127: How to Set Boundaries and Say No: A Conversation with Dr. Erica Howe

When we’re knee-deep in the trenches of life it can be easy to forget about ourselves. In fact, there are implicit and even explicit messages in our culture, and our professions, that shape that point of view-that our worth hinges on our productivity or that our value is tied to helping others. But that leaves us lacking. 

Dr. Erica Howe is the founder of the Women Physicians Wellness and Women Professionals Wellness Conferences. Today you’ll hear how she took her own struggles in her medical career and used them as fuel to start a conference specifically geared at helping others to sustain wellness while advancing their careers and developing confidence as leaders. 

Listen in as we talk about the difficulty of setting boundaries, Dr. Howe’s experience of being an entrepreneur, and some of her best advice for how you can make sure you’re not overextending at your own expense.

Habits on Purpose with Kristi Angevine | How to Set Boundaries and Say No: A Conversation with Dr. Erica Howe

When we’re knee-deep in the trenches of life it can be easy to forget about ourselves. In fact, there are implicit and even explicit messages in our culture, and our professions, that shape that point of view. That our worth hinges on our productivity or that our value is tied to helping others. But that leaves us lacking. 

Habits on Purpose with Kristi Angevine | How to Set Boundaries and Say No: A Conversation with Dr. Erica Howe

Dr. Erica Howe is the founder of the Women Physicians Wellness and Women Professionals Wellness Conferences. Today you’ll hear how she took her own struggles in her medical career and used them as fuel to start a conference specifically geared at helping others to sustain wellness while advancing their careers and developing confidence as leaders. 

Listen in as we talk about the difficulty of setting boundaries, Dr. Howe’s experience of being an entrepreneur, and some of her best advice for how you can make sure you’re not overextending at your own expense.

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What you'll learn from this episode:

  • How women are indoctrinated to put everything in life before themselves first.
  • Ways to set boundaries—at home and at work—and learning to say “no”.
  • The importance of delegation when developing confidence as a leader.
  • Overcoming feelings of guilt or self-doubt, especially as a mom or partner.
  • How to develop a community and/or support system to help you flourish.

Listen to the Full Episode:

Powerful Takeaways:

9:18 “It’s a challenge to give yourself permission just to rest because you’re tired.”

11:43 “It’s so crazy that we can intellectually totally understand that we cannot pour from an empty cup.”

17:22 “Some of the best leaders are the ones that hand things off well to other people.”

18:57 “I don’t know a woman alive that hasn’t experienced mom guilt or partner guilt or work guilt.”

26:00 “Expectation can go a very long way when it comes to saying no in every setting.”

Featured on the Show:

Related Episodes:

Full Episode Transcript:

Welcome to Episode 127. I'm Kristi Angevine, your host, and this is a conversation with Dr. Erica Howe. Dr. Howe is the founder of the Women Physicians Wellness and Women Professionals Wellness Conferences. She's not only a source of inspiration, but someone I consider a friend. Listen in as we talk about the difficulty of setting boundaries, Dr. Howe's experience of being an entrepreneur, and some of her best advice for how you can make sure you're not overextending at your own expense.

Dr. Howe is passionate about helping women professionals find community and find clarity so they can thrive on their own terms. I hope you enjoy listening to this conversation as much as I enjoyed having it.

Welcome to Habits On Purpose, a podcast for high-achieving women who want to create lifelong habits that give more than they take. You'll get practical strategies for mindset shifts that will help you finally understand the root causes of why you think, feel, and act as you do. And now here's your host, Physician and Master Certified Life Coach Kristi Angevine.

Hello, hello, everyone. Today I'm joined by Dr. Erica Howe for her second appearance on the podcast. If you haven't heard our first conversation, after you listen to this one, go back to Episode 64 and enjoy that one as well. And then, go check out her conferences. Go to WomenPhysiciansWellness.com or WomenProfessionalsWellness.com, you will be happy you did.

