In this reflective episode, Dr. Anders Apgar revisits conversations about burnout, money, family, career decisions, and security to uncover a deeper theme: agency. He explores how today’s financial and professional choices can either preserve or limit the freedom available to our future selves.
What if physician well-being is ultimately about having choices?
Join Dr. Anders Apgar as he revisits earlier Direct Well-Being conversations and discovers a deeper theme connecting burnout, military medicine, family, finances, and career satisfaction: agency. He explores the freedom to make choices intentionally rather than feeling trapped by professional, financial, emotional obligations.
The episode examines how today’s decisions shape future freedom, especially around money, career commitments, family, and lifestyle. Apgar encourages listeners to preserve optionality, revisit conversations, complete the Ghost worksheets, and consider what their future selves may value differently over time.
Maybe the goal of well-being isn't creating a life where nothing is difficult. Maybe it's creating a life where you still have choices when things become difficult.
Top Host Competition: https://tophost.org/2026/anders-apgar
Top 3 Actionable Takeaways:
About the Show:
Direct Well-Being is hosted by Dr. Anders Apgar, MD, FACOG, M.S., a physician leader dedicated to transforming clinician well-being. The podcast creates space for honest, practical conversations about the factors that influence physician well-being, including financial stress, career sustainability, healthcare systems, relationships, and professional purpose.
About the Host:
Anders Apgar, MD, FACOG, M.S., is a physician leader dedicated to transforming clinician well-being. As host of the Direct Well-Being Podcast, he leads honest conversations about the real drivers of distress : financial stress, mental health, family dynamics, and broken systems, for physicians and the organizations that support them.
A trusted voice in health care, Dr. Apgar blends lived clinical experience with evidence-aligned insights. He’s part of the Direct Ecosystem (Direct Self Care, Direct Wealth Care, Direct Practice Care), partnering with organizations like Tend Health, the Well-Being Index, and Champions of Wellness to move the conversation from awareness to agency.
Connect with Dr. Anders Apgar
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Emails:
General contact: info@directwellbeingpodcast.com
Listener feedback: feedback@directwellbeingpodcast.com
Guest pitches: guests@directwellbeingpodcast.com
Sponsorship conversations: sponsors@directwellbeingpodcast.com
[00:00:00]
Welcome back to the Direct Well-Being Podcast. In my never-ending attempt to bring you entertainment, education, and a little bit of inspiration, this episode is going to be a little different. Because I've spent the last several weeks having conversations with physicians and experts, my own family, and even occasionally just myself.
Of course, that's not psychosis, people. That's called introspection. And lately, I've found myself thinking about those conversations long after they were recorded, not individually, but collectively. I started realizing that some of those episodes sounded different to me after I had recorded later episodes.
Something somebody said six weeks ago suddenly hit differently. A question I thought we had sufficiently asked and answered turned out to be connected to another question entirely. And an episode that I originally thought was about money turned out to be about freedom. An episode I thought was about military medicine turned out to be about security and [00:01:00] autonomy.
An episode with my children that I thought was about growing up with two physicians as parents turned out to be about the consequences of our career decisions and apparently some vehicle purchases made by yours truly. But career decisions on people who never got a vote in making them. To be fair, the kids all thought the cars were pretty cool back when I bought them.
But that also made me realize something. Maybe we shouldn't always listen to a podcast once, and at the risk of shamelessly promoting the Direct Well-Being podcast, maybe some conversations deserve a second listen because you're not the same listener anymore. Heck, if this production is working the way I hope it does, then you should not be the same listener.
And sometimes the episodes that come afterwards change what you hear in the episodes that came before and vice versa. So today, I wanna do something I really haven't done before, not recap the podcast, connect it, create a resource. I wanna go back through some of these conversations and ask, [00:02:00] what were we really talking about?
And maybe more importantly, what am I starting to understand now that I didn't completely understand when we began these conversations?
When I started Direct Well-Being, I thought I understood what the subject was. Physician well-being, obviously, burnout, financial literacy or the language of finance. I've actually had feedback saying that literacy suggests that others may be considered illiterate. So learning the language of finance allows some to be more fluent than others without there being an all or none classification.
