-figure sums of money is- Mm-hmm

is pretty bonkers, right? That's- 

Dr. Sue: Yeah ... 

Dr. Corey: not something I grew up around. That's not something I have ever had any experience with before or since, unfortunately. Maybe I'll win the lotto one day. Uh- Mm-hmm ... but, uh, but yeah, it's, it's wild. You get pretty used to that, um, pretty quickly. And, and the f- degree to which those things get normalized was, was pretty surprising, for sure.

Dr. Sue: Yeah, I definitely, uh, was aware of what a big wheel you were all of a sudden. I was really impressed. 

Dr. Corey: Well, the thing of it is, is I'm not sure about the size of [00:23:00] my wheel, uh, but I, you know, it's, it kinda makes you feel like that, you know? Yeah. And, and it's, uh... You know, you're going to these conferences, and, you know, there's celebrities in the room, and- Wow

it's just, it's kinda wild, you know? It's kinda wild. It's a little gross, but it's also kinda wild. 

Dr. Sue: Yeah, yeah. It sounds like a good experience to have had. 

Dr. Corey: Yes. I learned a lot, for sure. 

Dr. Sue: Is there anything looking back that you would have wished you had done differently to- Yes ... avoid any of the hard parts along the way?

Dr. Corey: My whole attitude when I took on a partner and we started to grow this thing was like, "Oh, I don't know anything about this world. I don't know anything about the intricacies of running a business this size." 

Dr. Sue: Mm. "

Dr. Corey: So I'm just gonna depunt all those decisions. I'm gonna [00:24:00] defer all that to others." And the mistake that I think gets made is the deeper you peer into that world, the more you realize it's a lot of, an awful lot of folks are just winging it until you have enough data to make data-driven decisions.

Because early on, you don't have any data, right? So you just have to tell a story and come up with an idea- Mm ... and hope somebody writes you a check, and then pressure test it- Mm-hmm ... until you get proved wrong or right or pivot or whatever. And the mistake that I think I made is that- There's a lot of it that just comes down to common sense, and I really wish I would have pushed back more because I think unfortunately You have to say s- you have to stay so laser-focused in those early stages on what is the [00:25:00] North Star, what is the mission, and how are we gonna get...

how is everything we are gonna do get oriented to great patient care- 

Dr. Sue: Hmm ... 

Dr. Corey: and to making a profit as quickly as possible. Yeah. And just stay laser-focused on the margins of the business and driving everything towards those two things. And if something you're doing is just shiny and cool and looks awesome, but isn't materially driving either one of those things, then you should not be doing it, and you should be doing something else.

Dr. Sue: Mm-hmm. 

Dr. Corey: And we spent a lot of time building stuff that was shiny and looked cool, but that did absolutely nothing to move the business forward. Hmm. And that stuff is very expensive to build. Um, you know, those engineers are not cheap. Those designers are not cheap. Mm-hmm. And, yeah, it looks cool or maybe you do it because of optics, but it doesn't help the business, and it doesn't help provide better patient care.

So [00:26:00] I, I really wish I would've been more vocal about asking some of those questions early on- Mm-hmm ... um, to try to not discount my own horse sense so quickly. 

Dr. Sue: Yeah. Yeah. That makes sense, totally. Um, is that something you still feel like you're hard on yourself about, or you have enough self-compassion to be like, "You know, that makes sense that I proceeded in that way," and- 

Dr. Corey: Mm-hmm.

Yeah. I ha- I have gotten-- I have found the peace with all of that now. Um- 

Dr. Sue: Mm-hmm ... 

Dr. Corey: you know, I, I think I'm, I'm far enough from it, and I learned a lot, um, and I've been able to kinda pivot my career in a direction that I really enjoy. And I think a lot of that is due to those experiences and what I learned and how I learned I wanted to be and how I learned I didn't wanna be.

And so I, I think I've found the peace with it now, but it [00:27:00] took a while, a lot of therapy. Yeah. 

Dr. Sue: Good. 

Dr. Corey: Yeah. 

Dr. Sue: Cory, does this, um, talk, uh, unsettle you, or you feel like, "Yeah, no, this is, this is great"? 

Dr. Corey: No. There, uh, I'm a pretty hard person to unsettle, Sue. I think you maybe know this already, but- I do know 

Dr. Sue: that

Dr. Corey: yeah. Yeah. 

Dr. Sue: Yeah. 

Dr. Corey: Yeah. 

Dr. Sue: Yeah. Yeah. That's why I know when you, uh, when you talk about how dark the days were around Pacific Crest Pediatric Urgent Care, I, uh- Yeah ... I know that means a lot. 