Dr. Howe is a certified hospitalist-turned-physician entrepreneur. She's the founder of WPW, a nationally known speaker, and nationally known educator. She took her own struggles in her medical career and used them as fuel to start a conference specifically geared at helping others sustain wellness while advancing their careers and developing confidence as leaders. Here we go.

Kristi Angevine: Alright, so Dr. Erica Howe, thank you for coming to the podcast. It is so fun to have, essentially, a part two.

Dr. Erica Howe: Thank you for having me. I'm so excited to be back. This is great.

Kristi: You've been on the podcast before, and we have so much fun on that episode. And we've gotten to see each other in real life several times since then. But for the people who don't yet know you, or people who just need a little refresher, can you introduce yourself?

Erica: I am a Hospitalist Physician by training and trade, now retired, and I am the founder of the Women Physicians Wellness Conference and also the Women Professionals Wellness Conference.

Kristi: I am excited to hear about how your business has changed and evolved, and things like that. And I have some questions since our last conversation that have been percolating. I've been dying to ask you, so I'm just going to go through different things and kind of see where this goes.

But before we jump in, you have this beautiful background behind you. This lovely white… I don't know if it's walnut. I don't know what it is… But what's going on? Where in your house are you? Where in the world are you right now while we're talking?

Erica: I am in Kansas City, Kansas, and I am sitting in my office. It's just for me. It is such my happy place. I decorated it the way I wanted. I have the kind of the desk and all the accessories that I want. It's very probably simple in a sense. But I love just a very clean, crisp modern space. And yeah, that's where I am now. It's about 90⁰ and sunny outside; very hot. So, I'm glad to be sitting here in the air conditioning with you.

Kristi: If I'm remembering from the last time we talked, this seems like a new background for you. I think you were somewhere else when we talked.

Erica: This is new. So we, in the last, gosh, like three years ago, started building our dream home. It finally got completed last year, almost to the today. So, we moved in just about a year ago. We kind of settled, and we've got everything in here that we want. Everything's in the place it needs to be and it feels like home. It's really great. I mean, there were so many months of walking into our home and just like, “Is this really ours? This is ours?” And now, we're kind of feeling like, “Okay, it's ours.”

Kristi: Oh, good. So, for those of you… This isn't video, this is all just audio. But everybody listening, you can probably imagine lovely Erica has this great smile on her face. It looks like you feel at home. This is great.

So, your conferences, the Women Physician Wellness Conference and the Women Professionals Wellness Conference, when I have been to your conferences I have heard you talk a lot about the implicit, and sometimes explicit, messages that are in our culture, and sometimes in our professions, that sort of shape our experience of ourselves and of the world.

And there are two main ones that really stick out for me, that are ones that I've grappled with, and once, when I've been at your conference, I've seen attendees there really kind of struggle with. The first one is this message that your worth hinges on your productivity. And the second one is that your value comes from how much you help others.

What I'm wondering is, when I think about this for myself all sorts of things come up for how I have built my life around this. And I'm wondering if there is a point for you, where you realized that these things were really influencing your experience?

Erica: I think one of the big challenges that I had was having three kids very close together. So, we had three kids in five years, and I was a practicing full-time academic hospitalist at the same time. We didn't take a vacation, my husband and I, for seven years during this time. Because we were pregnant, we just had a baby… you know it's no fun traveling with infants, etc. etc.

Oh, sorry, we took family vacations, but we didn't take a couples only vacation. And anyone who's taken a family vacation with a toddler knows that that is not a vacation, that's a trip. We’d go, but we'd be getting up at 5am because the toddler was getting up at 5am, and the baby's crying for half the night, and all the things.

And I remember, when we finally took that vacation after seven years. We ended up going to Jamaica, and I will tell you I can say I learned nothing about Jamaica going there. Because all I did was stay at the resort. and go from the hotel to the buffet to the pool to the hotel room. That first night, we slept 14 hours, both of us. When we woke up it was like someone had turned the TV from black and white to color again.