I like that. I thought the conversations would be about career satisfaction, family, the pressures of medicine, and all of those things are still very much what this show is about. But increasingly, subtly, I think there's something underneath all of them, something much deeper and much more relevant: agency.
The ability to make choice. The ability to say yes because you want [00:03:00] to say yes, not because you have to. And the ability to say no because you can afford financially, professionally, and emotionally to say no. A colleague of mine from two thousand and five gave me some really good advice that I will pass on to you.
No is a sentence, period, and you don't have to say period. That's a very different definition of well-being, And I think that's what many of these conversations have actually been about. Think back to Diane Shannon. We began with burnout, but burnout wasn't the most compelling aspect of the conversation.
The deeper, almost unspoken part was what happens when the career gradually consumes so much of your identity that you're not entirely sure where the physician stops and the person begins? And then Aaron Pitney gave us a completely different environment around agency: military medicine.
There are structures, rules, [00:04:00] limitations. There is security, and immediately you're confronted with trade-offs. For Dr. Pitney, I mean, it was humorously sacrificing skiing to practice in Hawaii. But for sure, he and his family made commitments to career and country that occasionally superseded their values and priorities How much autonomy are you willing to surrender in exchange for stability?
See what I did there? See what I did? Surrender and a military reference. Get it? Now, it's undoubtedly easier for us on the outside to listen to all that and think, "Well, that's military medicine." Except it isn't. We make versions of that bargain constantly. We make it with our employers, our practices, our mortgages, our call schedules, our lifestyles, our compensation, our children's tuition.
And man, we are over some serious cheddar for three tuitions this year. I'm sure there are millions of [00:05:00] listeners out there doing just the same. I feel for you. Bargaining continues with the house we bought, the car we financed, the number we need to see deposited into our bank account every month simply to keep the lights on and the machine running.
I think that's called cash flow in financial language. And suddenly, what sounded like an episode about one physician's career becomes a much bigger question: How much freedom have I exchanged for security? And was that exchange intentional or consequential?
Then I sat down with my own children, and that episode affected me differently than I expected. We talked about this because physicians are very good at calculating the cost of a career to ourselves. We know how many nights we're on call. We know how many weekends we work. We know whether we're tired. We know when we're burned out, or maybe not.
Maybe we should know when we're burned out. We know when we miss dinner. But because we are [00:06:00] head down in medicine, we're not always very good at calculating the cost to everyone standing around us, everyone we love. My kids didn't choose medicine. Our kids didn't choose medicine. They definitely didn't choose OBGYN.
They didn't choose to the associated call schedule. They didn't choose the interruptions, the reprioritizations. They didn't choose the unpredictability that comes with two parents whose patients often needed them more urgently than their children did. And I'm not saying that to create guilt. Guilt is not particularly useful, but perspective is because it forces you to ask a different question.
When I make a career decision, who else is coming along with that decision, even if nobody asked them? Kids, spouse, partner, the ghost, and that changes the equation. After that came conversations about the business of medicine, about understanding compensation, understanding [00:07:00] what you're worth, contracts, understanding how the system works, and how your value is measured within the system.
FTE, RVU, and that other term Jonathan said that I really can't remember at this juncture. and I increasingly believe understanding financial language in medicine isn't about generating wealth. We talk about money as if the objective is always accumulation, more, a bigger investment account, a higher salary, a larger house, a better retirement number.
But money becomes really interesting when money buys you a choice. That's where Jerry's conversations really hit me because the question isn't simply how much lettuce, cabbage, paper, cheddar, or dead presidents do I have? The question is, how much money do I need before Benjamin stops making my decisions for me?
That's a much harder question
What's enough? Enough to turn down extra call. Enough to leave a job that makes you miserable. [00:08:00] Enough to change specialties. Enough to work four days instead of five, twenty percent of time. Enough to tell a partner, administrator, hospital system, or employer no, period. Of course, without saying the period.