Dr. Corey: Yeah. Yeah, totally. And you mentioned, you know, uh, I, I think it's important for people to hear. So, um, ask away. I, I will, you know, I'm happy to be totally transparent, um, with, with all of that 'cause I don't think we talk about it enough.

Dr. Sue: No, we surely do not. Along those lines, uh- If you were able to talk to yourself in that moment when the wheels were starting to come off, uh, knowing [00:28:00] especially that there might be somebody else who's currently in a similar situation, is there anything you would say to yourself now, being on the other end of it?

Dr. Corey: Yeah. I th- the biggest thing is just kindness to self. Um, you know, I'm one of those people that, uh, interprets mistakes that I make as a commentary on my worth as a person- Mm ... um, and how, you know, good or not good I am as a person. And, um, boy, that's just got nothing to do with it, you know? And so, just whatever that mantra looks like, you know, just super kind to yourself.

Um, and that, you know, turns out nobody's perfect, uh, which is, I'm su- you know, not the most earth-shattering thing I've said today, but- Mm-hmm ... uh, you know, nobody's perfect. And, and we all make mistakes, and [00:29:00] everybody's got their stuff they're, they're dealing with. And it's okay for things to be messy and to feel hard and to feel like you can't do it anymore.

And you just- Mm ... need to give yourself a big hug and say, "Hey, it's all right," you know? 

Dr. Sue: Yeah. Simple and profound at the same time.

I'm curious which of those two experiences were personally harder. Was it, um, your private practice not thriving and, and feeling at personal financial risk, or was it the implosion of the fancy venture capital situation? 

Dr. Corey: Um, they f- both felt hard in kinda different ways, um, to be honest with you. I, I think the, the commentary, uh, the self-commentary, I think, was louder and [00:30:00] harsher with, uh, the first, you know, the f- kind of the first go-around- Mm-hmm

um, because it was, you know, my, it was our, our family's financial security on the line and, and that felt real in a way that the latter did not. Um, but I, I think the, the second part, kind of the implosion of, of this thing, um, you know, felt just as hard but in kind of a different way, if that makes sense.

Dr. Sue: Mm-hmm. Were there things at either juncture that still were bringing you joy? Were there things that you were looking forward to, that were helpful, that were reminding you that you needed to change something to get some better balance in your life? 

Dr. Corey: As far as bringing me joy, um, you know, professionally when, when you'd have a day where you knew, like, all right, like, this was a day where we filled the schedule or [00:31:00] mostly filled the schedule, and I got to do some really cool stuff, and just these parents being so thankful for that set of stitches you put in or for that, um, you know, nebulizer that you gave their kiddo and the steroids that you gave their kiddo for croup and the-- you know, at, at 8:00 at night were gonna save them a trip to the ER.

Mm-hmm. Like, that felt very, very gratifying. Um, and interestingly, this is a bit of a segue, but it's an interesting story, I think. Um, I had, I, you know, early on in kinda the, we'll call it the Pacific Crest Children's Urgent Care, so that was what I called the urgent care before it became Brave Care. So in the Pacific Crest days, um, I had cobbled together enough, um, you know, kinda per diem help where I could take a little time off.

So, so the, the low point of that experience was when I realized things were so bad financially, I had to let every single staff person go. That was, like, two nurses. That was [00:32:00] another provider or two, some medical assistants, some front desk folks, and it, I-- it was down to me and one medical assistant who was there, you know, not all the time, 'cause we were open seven days a week.

I think we were open, like, 70 hours in the, in a 70. We were open seven 10-hour days is what that amounted to. And so I worked all seven of those days, all 70 of those hours, uh, every single day for three months without a break. Um, and, you know, had the, that medical assistant who was there, you know, some of the time or a good chunk of the time, which I'm very grateful for.

But that was rough. And coming out of that, you know, when things were finally starting to maybe change a little bit, had cobbled together enough help to take some vacation. My wife, who also had a podcast, had been invited to South by Southwest to do her podcast in Austin. Hmm. She said, "Cory, you should come down and, like, take a little time."

And I was like, "That sounds great." And I remember [00:33:00] on the plane as I was leaving, I was kinda flipping through the concert lineup, and one of my, like, all-time favorite singer-songwriters was playing a set there, um- And, uh, b- a guy by the name of Butch Hancock, who was in a band called The Flatlanders, um, uh, I will stop because otherwise we're gonna get off on a '70s country music tangent, so we'll stop before we do that.