I didn't even realize what a fog I was in. How blurry my thinking was, in a sense. I just wasn't firing on all cylinders. I was so fatigued by constantly doing everything for everyone else. And being that person that constantly does for my children, does for my patients, does for my colleagues, does for the consultant, does for the job. Never taking time just for myself. It almost felt like this indulgence, this luxury, that I wasn't afforded. Like, I hadn't earned the right to rest.

And I absolutely, looking back, can see so much faulty thinking with that. It really hurt me for many, many years. I don't think that I was my best as a mother, as a physician, or as a colleague, because I was so tired. And I could not give myself permission to rest just for the sake of rest; not earning it and then resting. Because I think we do that, right? Like, “If I've had a long call night, now I have the right to take a nap.”

But what if you took a nap just because you were tired, and it was Tuesday? When I think about what you said, I really think about us stepping out of the need to provide service to someone else in order to give ourselves permission to be, to just be. I don't know if you see it the same way, but I think that's something that I learned the hard way.

And then, since that time, it's just become a huge motto of mine to really make sure that women start to hear from us on the other side of medicine saying, “You know what? You don't have to live like this. And it's okay to take a break just because you need a break. Not because you've “earned it” or not earned it, whether you worked hard that day or not, whether you did “enough”. You still have the right to rest, to look after yourself, and to put yourself first.

Kristi: I see it very similarly, and I also learned the hard way. And frankly, if I really am honest, I think I'm still unlearning some of those connections. I think if somebody's listening and recognizes that they are in the trenches of overextending at their own expense, and maybe just realizing it. I mean, it's a journey. Sometimes we just don't even notice when we're doing it.

So, I love how you put it that it's a challenge to give yourself permission to just rest because you're tired. Because if you've been told that rest is a luxury, you should rest when you die. And that if you actually care about anybody in your life, your kids, your patients, your partner, your family, that they come first.

What is the thing that we heard over and over and over? Patients come first. Patients come first. Patients come first. And I'm not saying that we don't care. But the irony of that, of ‘X comes first,’ is that we can end up running ourselves so haggard that we don't really have much to give the very people that we want to give to, right?

Erica: There will always be someone else who is willing to take from us. You really have to put yourself first. And it's unfortunate that in our current culture of medicine… Which I really do hope that it's changing. It just may not be changing at the pace that we want it to... But I really feel like that culture does tell you to put everyone else first. Because you're dealing with patients in, many times, life and death situations in our profession.

However, I also think that we should be teaching a curriculum of, “Hey, you need to take care of yourself first, so that you can take better care of the patient. So you can be your absolute best.”

You and I both know, I have been through the breast cancer journey in the last few years. And I will tell you, the first thing I asked my surgeon, when she showed up to do my mastectomy, was, “Did you get some good sleep last night?” I wanted to know that my surgeon was well rested. I didn't want to think that she had put every single patient she had above herself, and not slept well the night before, when she was coming in to do a very big surgery for me.

And there's nothing like a fun little cancer diagnosis to wake you up to that idea. To make you realize that we really do want our doctors to take care of themselves. It not just increases their longevity in medicine, but just increases their lifespan and their happiness, and their burnout rates. So, it seems almost counterintuitive that we would constantly teach to put other people first.

I think women especially are indoctrinated into that culture, even long before medicine, to put their family members, put their children first, put their partners and spouses first. And I could not disagree more.

Kristi: It's so crazy that we can intellectually totally understand that we cannot pour from an empty cup. And we can be like, “I don't want my surgeon, my kid’s teacher, the pilot flying my plane to be exhausted, overworked, and overextending beyond their capacity. I don't want that for them.”

And yet, still, when it comes down to it in our ordinary everyday life, we just almost reflexively put ourselves last at the list, definitely see rest as an indulgence, and struggle with something as simple as the word no, or “No, I can't.”

