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Orthopedic surgeon Yoshihiro Katsuura discusses his KevinMD article, “It’s not a normal job, folks: How 3 elemental forces of reality shape the profession of medicine.” In this episode, Yoshihiro, along with premedical students Andrew Roos and Rebecca Hu, explores the cultural, economic, and natural forces that uniquely burden physicians, leading to high rates of burnout and workforce attrition. Together, they analyze how these elemental forces exacerbate the demands on medical professionals and discuss the resulting impact on patient care and the health care system. Yoshihiro also offers innovative training approaches designed to equip the next generation of doctors with the skills needed to navigate these challenges, aiming to mitigate burnout and enhance physician well-being. Listeners will gain a deeper understanding of the systemic issues in the medical profession and discover actionable strategies for fostering a more sustainable and fulfilling career in medicine.
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Transcript
Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast. Today, we welcome back Yoshihiro Katsuura, and we also have Andrew Roos and Rebecca Hu. Yoshi is an orthopedic surgeon, and Andrew and Rebecca are pre-medical students. They are the co-authors of the KevinMD article, “It’s not a normal job, folks. How three elemental forces of reality shape the profession of medicine.” Everybody, welcome to the show.
Yoshihiro Katsuura: Hi, Kevin. Thanks so much for having us back on the show.
Kevin Pho: Perfect. OK, Yoshi, let’s start with you. Tell us what this article is about.
Yoshihiro Katsuura: Yeah, thanks so much, Kevin. First, let me introduce myself. My name is Yoshi Katsuura. I’m an orthopedic surgeon. I practice in Northern California. I was formerly on the faculty at Weill Cornell Medical College and at the Hospital for Special Surgery in New York, practicing spine surgery, but now I’m in private practice in Marin, California, which is just north of San Francisco. Not only do I run my own practice, but I also run my own research group, and we have a couple of my students on with me today.
One of the things I’m really interested in is giving tools and tactics that I think are very useful but not necessarily taught in medical school to young doctors in training—both so they can nurture these skills and also have a realistic understanding of what the job entails. That was really the motivation for why I wrote this article.
I’m very interested in physician burnout. We know that physicians play a vital role in society: we care for you, your parents, your kids, and we do it during your most vulnerable moments. It’s one of the most critical, if not the most critical, roles in society, and we need to protect and nurture the people who are going into that role as much as possible. But burnout among doctors is at an all-time high, and there’s been a ton written on the subject. The purpose of this article is really for me to share my own personal experiences, some of the challenges we face on a day-to-day basis, and what can be done to help support those who dedicate their lives to healing others.
Thinking about this, I tried to boil down what makes the job difficult into its most basic concept—hence the title of the article. I break it down into what I call the “forces of reality.” I say “forces” because these are things I literally feel day to day, and they shape how I practice. They’re fundamental because they’re constant and irrevocable. There’s not a lot that I can do to change these forces. There are three main ones:
- The forces of culture. I define this as trends in social acceptance, inclusion, organizational politics, administrative politics, and medical-legal conventions.
- The forces of the markets, basically economic forces such as compensation rates for physicians, supply and demand, government regulation, and value/productivity measures.
- The forces of nature. These are the most visceral ones we deal with—the powerful elements of disease, the unknowns in treatment, and prognosis. Some of these are out of human control.
I’ll give you an example from my day yesterday to illustrate how these forces intersect. Yesterday was an operating day for me—I spent about 12 hours in the OR dealing with unique anatomy and the pressures of performing surgery on a human being. I was dealing with the forces of nature: physiology, the physics of inserting orthopedic instrumentation into the human body, my own fatigue and mental exhaustion. Surgery is a team effort, so I had to orchestrate an entire team around me—nurses, techs, people who share the same goals as physicians. But we also have administrators, who have different priorities, and so I had to navigate cultural forces to ensure proper staffing and safe, excellent patient care. During that entire time, I’m dealing with market forces as well because I’m in private practice. There’s a set reimbursement for each case, and if a case is more difficult or takes longer, the hourly compensation goes down. That also means I have less time to spend with my family.
