Ercast

No one enters medicine expecting to land on a performance improvement plan, yet for many physicians, it becomes a disorienting reality. A PIP can feel like both a warning and a test, raising existential fears about career, reputation, and future. Behind the formal language is often a complex mix of organizational risk management and legitimate behavioral concerns. In this episode, we explore what it really means to be placed on a PIP, how to navigate the process effectively, and why resistance is rarely a successful strategy. Finally, we share a structured approach to coaching through a PIP that can turn even the most fraught situation into meaningful professional growth.

What if addiction isn’t about drugs, but about pain? Beneath compulsive behaviors often lie histories of trauma, anxiety, and unmet emotional needs, hidden behind layers of stigma and misunderstanding. In medicine, addiction is still often mischaracterized as a moral failing rather than a treatable illness with deep psychological roots. In this episode, we explore the personal and professional evolution of Dr. Casey Grover, an addiction medicine physician who reframed both his own struggles and the way he cares for patients. Finally, we uncover how shifting mindset and language can transform both clinical outcomes and clinician well-being.

What is it about your work that still lights you up inside? At the center of every profession is a core - the reason we chose it in the first place, the part that feels meaningful no matter the chaos around it. When we reconnect with that core, even amid challenge, fulfillment often follows. Sometimes, though, that spark fades. Sometimes the core of what we love evolves, shifts direction, or gets buried under layers of stress and routine. In this episode, we explore how to evaluate your relationship with the essence of your work and how small (or big) recalibrations can realign your day-to-day with what matters most. Finally, we share strategies to clear out the noise, fuel the flame, and shape a career that energizes rather than drains.

Burnout isn’t just emotional, it’s financial. Many doctors put off financial planning until they’re deep in debt, stuck in lifestyle inflation, and too burned out to pivot. In this episode, The White Coat Investor Jim Dahle lays out how to build a burnout-resistant career by making smart, intentional money decisions, whether you’re a student or a seasoned physician.We delve into frugality (the useful and the absurd), how burnout can quietly become your biggest financial threat, what makes a solid investment plan, the waterfall method of managing your money, and why many doctors end up wealthy on paper but broke in practice. Plus: when hiring a financial advisor is the smartest move you can make—and when it’s the worst.Guest bio:  Jim Dahle, MD, FACEP is a practicing emergency physician and the founder of The White Coat Investor. After early experiences with predatory financial advisors, he taught himself personal finance and saw firsthand how financial literacy transformed his life. Motivated to help col

Making a major career shift is never easy, especially when you've dedicated decades to a profession that has become part of your identity. The decision to leave clinical medicine can be fraught with self-doubt, financial considerations, and the lingering question - what comes next? But at some point, the balance shifts, and the cost of staying outweighs the fear of leaving. In this episode, we explore what it takes to walk away from a stable medical career, redefine success, and craft a life that aligns with evolving priorities. Finally, we dig into strategies for managing stress, investing in personal growth, and finding fulfillment beyond the bedside.

Delivering the news of death is one of the hardest yet most overlooked skills in emergency medicine. Many learn by watching others or through trial and error rather than structured training (or just make it up as they go). This lack of preparation can lead to discomfort, stress, avoidance, and even systemic failures in how death notifications are handled. In this episode, we explore the critical components of death communication, how to navigate these difficult conversations with clarity and compassion, and why avoiding or mishandling these moments can have lasting consequences for both providers and families. Finally, we discuss the emotional toll of secondhand grief and the importance of proactive mental health care for those on the front lines of healthcare.

