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I'm Dr Rob, and this week we have the pleasure of hosting Brooke Shulay, who runs Shulay Performance Psychiatry, based in Paradise Valley in Beverly Hills.
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Thanks so much for having me today.
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I'm excited to be here.
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Great to have you.
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So today we're going to talk about all things with the mental state, especially like with high performers, which also can equal high stress.
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So what kind of people are your clientele?
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Yeah, so I mostly see 40% athletes, 40% executives, working professionals, physicians, and then 20% all their kids.
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So I do see kids to ages five plus.
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But I love working with executives and physicians that own practices.
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That's kind of my bread and butter nice, and are the kids all related to your clients that you have a lot of times?
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or the parents will be high performers and their kids are the 4.0 students that are upset.
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They don't have the 4.2, or athletes, so youth athletes are a big one I see trying to balance high school and then their club, whether it's club soccer, club, basketball, so a lot of kind of sports overlap there.
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With the NFL draft this past weekend.
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Did you have like anything to do with, like, do you see any of those people that go into the draft?
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yeah, so I.
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I'm a listed provider on the nfl player association's mental health directory, so if there's any player that needs services in a state that I'm licensed in, the pa will contact me.
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So it could be anyone from rookies all the way to people currently playing to retired players and physician burnout's just been a bigger thing, you know, and it's become bigger and bigger.
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And I've tried to partake in different, you know, because like the first five years I was in practice, I was pretty much doing it on my own.
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And you get into that state and kind of don't know and you start having more complications and issues like that so are are you seeing more physicians coming to you or you know, because it's kind of like looked down upon so not.
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Not enough people go and see seek therapy for something like this or.
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But when you see it, is it like later in progression than like when normal person would come see you.
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Yeah, oftentimes, like physicians are the worst patients, right, we try and treat ourselves until things get really bad, and so we're all kind of lucky that we own our own businesses and we kind of have somewhat of a say in our day to day practice.
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But a lot of the physicians I see with significant like clinically significant burnout are hospital employed or or like corporate medicine employed, even an outpatient, and in those types of environments there's a large sense of a lack of control, right?
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So like the owner tells me how many patients I need to see, or the insurance company dictates patient appointment duration, company dictates patient duration or appointment duration, and so a lot of times we talk about how can you modify certain things that are within your control to make your working environment better so your business is going to pick up even more because private equity is just taking over the life out of everyone taking well we we
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know, can we fund you to scale your business is what we're trying to ask.
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This is definitely going to be a hot topic.
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Yeah, because, like yeah, like day by day.
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Well, I get texts, emails like from few companies to buy our practice and I know like more than half dozen physicians that have, or plastic surgeons that have already turned to private equity.
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High-end people too.
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Yeah, Like high-end.
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I was just like shocked to hear the names that have already sold out.
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And so like that's where I'm thinking, I'm like, and from them taking over the derm practices, like I heard a lot of dissatisfaction in the physicians, so this is probably a good I'm guessing that comes from private equity requiring dermatologists to do work.
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Yeah maybe and not just the.
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NPs.
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They need to carry their own slack.
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Well, I think that's the tough part is we're all used to being our own bosses and making business decisions.
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So then, when you have someone else that comes in with, at first, an appealing offer and you might be tempted to take the money.
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Well, a lot of times they have a certain amount of time you have to stay.
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And then during that period of time, people can be really unhappy and feeling like they're being overworked and underpaid.
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So it's such a trade-off in terms of what you want your life to look like.
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Yeah, so do you see an age discrepancy or the amount of time they've been in the profession?
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Obviously the senior people.
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In a practice.
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When you sell out to private equity, you have two years, maybe three years, obligation, where the junior people have about five years or so On top of that.
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The junior partners also not just for private equity, for just being becoming employed physicians.
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Like you thought you'd have all this autonomy and you went through all this training and got all this shit all these years to like go out on your own and then be like oh wait, I have a whole nother set of bosses and a whole nother set of people to answer to.
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Yeah, I mean, I think it's risky for private equity to come in and expect that everyone's going to stay.
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I've seen it in my own patients, I've seen it in the community, as I'm sure you have, that private equity comes in and then the people that aren't bound to staying there that were the employees and not an owner of the practice they want out because it's just not the same.
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And so to me, and I'm sure for you guys too, keeping physicians happy is a huge thing that I take seriously.
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So really enabling like physician autonomy and allowing them to feel like they're running their own solo practice within our group, that stuff, I think, breeds kind of loyalty and longevity in a business.
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And what sorts of like you know information do you give to physicians and how can they help themselves when they you know, outside?
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of being in your practice.