I invited Andrew and Rebecca here because we talk about these issues in my research group, and I try to arm them with the tools to handle these forces. I’m happy to share some ideas, but I’ll open it up to you first.
Kevin Pho: Yeah, so let me follow that up, Yoshi. You talk about your day yesterday—you talk about all these forces, and I’m sure physicians across the country are dealing with the same things you’re describing. How does that wear on you mentally, day after day, especially in private practice where you acutely deal with these market forces? How does that affect your mental wellness?
Yoshihiro Katsuura: It’s a huge responsibility to shoulder. Sometimes it can feel like the weight of the world is on your back, and it’s an incredible amount of pressure. When you break down what you’re actually dealing with on any given day, you realize there’s a lot going on. You don’t necessarily think about it when you’re in the heat of the moment, but especially after things cool off, you realize just how much you’re contending with.
Kevin Pho: Andrew and Rebecca, both of you are pre-medical students. I have a daughter who’s a sophomore and on a pre-medical path, so I’m familiar with what you’re going through. I’m sure you both have shadowed, volunteered, and observed Dr. Katsuura. Andrew, let’s start with you. Tell us the impressions you’re getting from the various doctors you’re shadowing. Do you sense the forces Yoshi is talking about that could lead to burnout? What are you seeing?
Andrew Roos: Absolutely. In general, pre-medical training focuses on science and medicine—no one really exposes you to these other ideas of cultural and economic pressures. Over the last year, spending time with Dr. Katsuura in his practice, I’ve seen how so much of his time, mental effort, and energy is dedicated not to science or medicine, but to dealing with administrators, marketing his private practice, and making sure the clinic is running well. It’s incredibly valuable as a pre-medical student to see a private practice, where you get this “behind the scenes” look. You wouldn’t normally see that in standard pre-med training. You realize how many different forces a doctor really has to deal with on a day-to-day basis. A lot of Dr. Katsuura’s free time is spent thinking about the business aspect of medicine rather than purely the orthopedic side, so it’s been very eye-opening.
Kevin Pho: Rebecca, tell us what you’ve observed from your shadowing and volunteer experiences about some of these non-medicine forces affecting physicians today. What are your impressions?
Rebecca Hu: First of all, thank you for having me on the show. I definitely echo what Andrew said. I’ve shadowed doctors in both private practice and hospital settings, and I agree that in private practice, you clearly see those non-natural forces at play. One big one is the economic forces in a private practice. Doctors constantly have to deal with administrative issues like scheduling, when they can get OR time, managing bookings, and working with their team of nurses and receptionists. These forces are really prominent. You see some of it in a hospital setting, but a large, well-structured system might mean physicians focus less of their energy on economic and administrative forces. In a private practice, it’s often more front-and-center. As a pre-medical student, it’s enriching to get exposed to different clinical settings and roles in health care, because it gives a fuller picture of all the challenges in the profession.
Kevin Pho: I’m glad you have that opportunity to see what goes on behind the scenes. Like both of you said, you don’t normally see that in pre-medical training—nor do a lot of medical students. Yoshi, you mentioned you have some paths forward to address these causes of burnout. Talk about those.
Yoshihiro Katsuura: The first step is recognizing these forces exist. As Andrew and Rebecca said, you go through rigorous undergraduate programs focused mostly on science and clinical skills, and that’s what draws a lot of people into medicine. That’s what interested me—science, clinical care, technical work. But these other hidden forces were basically off my radar until I had to face them in the real world. Now, I try to share with the students in my research group that these forces exist and will be a big part of your day as a physician, whether you’re in private practice, in academia, or part of a large hospital group. You still contend with these three forces—cultural, market, and natural.
So how do you handle it when you’re facing these pressures, not only caring for the patient but dealing with the administrative side, the business side, and the constant threat of burnout? For me, it comes down to channeling unlimited love for what I do—why I do what I do. I love the operating room. I love the science. Going in and taking disease out of the body is very rewarding. Most physicians love their work so much they’d probably do it for free, and that’s what happens during training—you basically are doing it for free. Remembering that love of the craft helps.
