No. 002 · Sunday

THE MEMO

On March 13 I was running a workshop in my own conference room. Fifteen physicians and practice owners, people who had flown in for it.

In the middle of facilitating, my heart started racing. Palpitations, 100 to 120. I checked my blood pressure. 150 over 110.

I'm a physician. I knew exactly what those numbers meant.

I kept going anyway.

Not because I didn't feel it. Because stopping didn't feel like an option. These people had flown in for this. I told myself I had no choice.

That feeling is what I want you to hear, not the numbers. The sense that you cannot stop no matter what your body is telling you. That's what burnout actually is.

Here's what caused it, and this part will sound familiar. I was rolling out several AI agents at once while restructuring my programs. All of it at the same time, no breaks. I didn't balance myself.

What I did. I stopped. There was a family trip to Korea already on the calendar, and I treated it as a disconnect instead of a vacation.

Before I left I handed the fundamentals to three people. One on marketing, one on fulfillment for current clients, and Scott overseeing strategy. Scott knew it was serious and got out ahead of me on most of it. Having a great team is amazing, and I don't think I understood that properly until I had to lean on one.

What it cost. Letting go of things I'd never handed to anyone. That was harder than the trip.

What it returned. I came back fully recovered, at full energy. And I came back with one rule: no more than three active projects at any one time.

That was five months ago. I'm still holding it.

I can multitask. I'm known for it. That was the problem. The cap isn't about what I can handle. It's about what handling it costs.

I also step away from the screen every thirty minutes, and I golf and fish with my kids. That part isn't a productivity system. It's the point.

TJ

THE SIGNAL

76% of Gen Z and 63% of millennials now go to AI before they go to a doctor. That's Aflac's 2026 Wellness Matters survey of 2,000 employed US adults, fielded in March. The same groups are far less likely to have a primary doctor at all: 48% of Gen Z and 58% of millennials, against 79% of Gen X and 87% of boomers.

Medicare's proposed 2027 conversion factor drops 1.68% for physicians outside an Advanced APM, from $33.40 to $32.84. The 2.5% statutory increase Congress gave you for 2026 expires at the end of this year, so the net is a cut. CMS takes comments through September 14.

Physician burnout fell to 41.9% in 2025, down from 43.2% the year before and 48.2% in 2023, according to the AMA. Buried in the same body of work: physicians in independent practice report meaningfully lower burnout than their hospital-employed peers.

WHERE I’LL BE

MIS Intensive Private Cadaver Lab
September 25-26, 2026 · Glenview, IL · CME Dynamics HQ
misintensivelab.com

Syndicate Mastermind, In Person
October 23-24, 2026 · Glenview, IL