I'm just curious, when I think about people trying to set some boundaries, trying to say, “Okay, I really do need to take care of myself. Yet I also have all these other things that I either feel like I have to do, or I have to do, in order to stay in my current job. It's busy.” What is it, Maycember, Junecember? “The busy end of the year. It feels like December, but it’s really…” We’ve got all that stuff going on.

What's your advice for what somebody should do if they want to start saying no to some things, and they're finding it really, really hard?

Erica: One of the easiest ways to kind of get started with saying no is to sit down with the people who are important in your life… And that can be family, certainly, but it could also be your boss, it could be colleagues that are asking you to pick up extra shifts. That could look like many different things.

So, the people that are asking for your time, sit down with them and simply verbalize, “I am overwhelmed. I am exhausted. I need to start putting myself first. What are some things that we can work on together that you can either take off my plate? Or that we can really just reframe and say this just isn't important? I don't need to do this and you don't need to do this.”

This was something that I learned, as you know, the hard way. But I remember hearing from a colleague… and this is just the power of women together in community… and she said, “I thought, with my kids, I had to be the room mom and do all the things, and show up for every field trip and all of that. I remember asking my child, ‘What do you want me to do? What do you want me to be there for?’”

“I had them just list out ‘these are the things that I want you to present for.’ Like, at my school or at my activities, or competitions or whatever it is. ‘This is what means a lot to me.’” And it wasn't the entire list of possible opportunities to be present. Right? There were maybe three to five things that really meant a lot to her children, for her to be there for in a year's time.

And so, she made a point of being present for those things. I think, so often the voice that we hear says you have to be there for everyone, for everything. And we never actually have that conversation with someone else. To say, “Is that important to you? Do you care about that?”

So, I did this. I remember approaching my oldest child, my daughter, and I had thought that she wanted me to be the room mom, which was absolutely impossible for me to do. There's no way. I could not. I had this conversation with her, and she said, “No, I don't want you to.” She would always ask me if I was going to be the room mom; she was just curious who it was.

I thought she was kind of secretly trying to kind of get me to apply for the job. She wasn't, she was just curious. At the end of that conversation, I realized she didn't. I was a mom, she didn't… She actually wanted me to show up for the Valentine's Day party. That was what she cared about. And that's easy. Okay, I can take a portion of the day off each year and make sure that I'm there for her elementary school’s Valentine's Day party.

So, sometimes it's the message that we're telling ourselves, and that's not an accurate message. It’s really starting to question that and say, “Okay, I'm thinking that all of this is important, that I have to do all of this, but actually…” This might not be another example, but I will tell you, all my children now, ages 10 through 14, all do their own laundry. They wash it, they dry it, they fold it, and they put it away.

My youngest the other day… I said, “You got it. Your laundry is done, and looks like it's done in the dryer, take it out, and you’ve got to fold it and put it away.” He's like, “Why do I have to fold it?” And I was like, “Well, I don't know. I mean, so it's not wrinkled?” And he's like, “Can I hang it up?” I'm like, “Yeah, you can hang it up.” He's like, “That would be easier. I'd rather just hang it up.” Oh, okay.

I mean, it's these little things that gave him a lot more control, and allowed me to release a lot more control of that situation. He does it the way that he likes to do it and it's different from what I had planned. But it works out perfectly. But sometimes it's just having that conversation.

I think the first thing I would say when you're trying to set up those no’s and those boundaries, is sit down with those key players in your life, have a conversation, and say, “This is where I'm at. I'm exhausted. I'm overwhelmed. I'm just done. I want you to understand that I'm not going to say yes to any more moonlighting for the rest of the year. I'm going to make sure that I'm taking those weekends for myself, and really starting to nurture myself again, and rest.”