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Yeah Well, it's really clinically significant.
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I go through what's called the Maslow Burnout Inventory.
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Oh yeah.
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So there's kind of like a questionnaire you can go through.
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Is there a pyramid Maslow?
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No, it's more just questions like how I'm thinking of the food pyramid.
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Yeah, exactly.
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It's questions about like how much empathy do you still have towards your patients, how drained do you feel after a day?
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Connectedness to your job, and caring and compassion.
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So you can.
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There's three different categories and you can actually go through and put an objective number, which I like to do, because sometimes people they're like oh, I'm not sure if it's burnout, I just I'm unhappy.
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And then you go through that scale and it's like very clinically significant, and then we can get into a good discussion of well, how can you start to make some changes.
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I know I was feeling burnt out about like a year and a half in Like I was really happy with like my patient care outcomes and everything.
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But I was working like 100 to 120 hours a week and I was not getting the reimbursements.
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Like I was just like this is, this is not worth it.
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And I know for a few months in a row I was just fresh in my practice technically right, less than two years and I'm like what's going to be my fastest route to retirement?
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Because if I got to work extra hard to hit that, I'm down to do it and get out of here and there's something like I don't know I got to work extra hard to hit that I'm down to do it and get out of here and there's something like I don't know I had to do extra years to get here.
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So I spent like 10 years of training after med school to be where I was and then within like a year and a half, I'm like I got to get out of here.
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Yeah, and oftentimes as a business owner, you're also doing all the other things in the beginning right, like PR and HR and all those things plus patient care.
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It can be really unsustainable quickly, and so one big tool I give to people Dan Martell wrote this book called Buy Back your Time, and in that book it talks about creating your perfect week, and so that is one of the downfalls of what we do right Is that we don't have a set schedule because we're our own bosses, and so it talks about actually creating a set schedule where Monday, wednesday, friday, let's say like gym, from eight to 930.
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And you actually block off your own time, and I found that that's like the biggest protective factor against burnout is actually blocking your time to make sure you're still allocating time to things that you enjoy doing too.
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Yeah, and that's that's what I've tried to get him to do is like I'm like plan out your vacations, take those weeks out ahead of time.
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And then he tells me I'm taking too much time off.
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Well, my, my wife gets like eight weeks a year off.
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So we we know, like know like she works for a bigger company but like she does a lot of the stuff in the office.
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So we automatically know we're and I'm like no, we're going away and just like mentally and everything I think it prepares us and you just got to leave the stuff behind.
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Schedule it Like that period where I was feeling burnt out, like that's the last time I was like I can definitely say I was dissatisfied with what I was doing.
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And since then there were certain things I did.
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First thing, I finally started getting reimbursed, which was nice.
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Uh, that alleviated some stress.
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At that point I was working, like no joke, 80 to 120 hours a week, which sounds ridiculous.
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But on top of that I went like nine to ten months without any time off, more than like an extended weekend.
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So since then, like I made sure to look at my daughter's schedule so I'm like at the very least I can take four weeks off like fall break, winter break, spring break, and over the summer I've gradually like actually extended it to be like you know what I can squeeze in a couple days here and there.
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So like it probably works out to like five to six weeks off a year and that's where I see the good balance probably works out to like five to six weeks off a year, and that's where I see the good balance.
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What are your like?
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Do you recommend lifestyle changes that people should make when they come and see you?
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yeah, some lifestyle changes just include intentional movement.
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So sometimes people like you said, when you're working those 80 to 120 hour weeks, you don't necessarily have an hour five times a week to go to the gym.
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It's just not feasible.
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I wasn't working out at all.
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I was in the worst shape of my life.
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Yeah, and it's not sustainable, right.
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So, like for me, for example, I schedule my appointments in 50 minute increments so I can have 10 minutes between visits to like get up, walk outside in the courtyard of our office, building things like that, so it's at least moving and getting out.
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Maybe I'll call someone.
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So I'm killing two birds with one stone, and just different things like that.
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So asking yourself what brings you joy, like for some people it's working out, for some people that feels like an obligation for some people it's social connection and so actually building in that time where vacation's great to start with that and building in that time, but you have to create something sustainable weekly.
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So, like every Thursday afternoon is just my me time, where if I need to schedule like doctor's appointments or a haircut or whatever it is, every Thursday afternoon is blocked off just for that, for whatever I need to do for me, for whatever I need to do for me.
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And I find that when people start to carve out that time where if you imagine like a red solo cup and you're slowly draining energy and looking throughout the week.
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What are you doing to actually replenish that or refill yourself?
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It seems so hard for me.
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For me it's like block out time, what do you mean?