You also need to enjoy teaching the next generation. Dealing with the patient is one thing, but dealing with students, your staff, and everyone around you requires a basic curiosity about how things work. You need an insatiable hunger for improvement—always trying to get better clinically and in your business and administrative skills. That’s what keeps you coming back to the arena.
Finally, never give up. I tell the students in my group they are critical for society. They may not feel like it right now, and no one may be telling them they’re important, but they truly are. They’re the small crystals that will grow into frontline workers, caring for the sick and shouldering a massive societal responsibility. My passion is helping equip them with tools to face these forces and be safe, both for themselves and their patients.
Kevin Pho: Yoshi, to follow up, you mentioned that when you were training, you didn’t see a lot of these economic and cultural forces. If you could do this over again, would you have done anything differently in your medical journey?
Yoshihiro Katsuura: Absolutely, Kevin. One thing I tell Andrew and Rebecca is to have some level of business knowledge. Rebecca is double-majoring in a pre-medical program and business, which is phenomenal. Medicine is ultimately a business. If you don’t understand business, you risk having others take advantage of you or you might not fully use the knowledge and power you gain from your clinical training. Also, be aware of cultural and administrative forces. Dealing with people is nuanced, and you have to approach it as carefully as you’d approach a surgery. I wish I had realized those things earlier, and I’m still learning.
Kevin Pho: We’re talking to Yoshi Katsura, Andrew Roos, and Rebecca Hu. Yoshi is an orthopedic surgeon, Andrew and Rebecca are pre-medical students, and we’re discussing their KevinMD article, “It’s not a normal job, folks. How three elemental forces of reality shape the profession of medicine.”
I’m going to ask each of you for take-home messages. Andrew and Rebecca, I’d like you both to comment on how working with Dr. Katsuura and writing this paper has shaped or changed your views about medicine and your future. Rebecca, let’s start with you.
Rebecca Hu: For sure. As Dr. Katsuura mentioned, I’m also studying business. My biggest take-home message is the importance of interdisciplinary study as an undergrad—even though you’re on a pre-med track, explore other fields. My business studies enrich my understanding of the world and the medical field, especially for dealing with the economic and cultural forces of reality. Pre-medical students are going into medicine to help patients and deliver better care, but the world is evolving—AI is advancing, and new challenges are emerging. Working with Dr. Katsuura on surgical fitness, developing better tools for surgeons, and discussing what we’ll do if these forces change or if hospital structures shift is so valuable. It’s helped me better appreciate the nuances of the medical field and prepared me for what lies ahead. It’s also made me more interested in becoming a physician in private practice. Seeing how the team works together in private practice and how Dr. Katsuura handles his cases has been really encouraging.
Kevin Pho: Andrew, how about you?
Andrew Roos: I’ll echo what Rebecca said. To any other pre-med students, expose yourself to as many facets of medicine as possible—you don’t know what you don’t know. Before working with Dr. Katsuura, I had no clue what private practice was like. Seeing what the day-to-day life of a private practice physician is like is very different from a hospital-employed physician, and it’s changed my perspective on medicine and my future. I’m definitely more interested in private practice now. I see how you get autonomy and can shape your practice to align with your personality and goals as a physician, and that’s very attractive.
Kevin Pho: Yoshi, I’ll give you the last word. Your take-home messages?
Yoshihiro Katsuura: Thanks, Kevin. First, I want to give props to all the people who work alongside me—nurses, techs, preoperative staff, the people handling blood management, neuro monitoring, reps who bring equipment. It’s a huge orchestra of passionate people, and I’m grateful for them.
To the pre-medical and medical students out there: never give up. You’re critical for society. You’re the small crystals that will grow into large ones over the next decade of training, and you’ll become frontline workers. You won’t recognize the skills you’ll have when you’re done, but you’ll become an amazing instrument for healing, carrying society on your back. That all starts now. And if any pre-medical students are interested in learning about surgical fitness or being involved in research, please feel free to email me. I’d love to hear from you.
Kevin Pho: Yoshi, Andrew, and Rebecca, thank you so much for sharing your perspectives and insights, and thank you for coming on the show.
Yoshihiro Katsuura: Thanks so much, Kevin.
Andrew Roos: Thank you.
Rebecca Hu: Thank you.