“So that I have my best self when I come to work each week.” Or maybe it looks like, “Hey, we're going to hire out a cleaner to come in and take care of the house twice a month, because that's something I don't enjoy. I value a clean house, but I don't enjoy cleaning it. So, we're going to delegate that.”

I think it's really just kind of thinking outside the box and not accepting that everything has to be your responsibility. Some of the best leaders are the ones that hand things off well to other people, and know who is the right fit to come in and take that job or task over. So, I think that's the question to ask yourself.

There is a 14-year-old in every woman's neighborhood that is listening to this right now, I promise you. There's a 14-year-old down the street that would die to come and fold your laundry for 10 bucks an hour. Oh my gosh, big money.

Kristi: What I love about this so much, is it sounds like you're doing something that I think is super important. That I like to do with myself and I sometimes forget to do, but I do with my clients all the time. It’s tapping into curiosity. Where we have assumptions that we don't even realize are assumptions.

So, it's so interesting, these assumptions that you are making about what your daughter wanted, and imagining you were feeling some guilt and some, “I should be there.” But then I also need to be curious about, “Okay, so what does she really want? What really matters to me? And how can we connect and maybe find out something new?” I just think that's such a great thing to point out.

I'm going to take a little pause here for a second, because I think we would be remiss if we didn't talk about the guilt that comes sort of baked into this. And it's not just mom guilt; there's dad guilt, there's friend guilt, there's ‘I'm not a good enough daughter’ guilt. It doesn't matter if you have children or not, but the guilt factor I think can be really heavy for some people.

I love that curiosity can help us kind of dispel some of that. Have you experienced this yourself, where guilt is the driving force for that?

Erica: Oh, have I experienced it. I don't know a woman alive that hasn't experienced mom guilt or partner guilt or work guilt. I mean, there's so much. If you're going to get away from the guilt, I think very often, it's the voice in our head. And it's recognizing that no one has the right to tell you to feel guilty for these things.

So, you have to tell yourself a different version of the story. You have to reframe what that story is and what it means. I was feeling guilty for not being the room mom, and no one had ever said, “I need you to be the room mom or I feel like you don't love me.” That was what was going on in my head.

We really have to start questioning that. It does not mean that it came out of nowhere, because I think a lot of this does come from our culture, and the American culture in general, especially towards women.

So, it's definitely coming from somewhere, but you have to start asking yourself, “Where is this coming from? Has anyone actually told me this? Do I have any facts or data that backs this up? Has my daughter said anything to me? Does she cry when I pick her up because I wasn't there?” That type of thing.

If not, then we have to start to question, “Okay, these thoughts in my head that are telling me that I'm a bad mother, I'm a bad person, I'm a bad doctor, I'm doing the best I can,” and start to reframe. “I refuse to feel guilty today. I am doing the best I can with what I've been given today.” To really start reframing that conversation that we have in our heads so that it's not about shame and it's not about guilt anymore.

It's about recognizing all the things that we do and all the hard work that we put in every single day. We're not supposed to be perfect. We are human beings. But boy, do we hold ourselves up as if we're supposed to never make a mistake. And doctors are; we're famous for this, right? Because we are dealing with life and death.

But how can you start to pat yourself on the back and switch that narrative in your head, so that it supports you and encourages you and starts to act like your best friend, and not as your worst enemy?

Kristi: Yes. And I think that you just hit the nail on the head right there. When we're telling ourselves something… that we didn't read on a billboard, like, “You're a bad mom. You're not the room mom,” but that we internalized from all the things… when we're telling ourselves something like that, that's not serving us, we usually feel awful. It’s the opposite of what we would feel if our best friend was talking to us with so much love, right?

And so, that, I think, is almost the litmus test for, “Okay, you're feeling guilt and shame, and you're not really sure why.” Is this an amorphous ‘I don't know why’? Or is it very clearly linked to a laundry list of things that you “should do”? “I should be room mom. I should do this. I should always be present. I should love doing arts and crafts with my kids, and I should always want to. And I should…”

That could be your sign that you could be believing something that's just bullshit, painful, and not helpful to anybody. And, ironically, getting in the way of you actually connecting with your kid, right? Like in ways when your cup is full.