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Like it's just been difficult, like that's why, like my daughter's school schedule has worked well for me, cause I'm like I can definitely block this time out and do it like a year, two years in advance, but like when it comes out to like oh, maybe like three months, I almost feel guilty doing it.
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I promise you you can do it Like if you, if you start from scratch, like let's say quarter two or quarter three, and you actually redo your entire calendar where, let's say, you are only available between 8am and 2pm every day and that's it.
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Well then, how do you build in that time?
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It actually can make you more productive and more high performing because you're more concentrated, and I had a few executives come to me that were working like 80 hour weeks and they felt like their schedules were controlling them.
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And as soon as we implemented a really regimented schedule, as if they were employed but, dictating how their time spent.
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They're like holy shit, like this works I feel so much better and this is sustainable.
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I think if you journal document or just just like with eating food, like once you journal what you're eating, you you know then you notice what like?
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You're like oh, I'm putting all these extra calories that don't matter.
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And if you're journaling like, you know journal how much time you spent on your phone.
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Like that time could have been spent.
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Your phone does that for you?
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Yeah, it does, it does, but like there's a lot of stuff that you waste your time on that you don't need to be wasting you know, and it's building routines and like, especially like in the mornings, like I have my routines, although, like sometimes the kids but I try to stick with those routines.
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You know, like in the wintertime I cold plunge in the pool, I do my workouts before they even wake up and like try to get those stuff done right away.
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Now it's like you know I I don't do the workouts in the morning, the kids are sleeping and I just try to do the workouts at nighttime.
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The kids just join in and working out.
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That's huge, though.
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A lot of the most elite top athletes have such regimented routine and discipline, and it's different for every one of them.
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But just that ability to predict what's coming in your schedule sets you up for feeling more relaxed, less tense and higher performance overall that fits into what you were saying.
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like if you can predict and set in that time for yourself also goes with the screen time thing so like if, if you can predict, set up like, let's say, like a wednesday or thursday afternoon for yourself to whatever get a massage, go, get an intense workout in sauna, cold plunge, and that'll just make all the hours for the rest of your week way more like enhanced productive, so you can just like even at nighttime, like I gotta put my son to sleep, but I put out my red light mat lay on the mat while I put him to sleep and, and you know, at least I didn't waste my time doing that I don't think that's considered wasting your time.
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It's productive, no, but like it's productive Like then.
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I don't have to take another like 20 minutes, half an hour to lay on the red light after I put him to sleep, because he's like moving around drinking his milk until he goes to sleep, so it's like yeah, and it's all about what works for you and it's different for every person.
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There's some athletes I worked with that.
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Before every game they would go drive through Starbucks.
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No, I'm kidding, and that was like their routine, right?
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Because?
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if you think about it, that's mindfulness.
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You're sitting waiting in line.
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Oh yeah, some people eat like gummy bears and stuff before games, stuff before games.
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So it's like everybody's like, oh, why are they doing that?
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It's like, oh, randy moss doesn't stretch.
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Before games, like have you seen that guy play a game?
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Like I don't know where you're coming, coming off telling them what to do but you bring up a really good point before too.
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Um, I always tell people to do a task audit is what I call it and then that brings up how to buy back your time, which is through delegation.
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So if you're realizing like, oh, I don't know, maybe you realize, over the last week you spent an hour paying various bills in the practice, well, that's something that takes a low, low skill right and you're low passion to do that.
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So that's something that you would delegate.
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Yeah, yeah, and that's you know, and getting my wife to kind of because she micromanages a lot of things and like getting her to trust someone to like delegate that stuff out, and she's gotten better and better at it.
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But like, yeah, that, yeah, Like it does.
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At times she's like she's like I got 400 emails to read or thousand emails to read and I'm like, just take it one step at a time.
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Just delete all of them.
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Yeah, start fresh.
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If it's important, they'll email you back, they'll email you back.
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Or if they're good salespeople, they'll email you right back.
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Well, my biggest email hack is the two-minute rule, which is, if it takes you less than two minutes to do, just knock it out and then file the email away.
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Yeah, and a lot of people they feel like they just get so overwhelmed with emails that they just can't.
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Even so, you have different email files, though yeah, so every so I do I go through this exercise with executives too, or practice owners is uh, creating subfolders yeah like psychotically organized uh, so like locations of your practices and then, within that website, marketing insurance, like all the things, so that when you hire an executive assistant again to buy back your own time and delegate, they will be able to follow your organizational system too.
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That makes sense.
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And look, even with athletes.
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I know athletes, they're traveling all the time and they're not around people, but they're around.
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You know, sometimes they feel like it's a family, as a team.