But, uh- ... uh, he was playing with one of his old bandmates from The Flatlanders, each of their two kids, and then another guitarist, a guy called Bill Kirchen, who was in another amazing Austin band called- Yeah ... Commander Cody and the Lost Planet Airmen. It's a fantastic band. Check it out if you're not familiar.

Um, but they were playing at Threadgill's World Headquarters in Austin, and went there, and it was just this really tiny outdoor venue, kind of wood chips, you know- Mm-hmm ... these dust motes floating through the lights from the wood chips. And it was just this really kind of profound moment of [00:34:00] joy that I was experiencing.

Oh. And at one point, this woman walked up to me in a hand-crocheted hat and one of those color block jackets from L.L.Bean from- ... like, the '90s, '80s, you know, with the purple and the yellow, and she just looked at me and she was like, "You could use this." And she, like, pulled this palo santo stick out of her pocket and handed it to me, and I was like, "What is this?"

And she was like, "Oh, you burn it. It's like incense." And I was like, "Okay, yeah." She's like, "Yeah, you know, just thought you could use it." And then she wandered off. And the really weird shit is that I never saw her again, like, the rest of the night. And I was like, "This has gotta be a sign." And so I took this stick and I started to burn it, like, in the clinic.

Like, I smudged the clinic out with it. I would burn this thing, like, every single day. And that was right around the time where, you know, Brave Care started to happen, and things started to go. And we were raising money, and I, I mean, I, [00:35:00] I don't say this lightly, but I think she was a witch, and I think she kind of saved my life with this thing, and it was, it was one of the most otherworldly experiences I've ever had And for a person of science, I am all in on crystals and that kinda stuff.

Yeah. And I, I totally believe there was something there. And so- Yeah ... you know, that was a moment where I was, I look back on to this day and am like, "That kinda changed my life." How about that? Something about that experience kinda- 

Dr. Sue: Huh. That is- ... made, 

Dr. Corey: made some things change ... a 

Dr. Sue: story I have not heard from you.

Dr. Corey: Yeah. 

Dr. Sue: Uh, yeah, you had a deep spiritual need in the moment, and she showed up. 

Dr. Corey: Yes. 

Dr. Sue: Wow. 

Dr. Corey: Like, appeared- That's pretty 

Dr. Sue: crazy ... 

Dr. Corey: and then disappeared. I don't know what to make of that. I still don't. 

Dr. Sue: I mean, have you been on Etsy looking for that jacket too? 

Dr. Corey: Um, I haven't, although one did pop up on my Facebook Marketplace- Oh my gosh

the other day. 

Dr. Sue: Oh my gosh. You gotta get that. 

Dr. Corey: Yeah, 

Dr. Sue: I probably should. That's just, that's [00:36:00] another sign. Another sign. I probably should 

Dr. Corey: do that. 

Dr. Sue: Now you're in this new gig. Mm-hmm. It is so different from what you spent the first 10, 12 years of your career doing. Mm-hmm. Maybe a little longer even. 

Dr. Corey: Mm-hmm. 

Dr. Sue: Um, what do you have in this part of your career that you might have thought back in the hard times wasn't even possible to get to?

Dr. Corey: There's a couple of things. One is I think my perspective has changed. 

Dr. Sue: Hmm. 

Dr. Corey: And that I don't, I do not, I did not have a lot of balance in my career early on. You know, I was all in all the time, and that has been, uh, true for me since I think probably before residency. It was just my, my MO, you know? 

Dr. Sue: Mm-hmm.

Dr. Corey: We're gonna go all in on this thing. We're not gonna take any breaks because, you know, if you need a break, then that's something, there's something wrong with you, right? Mm-hmm. I'm just tongue in cheek of course, [00:37:00] but- 

Dr. Sue: Yeah ... 

Dr. Corey: um, and I think the time at BraveCare, going through all of that, um, both bef- you know, before pre-BraveCare and, and post-BraveCare really taught me the power of perspective.

And so I think more than anything else, that the way that I am approaching career and professional life has changed. 

Dr. Sue: Hmm. 

Dr. Corey: But beyond that, um, you know, the other thing is I have some distance from direct patient care now, you know. I haven't done direct patient care, um, full-time for, you know, a good couple of years.

Um, and you know, there's, there's maybe something, something to that as well. But, uh, but yeah, I think it's the perspective more than anything else, honestly. 

Dr. Sue: Yeah. Yeah. Tell me a little more about how it's different. 

Dr. Corey: Um, yeah, I think the concept of setting boundaries and work-life balance, you know- Mm ... I am-- I-- One thing I realized is no- nobody will set your boundaries for you.