Erica: Completely. I did not enjoy playing with toddlers, not one time. I just didn't. I'm just not that person that likes to play blocks and write the alphabet over and over again. That's just not my thing, and that's okay. That is all right. I'm still a really good mom and so are you. These are not the criteria for being a great mom.

So, we need to really start thinking different thoughts about what makes a great woman, a great physician, a great partner, a great mother. It's not doing everything, it's doing the things that are important to the person that's receiving them. And I think the same goes for your patients.

Sitting down… especially when we think about things like the outpatient setting… sit down with your patients and say, “I want to be the best doctor I possibly can for you. I have 20 minutes. And in that 20 minutes, really, we can only focus on two or three things, tops. Whatever that looks like for you. And so, I want to hear from you. What are those two or three complaints or issues that you want to focus on, so that we get them covered and that you feel like you were heard?”

You can voice all of this to a patient. And it can be so powerful, because it puts the two of you together as a team collaborating on the patient's care. It's not us against them. It's really, “We're a team and I do want to do my absolute best for you. I don't control the time limit, but I want to be there for you. And since I want to be there for you in the best way possible, what are those two or three items that we definitely need to address today?”

Kristi: Oh, my gosh, so good. Those instead of, “It's me versus the patient.” And the patient versus the doctor. “We are sitting on the same side of the bench, and we have this time limit. How can we work together to get you what you need, so I can give you the best of me?” That's so beautiful, Erica. I love how you put that.

Erica: Can we talk just for a second about expectations? I think that's another really powerful concept when it comes to boundary setting and saying no. Just starting with that expectation.

“I want to make sure that I am on time as much as I possibly can be. And that means making sure that we end on time and we start on time. And you know I'm going to do that for you. I'm going to do that for the next person too. So in that time that we've got together, let's make sure that we get the things that you really need addressed, addressed. That can only be two things, or we need another appointment?”

Having those conversations, and setting up that expectation before you kind of get into the murkiness of the big conversations of, “My chest pain has been going on for 18 years and radiates to my big toe.” That can just go such a long way. And the same holds true for our partners, our spouses, our kids, our friends.

Saying, “Gosh, I absolutely love you and I want to be hanging out with you every single Tuesday for that happy hour Ladies Night. My schedule just doesn't allow it. My time is short, so I need to really focus on my family when I'm not at work. But I can probably join a couple of times a year. So, let's think about are there some big celebrations that I should be there for?”

Just starting with conversations like that lets other people know where you sit, and where your head’s at, and that gets that kind of crazy conversation in their head out their head. So, they don't think, “Oh, she just doesn't like me very much. She doesn't want to hang out. She doesn't think I'm a lot of fun.”

Then they realize, “Oh, no, she's just busy. She wishes that she had more time. She wishes she could, and she's going to be there on my birthday celebration. She's going to be there in February, when everybody is sick and tired of the doldrums of winter, and we all go out.” So, I think expectation can go a very long way when it comes to saying no and boundary setting, for sure.

Kristi: Yeah, I totally agree. As I'm watching you speak, I can tell when you find something that you are really passionate about, talking about, and you have a lot of wisdom about, there's a certain change in your body language. You're very animated, and clear with your voice. You're really good at this.

I want to shift gears for a second on this note. You're a physician-turned-entrepreneur. You've found something... I mean, I didn't know you as a physician, in terms of clinically… We didn't work together in Kansas City, we didn't do any of that stuff. And I'm sure you were amazing at your clinical focus. But what I can see here, from knowing you, is that you are really great at and passionate about promoting wellness in physicians, in professionals.