And not because you're angry or impulsive, but because your financial strategy has created enough margin that you actually have options. That's a very different definition of wealth. Wealth isn't necessarily having enough money that you never have to work again. Wealth is about having enough flexibility that you don't have to keep doing work that no longer fits your life.
Maybe true wealth is about being able to value time over money. And that brings me back to an episode I want you to revisit. How do you predict a ghost?
I called it the ghost because we're constantly making decisions for someone we haven't met yet, our future selves. The thirty-year-old physician is making decisions for the forty-five-year-old [00:09:00] physician. The forty-five-year-old is making decisions for the sixty-year-old who might not even be practicing anymore.
And the problem is those people will inherently value completely different things. Maybe it's not a problem. Maybe it's an opportunity. I keep ruminating over one thought from that episode. Thirty-year-old physicians aren't making stupid decisions. I mean, I made plenty of them at that age, believe me. But thirty-year-old physicians are being asked, no, they're being forced to make irreversible decisions using values that haven't finished developing yet.
Think about how absurd that is. At thirty, maybe the most important thing in the world is building a practice, making partner, earning more, taking every call, saying yes to every opportunity. Isn't that the way you get ahead? Buying the house, starting the family, paying down the loans.
Proving that all those years of training were worth it. Blink. Then you're [00:10:00] forty-seven. The Latin phrase is tempus fugit. And suddenly the scarce resource isn't money. It's time. It's sand. Now it's Tuesday afternoon. It's dinner with your kids. It's being able to go to the volleyball game.
It's waking up without your first racing thoughts being the operating room schedule or what's already awaiting you on labor and delivery. It's having enough emotional energy left at the end of the day to be present for or to be interesting to the people you love. The value's changed. They're supposed to, but some of those decisions don't.
The mortgage, the partnership agreement, the spending habits, the lifestyle, the debt, and now you're living inside a financial cage designed by somebody you used to be. That's the ghost, and that's why I created the worksheets that go with that episode. If you listened to the ghost episode but didn't do the worksheets, shame on you.
Kidding. [00:11:00] I actually just want you to go back. They're on the Direct Wellbeing website, directwellbeingpodcast.com. But don't just listen to that episode again. Do the exercise. Do the paperwork. Print out the worksheets and pour over them with a pen or pencil or crayon or magic marker, but don't do it on a computer .
Because the point wasn't for this podcast to give you the answers. The entire point was for you to interrogate your own assumptions, your own ghosts. What does the person you are today value? What might the person you're becoming value? And which decisions are irreversible, like a vasectomy? And don't give me that reversible stuff with the vasectomy stuff.
I don't wanna hear it on the feedback. They're not reversible. Don't go into them thinking they're reversible. But that's the part I think we underestimate, n-not the vasectomy part. Sometimes we become obsessed with making the perfect decision. Resist the temptation to obsess. Luck favors the doers. [00:12:00] Maybe the smarter objective is preserving optionality.
Don't build a life where every choice locks down another. Give your future self room to maneuver. And here's the interesting thing. I think that exercise becomes more valuable after listening to the other episodes. So I want you to try something. Go back and listen differently. Go back to Aaron Pitney.
The first time, maybe you heard a story about military medicine. The second time, listen for the bargain between autonomy and security. Go back to the episode with my children. The first time, maybe you heard a family talking about what it was like growing up with two physicians. The second time, listen for the downstream consequences of career choices.
And not all of them were negative. The kids actually wouldn't change their lives that much. That was new, and that was news. Go back to Jerry. The first time, perhaps you heard a conversation about money. The second time, listen for [00:13:00] freedom. Listen for enough. Listen for the moment when money stops being the objective and starts becoming a tool.
And then go back to the ghost. And when you do the worksheets, don't just ask, "What do I want?" Ask, "What choices am I making today that reduce the options available to the person I may become?" That's a harder question. I get it, but I think it's a better one
There's something else I realized while putting this show together. And let's be honest, I don't put the show together. The producers all do that, and they do a great job of it. Shout out to them. A podcast shouldn't necessarily be disposable. We have trained ourselves and we've been trained to consume content like milk with an expiration date on it.