Mm. Um, [00:38:00] your employer, generally speaking, you know, the system that you work for, uh, you know, everybody's well-meaning. I think everybody wants their people to succeed, and everybody says they want people to have work-life balance and how important that is, and companies do all these things to foster that idea.

But at the end of the day, if you let your boundaries start to slip, people will be happy to take as much as you are willing- Mm-hmm ... to give. Mm-hmm. And so y- the only person who can do that is you. And both as, like, personally and as a manager of people, which I have done from time to time in my career and, and actually enjoy, I, I am pretty vocal about that, about getting both the people that report to me to be pretty, um, strict about their boundaries, and I also have been pretty strict about that too.

So, you know, the notifications from my work apps get shut off, [00:39:00] you know- Mm-hmm ... after a certain time. Mm-hmm. And, um, you know, things get deleted from the home screen when I'm on vacation. And you know what? If there's a real emergency, I have a phone number. Everybody who needs to know that knows that information.

Dr. Sue: Mm-hmm. 

Dr. Corey: Yeah. Um, and if there's really a fire, like, uh, people can give me a call. Although, uh, one of my professional idols is Yvon Chouinard, founder of Patagonia, of course. Yeah. Um, I am in awe of that man. I love his philosophy to business. Um, but- Yeah ... he's pretty famous for saying things like, "If the building's on fire, don't call me.

What am I gonna do about it? Call the fire department." You know? And, and so trying to foster that approach has been one of the most helpful things that I have learned through all of this struggle. 

Dr. Sue: Yeah. Yeah, excellent. Empowering people that, uh, that they can, they can work through some of those problems and, and don't need you [00:40:00] necessarily.

Dr. Corey: Mm-hmm. Yeah. Yeah. Absolutely. 

Dr. Sue: I think that there's, um, wisdom in, uh, your maturation that I think is, uh, easier to come by in younger physicians. And it's funny, I think of you as a, as an early career physician, which according to the American Academy of Pediatrics, you're not anymore ... because you're outside the first 10 years of your practice, um, post-residency training.

Um, but I think of you as, uh, being better at setting boundaries- than me and my cohort of colleagues. Um, but it turns out, um, we can probably still keep learning more from even younger, uh, physicians, uh, pediatricians, because I think they are, I d- I think they do [00:41:00] have better boundaries. I think that is encouraged more, um, even within their educational process.

Uh, and hopefully that will help them Be set up better to avoid some of the pitfalls that both you and I have found our way into. 

Dr. Corey: Yeah. Yeah, totally. And I, I think it, you know, it's one of those things too where I, I think you, you have to be-- you have to have some balance about it. You know, medicine is n- is not a 9:00 to 5:00 job, you know?

Mm-hmm. Kids don't get sick between 9:00 and 5:00 Monday through Friday, and they don't... You know, a really sick kid doesn't care if your shift ended an hour ago. And so I think you have to be real about it. 

Dr. Sue: Mm-hmm. 

Dr. Corey: But also, I think you, you have to then keep in mind that, okay, like, I'm g- I'm gonna be mindful that this is an exception that I am gonna make because the circumstances dictate that I have to, but that means that then, on the flip [00:42:00] side of this, I'm gonna take a day off, or I'm gonna come in late, or I'm gonna, you know.

Just whatever it looks like, or I'm gonna call for help, you know, um, because I, I need help to extricate my sit- myself from this situation. So I think it kinda cuts both ways, but insofar as we can, I, I think we just have... I think that's what it comes down to is we just have to be really mindful about it instead of just saying- Yeah

"Oh, I'm gonna, I'm gonna crush myself and whatever." Yeah. "I'll, I'll figure it out later." 

Dr. Sue: Yeah. Yeah. To go back to the very first thing, one of the first things you said, which is, "I'm just gonna do everything myself-" 

Dr. Corey: Mm-hmm ... "

Dr. Sue: and then there'll be no problems." 

Dr. Corey: Mm-hmm. 

Dr. Sue: Turns out not to be quite the right approach.

Very much so. Nor is it to say, oh, medicine is a 9:00 to 5:00. Somewhere, somewhere in between those, though, is, uh, a sweet spot that we should all be trying to find, I think. Yeah. 

Dr. Corey: Yeah. 

Dr. Sue: So now that you have this nice, uh, mature point in your [00:43:00] professional life and you're setting some healthy boundaries, um, what does it allow for you?

What brings you a sense of fun these days? What makes you, either within medicine or outside of medicine, uh, look forward? Um, and, uh, what are you excited about from day to day? 

Dr. Corey: Yeah, I mean, f- from, in my personal life, um, we, my wife and I just took a trip to Japan last year- Mm-hmm ... uh, or this year, I guess it was.