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Sometimes it's a broken family.
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But do you do any recommendations with, like you know, like finding someone that they find and that supports them?
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That's going to be important and how they think psychiatrically.
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Yeah, I think a lot of them luckily come into the league with that, so either their college coach or their high school coach or some mentor someone this was public.
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I recently did an interview with DeMar DeRozan on the Kings and he talked about the importance of his community and how that for him has been coaches, teammates and just having those people to go to when things get hard, whether it's on court stuff or off court stuff.
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So having that community is huge and it doesn't have to be a mental health professional if things are otherwise going well it's.
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It's just important for everyone to feel supported in some way.
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And then do you discuss sleep with the athletes at all?
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Yes, so there is a study I love to quote from.
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I think it came out of Stanford, but they looked at 120-some athletes that got less than eight hours of sleep a night and those athletes were at 65% increased risk of injury.
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And so when?
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it's huge and so when I have high schoolers that are like, oh well.
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Or college students oh, I had to stay up late to study for the test, or I stayed up late watching film so I could be prepared for the next game I reframe for them sleep as a performance strategy.
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So sleep is when your kind of mind is consolidating memory and recovering physically in order for you to have improved cognitive and physical performance.
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Significant growth hormone release too.
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One thing that laid on me was like if you're not getting that deep sleep, like that trash just stays in your brain and your brain doesn't clear that out.
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So you wake up the next morning and you still got these bad thoughts and bad feelings in your head.
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So if you're getting enough sleep, all that stuff gets cleared out and you start fresh the next day.
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And the other thing is I wear the aura ring and I kind of listened to it because if it, no, that's my wedding ring, but I was going to get a different ring to compare it.
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There's the super, but but.
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But the aura ring like tells you your readiness your readiness score, your stress level and yeah, and like it seriously, like it can tell me I'm sick before I know it, and also like I'm like I'm not going to push it hard working out today.
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Can it lie to you and affect your thought process on it, like you're feeling really good?
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You know what Oura Ring?
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I felt like shit when I rolled out of bed, but now I feel really good If it says go for it, like I usually go for it.
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But if it says like your recovery score is like in the 60s, 50s, 60s, I'm like, yeah, I'm not going to go work out and at my age I'm like yeah, it goes up to.
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I'm like I'm going to tear my pec muscle or my Achilles is going to pop.
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I'm like I'll keep it light today until I'm, like, well recovered.
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So I think it affects how you know it, kind of messes with the brain.
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I can picture you waking up and the aura ring gives you a 100 score and you just run outside and throw rocks over the house.
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I would.
00:21:35.900 --> 00:21:39.814
Yeah, sleep is really important and and so that's why, from a young age, I love working with adolescents and young adults, because they're still kind of malleable.
00:21:39.814 --> 00:21:51.469
You can still help them establish routines and change their ways, because as we get older and become adults, we're more rigid and we're kind of stuck in our thought process, so I find that age group really fun to work with.
00:21:52.500 --> 00:21:55.750
So I know there's some genetic variance.
00:21:55.750 --> 00:22:00.132
Some people can get by with like four to six hours of sleep and be like fully functional.
00:22:00.132 --> 00:22:02.805
Where are you at with sleep?
00:22:02.805 --> 00:22:03.587
What do you need?
00:22:04.421 --> 00:22:12.701
For me I need about seven to eight hours and I wouldn't necessarily I don't know every.
00:22:12.701 --> 00:22:17.883
Everyone has a different opinion, but I wouldn't necessarily say that some people can just get by on four to six hours, I would, I would almost say, well with those people.
00:22:17.923 --> 00:22:20.071
Do they have some sort of bipolar disorder?
00:22:20.071 --> 00:22:32.913
Because in bipolar disorder you could sleep, you know, less than six hours and still feel super high energy the next day and then crash at some point, whether that's a few days or a week down the road.
00:22:32.913 --> 00:22:43.527
So I do think that people that get less sleep I also screen for substances like are you, you know, using some sort of a stimulant?
00:22:43.547 --> 00:22:54.051
Yeah, but it's going to lead to dementia, Alzheimer's, and we've talked about this before because Dave Asprey, you know, when he wrote the Bulletproof Diet and stuff, he talked about not sleeping.
00:22:54.051 --> 00:22:57.963
He's like oh, you don't really, you only need four to six hours and go and talk to him.
00:22:57.963 --> 00:23:02.886
Today he talks about you got to get at least eight hours of sleep.
00:23:03.248 --> 00:23:05.030
So his thought process it matters what he's selling now.
00:23:05.030 --> 00:23:06.795
Yeah, now he's selling.