What I'm curious about is seeing how you're so lit up doing this, and seeing how much you've really dedicated a lot of your life and energy to this. Was it scary for you when you started cutting down on clinical work, and when you stopped doing clinical work, so that you could focus on this new chapter?

Erica Oh, yeah, it was terrifying.

Kristi: Okay. What was terrifying about it?

Erica: Oh, gosh, I mean, we've talked about this before, I know, kind of offline. Your identity is being a physician. You're kind of taught that your identity is being a physician. Even in my neighborhood I'm known as “the doctor.” I was really afraid about losing that identity. Who would I be without it?

And it's kind of funny, because one, I didn't stop being a doctor. I still get a p.m. on a Sunday phone call from somebody down the street when their kid has cut their head open. And, “Do I need to go to the emergency room or not?” So, I'm still known as the doctor. Nobody took away my medical degree when I transitioned to being an entrepreneur.

And even though it was scary, I will tell you like… Let me tell you a quick side story. I remember having this idea sitting on the couch with my husband, and I'm proposing this idea. And I kept proposing it. Every night I would talk about it with him.

Then I would ask him, “Am I crazy? Is this crazy? What am I doing? I've never started a business before. I don't know anything about starting a business., I'm crazy, right? Is this insane? Do I just need to calm down and go back to work?”

And he asked me a really powerful question. He said, “Okay, so if you don't do this, if you think about it and you dream about it, and then you decide not to do it, at the end of your life when you look back, will you feel like you missed out on something? That you should have done it and you missed out?” And I was like, “Yes.”

And he's like, “Okay, and on the flip side. If you put on this conference and 10 people come and that's it… so, only your best friends, anyway, because you kind of cajoled them into it... are you going to regret having done it?” I said, “No, it'll totally feel like a success. I have to do it. It feels like I'm on the right path, and I really have to just go down this path and see where it leads. I feel like a spark every time I think about it.”

And he was like, “Well then, that's your answer. Listen to your intuition. Listen to what your body is telling you, your soul is telling you.”

So yeah, it was totally terrifying. I was really nervous and really scared. And I was like, “What am I doing?” But when I thought about it, and kind of broke it down in the pieces, I was like, “Okay, I've done all the different pieces of running a conference before, not maybe as a conference itself, but I've spoken.”

I was a national speaker at that time, and I was kind of doing the circuit and talking to a lot of different groups. I knew how to get CME, because I put on a faculty development course at my institution. I knew other speakers, because I was on that speaking circuit. I knew other wonderful women physicians who I thought would enjoy it. And I planned a wedding before, so I figured I could plan a big event. I knew that I’d probably be alright there.

And that actually gave me a lot of comfort, to break it down. I had done something similar to all the things I was going to need to do, and the rest of it I could probably figure out and just piece it together along the way. And that's held true.

Now, that doesn't mean that I always figured it out. That doesn't mean that I know all the answers. At least once a week, something comes up that’s like, “Okay, what are we going to do about that? Didn't see that coming.” But that's also the fun of running a business. Much like medicine, you never know what's going to walk through the door. And then, I get to be creative and kind of think outside the box.

I was definitely afraid that I was going to lose my identity. And then I realized that who I am goes way beyond what I do when I'm rounding on the wards or in the clinic. And that who I am is Dr. Howe. That's just a part of who I am, whether I practice medicine full time or not. And whether I have a clinical practice versus running a wellness conference.

Sometimes it's that leap of faith too, and just saying, “I'm going to be okay on the other side of this.” Thinking about what's the worst-case scenario, “Okay, 10 people came to my conference. That was fun. And now, it's over. I’ve got to go back to my clinical work.” And that's okay. If that's the worst-case scenario, then I'm back in the spot that I started. So, nothing's gone wrong.

Kristi: Thank goodness for your husband to ask you such a powerful question. And then, for you to be able to go through that. And one of the things I think is fantastic about the conferences that you put on is they do create a space where people can kind of peel back, in essence, the layers. And it sort of offsets some of their physical and mental exhaustion in order to tap into that spark.