New episode Wednesday. My mother announces, "It's podcast day," when I call her on these mornings. Listen to it, throw the old one away, and open another carton. [00:14:00] That's not what I want Direct Wellbeing to become. I want these conversations to become a library, a permanent resource to address the ghost, something you can go back to, something where episode fourteen makes episode nine more interesting, more valuable, where a conversation you heard six months ago suddenly makes sense because your life changed or because another guest gave you language for something you couldn't describe the first time.
That isn't shamelessly recycling content because good conversations don't become irrelevant simply because they're no longer at the top of the feed. Sometimes you have to hear something twice. Sometimes somebody has to tell you the same truth from a different context. And sometimes, for whatever reason, you weren't ready to hear it the first time.
I know I've had that experience recording this show. There are things guests have said to me that I understood, at least intellectually, while we're sitting virtually across from each other. And weeks later, I thought, "Oh, [00:15:00] that's what they meant." Insert light bulb emoji here
That's one of the unexpected pleasures of doing this. I'm learning while I'm doing it, and I hope you are too. Because I don't want to host a podcast where I ask questions, have conversations, thank them, and move on. There has to be a cumulative effect. An adjuvant like clavulanic acid is to amoxicillin.
You can't just have a beta-lactamase inhibitor. It just doesn't work as well. Each conversation should add efficacy to the next conversation or one before. Otherwise, we're just filling episodes, consuming oxygen, and wasting time. I don't want to waste time, especially your time. I want to build something
And that brings me to something I want to shamelessly request of you. I've entered the Top Host competition, and yes, I'm asking you to vote for me. But I want to give you a why. I'm not doing it because what I need is another microphone in my life. I already have [00:16:00] one. See? It's right here.
I'm doing it because I think there's a bigger version of this conversation. The opportunity through tophost.org is the chance to take this style of conversation further, to reach people who may never search for a physician wellbeing podcast. Because while this show often begins with medicine and revolves about medicine, I'm beginning to think these questions don't belong exclusively to doctors.
How much is enough? When should you stay? When should you leave? How much security are you willing to exchange for freedom? What did your career cost your family, your people? Can the person you were at thirty possibly predict the value system of the person you become at fifty? Those aren't just physician questions.
Those are human questions. And if you've listened to this show and think these conversations deserve a larger audience, I'd be grateful for your vote in the tophost.org competition. I don't make any money off that. there is a big twenty-five thousand dollar prize that would help me [00:17:00] continue the show, but, that's just, me being transparent about all this stuff.
But truthfully, I would use that directly for the show and help it continue and help it get better
You'll find the link through the Direct Wellbeing Podcast website, and I'll continue sharing it while the competition is underway. It's just a couple more weeks at most. But whether I win or not, this show continues because I think we're just starting to understand what we're actually talking about.
So here's the assignment. Yes, I'm giving you homework again. Apparently, I've become that podcast host. Go back. Pick one episode, not necessarily your favorite episode, although I'm sure that will be difficult to decide. Okay. But pick one that made you think. Listen again, but this time listen for something different.
Don't just ask, "What did the guest say?" Instead, ask, "What does this mean for me now?" And if you haven't done the ghost worksheets, my gosh, will you please do them [00:18:00] so I can hush? They're on the website. Take twenty minutes. Be uncomfortable. Write down the answers you don't particularly like, especially those answers.
Because maybe the goal of wellbeing isn't creating a life where nothing is difficult. Maybe it's creating a life where you still have choices when things become difficult. That's what I'm starting to think this entire season has been teaching me, and hopefully you too. Identity matters. Family matters.
Money matters. Career matters. Purpose matters. But underneath all of them may be something even simpler, more important. Can you still choose? Can you still change direction? Can you still say yes? Can you still say no? Have you built enough room in your life for the person you haven't become yet, the ghost?
Because the ghost is coming. Oh, it's October, and it's horror movie season. The [00:19:00] ghost is coming. You don't have to know exactly what that person will be, but maybe you can leave a few doors open for them. That's all for today. Go back, listen differently, find peace, and I'll see you next time on the Direct Wellbeing Podcast.