00:23:08.700 --> 00:23:09.241
Well, so his matters.
00:23:09.241 --> 00:23:10.205
What he's selling now, yeah, now he's selling.
00:23:10.205 --> 00:23:10.929
Well, he's part of aura ring.
00:23:10.929 --> 00:23:11.932
They, they advertise everything but like.
00:23:11.932 --> 00:23:21.299
But like, no, everyone like over the past, like since covid, like has kind of taken sleep to a different level because, like for me, I was like, oh, I'll sleep whenever.
00:23:21.299 --> 00:23:24.045
Now, like that's one of the reasons I was like I don't want to do trauma call and make me more nervous about trauma call is.
00:23:24.065 --> 00:23:25.406
I don't want to get called in middle of the reasons.
00:23:25.488 --> 00:23:29.654
I was like I don't want to do trauma call and it makes me more nervous about trauma call.
00:23:29.654 --> 00:23:31.847
I don't want to get called in the middle of the night.
00:23:31.847 --> 00:23:39.893
I want to get my deep sleep and my deep sleep comes usually between 8 pm and midnight.
00:23:39.893 --> 00:23:52.647
Whenever I fall asleep earlier, that's when I get my deep sleep and most of my REM sleep, and then you know a lot of the the rest of the time it's like light sleep till the morning.
00:23:52.688 --> 00:23:57.111
So so for you guys, now that you're like further into your careers too.
00:23:57.111 --> 00:23:59.086
And you've owned this practice for how long now?
00:24:00.000 --> 00:24:01.207
It's going on 10 years.
00:24:01.680 --> 00:24:07.185
Yeah, so do you feel like you're in a better work-life balance now that you have some systems in place?
00:24:08.220 --> 00:24:09.463
Yeah definitely.
00:24:09.463 --> 00:24:09.805
Yeah, from when I.
00:24:09.805 --> 00:24:12.030
You're in a better work-life balance now that you have some systems in place.
00:24:12.030 --> 00:24:12.372
Yeah, definitely.
00:24:12.372 --> 00:24:12.953
Yeah, from when I started.
00:24:12.973 --> 00:24:13.896
I started five years ago.
00:24:13.896 --> 00:24:17.104
It's definitely a better work-life balance, especially not taking trauma call.
00:24:17.104 --> 00:24:27.230
We had to stop doing like medicare medicaid because they had more complications and those were like the after hours care like because they had again.
00:24:27.230 --> 00:24:29.780
They had more complications, less reimbursement.
00:24:29.780 --> 00:24:47.010
But overall it for me absolutely, and it was it's, and this guy doesn't wake up at night to call so they end up calling me anyways so apparently this guy gets very good sleep I've been picking up your phone call.
00:24:47.030 --> 00:25:00.611
But yeah, no, no, I don't know what he has to say, but for me definitely way better work-life balance it's not that I don't wake up, it's my wife got mad at me because like my ring would wake up the kids.
00:25:00.611 --> 00:25:09.730
So, and your daughter's older, so I forget, okay, I'll get up then but, but it is better.
00:25:09.790 --> 00:25:16.791
But, like I, I like to be kind of uncomfortable and like if I'm not doing something, I feel like I need to be doing something.
00:25:16.791 --> 00:25:22.952
So I'm always trying to do, do things, um, you know, whether it's medicine or something else.
00:25:22.992 --> 00:25:31.180
So it's like percentage wise right, like it's a percentage of stress you put on yourself and some people respond differently with different percentages.
00:25:32.385 --> 00:25:35.000
Yeah, I always like to be highly stressed, I think.
00:25:35.059 --> 00:25:39.914
I like how we bring a psychiatrist on board and we're like this is what we think you should be saying.
00:25:39.940 --> 00:25:51.269
Well, it's interesting because if you talk about like a peak performance or flow state, right which is when you're so immersed in something that you don't even realize, kind of that time is passing, it's a bell curve.
00:25:51.269 --> 00:25:56.402
So as the stress level increases, performance increases.
00:25:56.402 --> 00:26:02.634
But once you hit that unoptimal point of high stress everything deteriorates from there.
00:26:02.634 --> 00:26:16.355
So finding that ideal level of stress where it's like manageable, right and you're still kind of worried about something and working towards something, is when you can really kind of achieve peak performance when you're optimally stressed.
00:26:16.921 --> 00:26:18.166
Just like your workouts too.
00:26:18.166 --> 00:26:20.104
You know when you're lifting and stuff.
00:26:20.104 --> 00:26:30.342
If you lift too much, you're going to tear your pec muscle, or you lift, you stress yourself, you get your HIIT workouts in and you're totally fine, right, yeah?
