Surgeons with Purpose

***********SENSITIVE CONTENT WARNING**************************
This episode discusses suicidal ideation. Please listen carefully.
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Jeremy Heffner is a trauma and acute care surgeon fifteen years into practice. He ran the COVID response at his institution. Somewhere in there, his compartmentalization strategy stopped working. He would find himself in situations where he couldn't contain his emotions and couldn't locate where any of it was coming from: which part of the past, which patient, which year. He had hypercompartmentalized to the point that he could no longer find the source. He saw therapists. He did EMDR. Eventually he admitted himself to a residential program for a month. Frontline workers, he says, are given almost nothing to process the day-to-day, so they don't.
In surgery we keep running until we hit a wall. He describes a room full of surgeons nudging each other about who is earning more and taking the harder cases, and nobody ever asking the only question that matters: did you ever figure out the work-life balance thing? His own verdict is unsparing: you have to run the race yourself and reach your limits before you'll believe they exist.
After admission to the residential facility, things got worse. Without the normal stressors he felt empty, and there was one night he came very close to dying by suicide. He couldn't work out what defined him anymore. He knew he couldn't go back to being who he had been, because that version hadn't worked. If he wasn't producing ridiculous RVUs, had he failed? For the first time in his life, he didn't know what the path forward looked like. Two realizations moved him. The first was that every single moment of the day is his choice — that the excuses, starting with “if I don't see these patients, then…,” were his own. The second arrived as a willingness to be fired: once he understood he didn't have to prove himself, the rest of the stress fell away. Recognizing your own intrinsic value, he says, is the muscle. And he's blunt about his own part in it; he had been blaming the system for hiding what he was keeping from them.
He also turned to AI during that stretch, in a state of high vulnerability and shame. It helped him, he says, by forcing his mind onto a new problem. But it also showed him what the models actually do. He argues the models can induce psychosis in vulnerable people, and he lays out three places this could land — we believe we're steering when we aren't; too many destabilizing ideas arrive at once; or we learn to work alongside these systems as neither boss nor slave, which he calls the real threading of the needle. His warning for medicine is sharp: whatever efficiency AI creates does not entitle administrators to more of a physician's time.
What got him through PTSD was his wife, and a life rebalanced around something other than output. He is worried about the surgeons being trained right now on a model that no longer matches the world, sent out like deer to the slaughter by leaders who haven't noticed the game changed, World War One generals all over again. His closing thought is about leverage: once you genuinely believe in your own worth, you simply stop accepting the terms. You are not an easily replaced part.
Follow Jeremy on LinkedIn here.
Join SurgeON here.
Get his book, Proof of the Impossible here.
If you're struggling: the Physician Support Line (1-888-409-0141) is free, confidential, and staffed by volunteer psychiatrists for U.S. physicians, residents, and medical students, 8am–1am ET every day and nothing is recorded. The 988 Suicide & Crisis Lifeline is available any time by call or text.

Interested in the Cabo retreat? Learn more about it here. And interview for a spot here.
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Gopi Shah and Ashley Agan met when Ashley was a PGY-3 and Gopi was a fellow. They’ve been friends ever since.
Both went on to spend about eight years in academic medicine. Ashley made associate professor at UT Southwestern and was the first physician in her family. Gopi built her own academic career. And eventually, they both hit a wall.
They describe that wall differently.
For Gopi, it was the realization that what she thought her career would feel like was not what it actually felt like. For Ashley, it looked more like a seven-year itch, coupled with a vision she’d carried for years of running a small practice of her own.
What I love about their story is that they didn’t leave in the same direction.
Gopi and her family moved to Paris on what she calls a pipe dream: the chance to live abroad. She put her professional life completely on hold. She needed the reset, not just professionally, but for her mind, body, and overall wellbeing. At one point, she genuinely wasn’t sure she wanted to keep practicing medicine.
Eventually, she tried locums.
It was supposed to be a try-it-and-see experiment. Instead, she found a way of practicing that she loves. Every new institution requires her to read the room, understand the system, and figure out how to work within it. She loves the variety, the call, and the hospital medicine.
And as a pediatric ENT, she has a pretty good explanation for why she likes working with kids: they keep you honest. They see right through the ego.
Ashley watched Gopi do all of this and describes her, in some ways, as a vision board.
Two years ago, Ashley left her salaried academic position and opened a direct-care, cash-pay practice, despite being told it wouldn’t work.
Her take on cash pay is refreshingly nuanced: it’s harder in some ways and easier in others. Building the practice is harder. Actually practicing medicine without the insurance model hanging over every decision is much simpler.
She figured insurance would always be there if she needed it.
She hasn’t needed it.
What Ashley really wanted was control of her time. Her old life had become two daily frenzies, one in the morning and one in the evening, with a packed clinical day sandwiched between them. Somewhere along the way, she started to feel like she was missing the point of her own life.
She understood why the system was built the way it was.
She also understood that she could not build the life she wanted inside it.
And then there’s BackTable ENT.
That started almost by accident.
Gopi’s husband had launched BackTable IR as part of a startup building an app that allowed proceduralists to rate devices. The app needed physician engagement, so they started a podcast to drive people toward it.
The podcast ended up being the thing of value.
Gopi and Ashley first shared a microphone while talking about nosebleeds. In 2020, they decided to make an ENT podcast together. They recorded five episodes, mostly with people they already knew.
Ashley’s summary of those early days is basically perfect: it was so fun, even if nobody listened.
They weren’t initially thinking about it as education. That came later, when they started talking about all the things that weren’t making it onto the academic agenda.
Their first episode in that series was about the idea that you can’t pour from an empty cup. From there, the conversations expanded into practice building, professionalism, personal development, mentorship, coaching, and all of the other things they wish someone had taught them when they were younger.
Some of those topics, like the difference between mentorship and coaching, were still genuinely unfamiliar territory when they recorded them.
And doing it together mattered.
There’s something about having another person beside you that makes it much less terrifying to ask the question that might sound stupid, hear your own voice coming out of a microphone, get in front of a camera, or put an opinion into the world where someone might judge you for it.
Their goal is honest conversation.
Even with sponsorships, they want to be able to say what they actually think. If there’s something their colleagues should know about a device, they want to say it.
These are the conversations that happen on the sidelines at conferences. The conversations that don’t always make it onto the Academy podium.
And underneath so much of what they do is a challenge to one of the most deeply ingrained ideas in medicine: that there is only one right way to be a surgeon.
Both Gopi and Ashley have learned what happens when you’re willing to fail forward, especially when the risk is one you chose for yourself.
That, to me, is the real story here.
Not that they left academic medicine.
Not that one built a locums career and the other built a cash-pay practice.
It’s that they stopped assuming the career they had been handed was the only career available to them.
Learn more about Back Table ENT podcast here. Learn more about Ashley's practice, Scottie ENT, here.