It was a few months ago. Um, and that was the first kinda international trip we had been on in a while- Mm-hmm ... first kinda real trip we had been on in a while, and really rekindled that joy of just- Mm ... walking around, looking at stuff. Um, and so very eager to do that with her again. Um- Have been, uh, doing more music.

I've always kind of dabbled in, in music, um, but have [00:44:00] been making more music lately. Um, I've been trying to, as my day allows, take music snack breaks. Um, I, I'm borrowing a little desktop synthesizer from, from a buddy, uh, and I try to just, um, you know, plunk around on that for 10 minutes if I've got a 10-minute break in between things, um, that I need to do for work, so- 

Dr. Sue: Nice

Dr. Corey: that kind of 

Dr. Sue: thing. A snack break. 

Dr. Corey: Yeah, a music 

Dr. Sue: snack. A music snack break. 

Dr. Corey: Yeah. 

Dr. Sue: Oh, I love 

Dr. Corey: it. Yeah, yeah. Yeah, totally. So I've been trying to do that more. Um, you know, getting outside has always been a, a great hobby. Um, I- for fun, I have been doing ski patrol up at Mount Baker, so I get to dabble in some adult medicine doing that, which is kind of fun.

Um- Nice ... kind of scary, but kind of fun. And- Did you 

Dr. Sue: get any snow this year? Was there much of a season? 

Dr. Corey: We... It got off to a late start, and I will say we made the best of it. I think we- Hmm ... were better off than a lot of places, uh, in North America this year. Um, we'll see how true that is, uh, this next winter.

Um, but, uh, but [00:45:00] yeah, we made the most of it. So been doing that, and then, uh, doing some riding of bikes as the weather gets nice. So, um- You know, just doing, trying to do some of these things for, for self-care 

Dr. Sue: Awesome. Awesome. Uh, my last question for you is, uh, is there anything you wanna say about your dogs?

Oh. I'm a little surprised that they haven't come up, quite honestly. It's been- 

Dr. Corey: Yes. Yes ... you know That is true They 

Dr. Sue: would be disappointed. 

Dr. Corey: They would be disappointed. Yes. We have two amazing dogs currently. Uh, our lab, Leon, who is five. He is very sensitive. He's the best dog ever, um, and is just an amazing creature to have in the house.

Uh, and we have a almost 10-month-old, um, mastiff bulldog mix named Ruth, and she is doing the thing that puppies do, which is to test [00:46:00] boundaries, but I think some of that was our doing. It... We, she had had several busy days in a row. She's learning to swim. We had been- Mm ... on some big walks. She is not as, um, action-oriented as the lab, and I think a lot of the time would probably prefer to lay on the couch, but we'd been, we'd been having a lot of, uh, activity, and I think she got pretty overstimulated and pretty overtired, just like a human toddler, and was doing- Oh, my girl

some acting out. 

Dr. Sue: Oh. 

Dr. Corey: But after a bunch of naps yesterday and, uh, sleeping in her crate, um, which she sometimes does, she's back to, um, behaving herself now, so. 

Dr. Sue: Good girl. Yeah. Good girl, Ruth. 

Dr. Corey: Yeah. Yeah. They're great. 

Dr. Sue: Oh. We love them. Well, they are great dogs, and, uh, Leon is one of, uh, our dog, Ula's, best friends, and she does not make friends easily, so that's a big deal.

It's a, she's a good judge of character. 

Dr. Corey: Nice. Yeah. Yeah. It's great. 

Dr. Sue: Oh, Corey, what a pleasure. Um, so great [00:47:00] to know you all these years, but get to have this conversation that is deeper than, than we have about these subjects, and, uh, I so appreciate your time. 

Dr. Corey: Yeah. Thanks for having me on. It's been awesome.

Dr. Sue: Do you have a burnout story? I would love to feature it on the show. Share it with us for a chance to have it read on an upcoming episode. You can email us, hello@stillpracticingpod.com or visit our website, stillpracticingpod.com. You can also check out sudaniels.md on TikTok and Instagram or Facebook to keep up with me and the pod.

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Thanks again for listening. I'm your host, Sue Daniels. Our executive producers are me, Aron Korney, Rob Goldman, and Shahnti Brooke. Our associate producer is Sundus Hassan Nooli. Our editor and engineer is Andrew Sims, and our music is by Omer Ben-Zvi. To learn more about Still Practicing's program disclaimer and ethics policy, submission verification and licensing terms, and HIPAA release terms, you can go to stillpracticingpod.com and reach out to us at hello@stillpracticingpod.com with any questions, comments, or smart remarks.

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