Leadership impacts everyone—whether you're steering an entire organization or simply navigating team dynamics. It’s an essential skill, yet it often feels elusive, even for experienced professionals. While every leadership challenge is unique, the core principles remain universal. In this episode, we break down eight critical leadership principles drawn from years of experience, hard lessons, conversations with seasoned experts, research, and coaching leaders at all levels. Plus, we share actionable strategies to help you refine your leadership, whether you're guiding thousands or leading a small team.Want more? Subscribe to our free newsletter, Doctoring Done Well. Every other Saturday, straight to your inbox—strategies to work smarter, lead better, and build a career that lasts.We Discuss:Don’t Worry About Leading, Worry About ListeningThis is Not Your Dumpster FireSlow Your RollYou Will Have to Be a Judge, Even When You Don’t Want to BeModel the ValuesWith Behavioral Issues, Build the Pathway, Not Just the

Violence has a cadence, a rhythm that disrupts the normal flow of life. When an act of violence erupts, the first sign is often a sudden, unexplainable shift in the environment—an eerie silence, a heightened energy, or a gut feeling that something is wrong. But when does that uneasy feeling cross the threshold into immediate danger? In this episode, we explore the critical decision points in an active violence situation in the healthcare/hospital setting, the moral and ethical dilemmas of medical providers staying versus escaping, and tactical strategies for survival. Finally, we break down the "run, hide, fight" approach and how to act decisively when every second counts.Guest bio: Mike Shertz, MD is an emergency physician who spent 13 years as a Green Beret and a Special Forces medic. He is the founder and purveyor of Crisis Medicine, which teaches tactical casualty care to medical professionals. Check out this video that we did together in 2019 on how to place and remove a tourniquet and this one on how to

Dealing with an angry, upset patient can feel like walking into an emotional storm. The frustration in the room is palpable, and even the most experienced clinicians can feel thrown off balance. While medical training equips us to handle complex diagnoses and emergencies, it often falls short when it comes to managing interpersonal conflict. That’s where the Universal Upset Patient Protocol comes in—a straightforward, highly effective framework designed to de-escalate tense situations, restore trust, and protect your own emotional bandwidth. In this episode, we explore Dr. Dike Drummond’s original protocol, breaking down each step with specific language to use in the heat of the moment. Finally, we’ll add a few practical tweaks to help make these conversations even more natural and effective in real-world practice.

What defines the unique mindset of an emergency clinician? It’s not just the fast pace or the chaotic environment—it’s the deliberate, top-down thinking that prioritizes patient safety over diagnostic certainty. This approach, though deceptively simple, often flies in the face of traditional medical training, which emphasizes comprehensive differentials and exhaustive workups. In emergency medicine, knowing what the patient needs often matters more than knowing exactly what they have. In this episode, we explore the emergency medicine mindset, the pitfalls of the bottom-up approach, and why experienced clinicians focus on acute interventions and dangerous conditions. Finally, we discuss how humility and strategic communication with patients can make all the difference in mitigating risk and building trust.

Mastering nonverbal communication can be an elusive task, but the fact remains: what’s unsaid leaves a significant footprint in any interaction. Nowhere is this more palpable than in the medical exam room, where trust and connection between physicians and patients often hinge on subtle, nonverbal cues.So, how can one build trust through facial expressions and tone of voice alone?In this episode, we break down how to silently establish rapport, effective use of pauses, the curious role of your eyebrows, impact of end-of-sentence inflection, how to convey uncertainty with confidence, and why learning a patient’s eye color can pay dividends.

What’s the biggest mistake people make about meditation? Thinking they’re bad at it. Why do they think this? Because they’ve tried meditating, and their mind just won’t shut up!It’s a common misconception that meditation means clearing your mind of all thoughts. But in reality, meditation has little—or nothing—to do with that. If your mind wanders or feels like a crowded room full of shouting voices when you close your eyes, you’re not alone. That’s exactly what’s supposed to happen!A wandering mind isn’t failure—it’s expected, even for seasoned meditators.In this episode, we break down the exact steps of how to meditate, what to do with a wandering mind, and why a flurry of thoughts—popping up like popcorn—doesn’t mean you’re bad at meditation. In fact, it means your mind is working exactly as it should. Ultimately, meditation isn’t about thinking less; it’s about changing how you engage with your thoughts, making it a skill you simply can’t fail.