Empowered Surgeons Group is going to Cabo January 6th-10th, 2027 for a mindset coaching intensive. Learn more about the retreat here. Interview for a spot at the retreat here.
You know that old adage: when life gives you lemons, make lemonade? What that means is solving for a result we want as opposed to indulging in our own mind drama. That's what this episode is all about. When you learn how to process through mind drama, you reach your goals faster and raise your self-concept to someone who can solve any problem.
Easier said than done. This is where a coaching relationship helps: to pick you up in your failures. If you are ready to jumpstart your personal development, the Women Surgeons' Retreat is the ideal place to do that.
Get on my calendar today to interview for a spot.
And join Empowered Surgeons Group to get started on this process right away.

My TEDx journey started while I was pooping on a very fancy toilet in NYC. But before I say more about that...
First things first, get Cesar's book, Great Speech, here.
Then book a call with him here.
And finally, join us for the Women Surgeons' Retreat in Cabo Jan 6-10, 2027. Calling all women surgeons who want to uplevel their lives and mastermind with colleagues. Get on my calendar here to interview for a spot in this mindset coaching intensive.
Back to that fancy toilet in NYC…
I was with my family on spring break, and an email from Cesar somehow showed up in my inbox. Next thing I knew, I had the thought, "I can do a TEDx talk." I booked a call with Cesar, and that same year I landed my first talk. Then I landed a second talk, which was selected for the coveted Editor's Pick (an honor reserved for less than 0.1% of TEDx talks). You can watch my first talk, How to save lives with two minutes of listening here and my second talk, Can we end fear-driven healthcare? here.
Cesar Cervantes was the kind of child whose parents concluded early that he was going to need a stage: theater camps, commercials, and a father he first learned to be funny with. He started doing stand-up and was touring by nineteen, work that eventually took him into war zones, performing at lunchtime on forward operating bases to service members. He calls it the worst possible setup for comedy and the most fulfilling work he has ever done.
What he ran into was the limit of the medium. He wanted to create transformation, not just laughter, so he went to graduate school and began teaching comedy inside a theater department. The keynote he built out of those classes drew a different question from other speakers: how do I get on a stage like that? And Top Talks grew out of answering it.
His case for humor is more serious than you might expect. Humor is catharsis. Pain and joy are both part of being a person, and comedy is where we metabolize the overlap; it is a celebration of the flawed human state. Pain plus time equals comedy, which also means a story told too soon is not ready for a stage. We also get into how badly a story suffers when the teller makes themselves the hero of it, a habit that feels like confidence and lands like distance, and one accomplished people fall into without noticing.
On TEDx, Cesar talks about how the stage is for ideas and how ideas change things, rather than motivational speaking or a personal story of overcoming. Ten to twelve minutes is the sweet spot, and the goal is a talk your audience can leave holding in one sentence. Getting there takes laser focus on your throughline, a clear sense of where the audience starts and where you intend to move them, a refusal to get precious about everything you write, and what he calls an "Oh My Gift" moment.
The structure runs in eight beats: an attention getter, an unequivocal reveal of the problem, the throughline, the solution stated plainly, then building the problem out, revealing the solution, the Oh My Gift moment, and a call to action. TED, he notes, loves reason-based thinking that arrives somewhere.
His advice on getting selected is unglamorous and correct. Land the idea, learn to communicate it, submit to events you would genuinely travel to, and separate the outcome from the process. Once selected, get a coach. TED is its own form. As a two-time TEDx speaker, I can vouch for this.
Join us inside Empowered Surgeons Group here.
Follow Cesar on LinkedIn here.

*************SENSITIVE CONTENT WARNING*******************
This episode discusses a recent suicide. Please listen carefully, or if this is particularly triggering for you, forgo listening completely.
On July 23, 2025, Vaibhav Duggal turned 24. He spent the morning of his birthday in a women's health clinic in El Paso, on his OB/GYN rotation as a third-year medical student at Texas Tech University Health Sciences Center. Six days later he was dead.
In this episode, I share more details that have come to light about this case, including the processes the institution followed to address the complaint against Vaibhav, what the culture was like inside the institution, and the conversation between the Dean of the school and Vaibhav's parents.
Please go back and listen to the first episode #111, Vaibhav's Story, before listening to this one.
If you or someone you know is struggling, the 988 Suicide & Crisis Lifeline is available 24/7 by call or text in the U.S. Medical students and physicians can also reach the Physician Support Line at 1-888-409-0141, staffed by volunteer psychiatrists.
Join us inside Empowered Surgeons Group here.