It started in medical school, when I witnessed the stark reality of the hidden curriculum: a transgender patient referred to as "it" by an attending physician. Over the years, I saw more subtle but no less harmful behaviors—snickers, misused pronouns, quiet biases. I often felt lost in how to respond.Today, transgender identity feels more politically charged than ever. But beyond the politics, what’s it like simply to be transgender? What challenges do transgender patients face—physically, medically, socially, and emotionally? And how do you navigate a world that sees you differently after transitioning?In this episode, Dr. Jailyn Avila shares her story. We cover the deeply personal aspects of transition, from conversations with her wife and kids to navigating professional dynamics as an internationally recognized expert. Dr. Avila offers candid insights into her experience as a physician presenting as both male and female, practical advice for providing better care for transgender patients, and strategies fo

Why do our minds seek explanations for everyday patterns, even attributing a cause where none may exist? "Regression to the mean" offers a statistical lens on why extreme experiences naturally revert to the norm. In medicine, this concept reveals why critical observations and repeated assessments are essential to avoid overreactions to abnormal results. In this episode, we explore the nuances of regression to the mean, breaking down its impact on medical decision-making, patient assessments, and even how we view high-stakes scenarios in healthcare. Finally, we delve into how understanding this principle can enhance clinical judgment and reduce unnecessary interventions.

Being a patient can feel like a lonely experience, especially when you sense your doctor is disconnected. A rushed or disengaged interaction can leave patients feeling unheard and uncared for, no matter how clinically skilled the physician is. At the same time, doctors struggle with overwhelming workloads, which can lead to unintentional detachment from those they treat. In this episode, we explore five ways to build connection in the exam room quickly, why small gestures matter, and how intentional preparation can change the entire dynamic. Finally, we dive into the emotional complexities of patient care and the essential role of listening and presence in preventing burnout. Our conversation centers around the ‘Presence 5 Practices’ from this article. 

Holding onto a grudge can feel strangely delicious, but that sense of righteousness often comes at a steep cost. In this episode, EMRAP founder Mel Herbert joins Rob to unpack a rift that’s lingered for over half a decade—and explore the way forward to healing. We also break down why achievement does not demand extraordinary genius or talent but a shift in how we view our perceived mediocrity. Why the idea that we need to be exceptional to succeed fuels imposter syndrome and keeps us from valuing the potential in our "average" qualities. We examine the pressing challenges of modern medicine, where corporate pressures often clash with the need for human connection, and how clinicians can reclaim compassion and autonomy. Finally, we address the role of forgiveness and communication in personal and professional growth, revealing how setting boundaries and letting go of resentments can transform relationships and renew purpose.

It's often not the big power moves that change our lives; it's the small, intentional actions. By focusing on micro-skills, even the most ambitious goals become achievable.In this episode, we talk with Drs. Adaira Landry and Resa E. Lewiss about their new book, MicroSkills: Small Actions, Big Impact.  We explore how financial literacy, self-presentation, concise communication, and allyship can be developed as essential micro-skills for a successful career. We also navigate workplace dynamics, including recognizing and addressing issues like mansplaining and bropropriating. Finally, we discuss the nuances of learning when to say “yes” or “no,” and the art of timely, respectful communication.

Ready to reset, recharge, and level up?Join us at our live event - Awake + Aware, a game-changing 3-day workshop from May 5-7 in Bend, Oregon. Learn how to stay cool when the pressure’s on and lock in the mindset you need to flourish. Space is limited.

How do you handle your authority being challenged under stress? Even minor communication missteps in high-pressure environments like medicine can create lasting rifts and missed details. While the instinct to push back is strong, it's rarely the best response.We share a story of miscommunication between a resident and a nurse, highlighting the importance of humility and inquiry in clinical settings. We examine why leading with curiosity instead of ego can save time, build trust, and improve patient care.

It’s hard to be a good boss and even harder to work under a bad one. This episode breaks down how to begin as a new leader with little to no experience, the critical errors leaders often make, and what to do when your boss is suboptimal. We explore how quick fixes, lack of empathy, and poor communication can alienate teams and stifle growth. Leaders who ignore the importance of relationships, skip proper onboarding, or impose their own agendas without collaboration set themselves up for failure. We also discuss how future writing can help leaders clarify their vision and avoid these pitfalls. Finally, we offer strategies to recognize and correct these missteps, creating a more effective and cohesive leadership style.