And be like, “Okay, what spark’s been covered up with all these layers of whatever? how can I listen to my intuition here with a little bit more ease, so that I can bring them back home?” So, I love that.

Erica: Honestly, like that, when I talk about our first trip in seven years to Jamaica, that's what it was. It was like the spark came back into my life. And I was excited and happy again. And not just, “God, I'm just so tired.” I think that is so crucial.

And then, on the flip side of that, we have all those conferences… I remember I went to a leadership development conference, a very renowned one; but it's academic. And that conference was 14 hours a day. You had to get selected, and elected, to it. And references; people to write letters of recommendation, also. It was definitely a very big deal for my institution to send me. And I was very grateful for that.

I got there, it was like 7am until 9pm every single day, and they would give me incredible information. I actually ended up becoming a speaker for them for a number of years. The information that they were giving was amazing. But I remember, the last day finally ended at noon, and I jumped right on a plane to get home to my family to then start a clinical service the next morning.

I remember sitting on the plane, and I was like, “I'm just so tired. And this has made me even more tired. I haven't had a chance to absorb or really reflect on any of this information.” I was teaching a class at the time, a faculty development class on clinical teaching skills, but we were talking a lot about adult learners, and how adult learners learn best, and take short term knowledge and put it into long-term memory when they have a chance to reflect on the information.

So many times, when I'll give a talk or a speech, at the end I'll say, “What are you walking away with?” Because that reflection is actually a really important part of them solidifying their knowledge. I realized that those four days I had had at that conference, I had not had one single second to reflect on anything I had learned.

And then I jumped back into my clinical life. And my busy home life; and I certainly didn't have any time there. Which was the whole reason I was going to the leadership conference. Literally two years later, I found the binder that they gave us. I started flipping through it, and I was like, “Wow, this is really good stuff. I really wish I had learned this two years ago when it was taught to me.”

So, I mean, that's a lot of what we do at WPW. It’s very strategic around knowing how adult learners learn, and how people grow based on new knowledge and new information. And so, the end part of that is you get the afternoons off because I want you to rest. I want you to reflect and recharge. I want you to actually send that email that you’ve meaning to send, saying that you're not going to be a part of that committee anymore. Or you're not going to accept that leadership position that doesn't pay well.

I want you to apply what you're learning, and not just kind of get taught at to exhaustion. So, I think that is super important.

Kristi: I totally do too. I remember going to, I can't remember what training it was, but it was a training in the world of therapy and coaching. And they were doing this very intensive training; is how it was touted. And there is a lot of talk about, “We want you to be able to take this information and really deeply integrate it, synthesize it, apply it. But we also need you to know that these are really long days. We have four hours of content.”

And I was like, “Four hours is…” They were like, “We just want you to wrap your head around the fact that we're giving you a lot,” because they recognize, exactly what you said, that little bits with reflection time is optimal. And so, they were very serious about, “We give you these four hours knowing that we need you to build time around it because we're giving you so much,” because for them four hours was so much.

Even though it had an hour break here and there. “We need you to be very careful with yourself so that you don't just come here and passively smile at all the information, and then a year later revisit it and go, ‘That's what we talked about.’”

And I think in other fields, ironically, other fields outside healthcare, many of them get this. Not all, but many of them really get this, and they're very careful about that and they are doing what you're doing.

Erica: I've had both. People who want to speak at the conference come and say, “Let me do an afternoon session.” And I'm like, “No, we don't do afternoon sessions.” Even if they've attended and know that. They're like, “What I could do is, I could do something in the afternoon or the evening time.” I'm like, “We don't do that. We don't do that at WPW.” I am going to protect your time for you.

And then on the flip side of that, I have, probably at least once a conference, I have someone come up and say, “Okay, so the itinerary looks like it ends at one, then what?”

And I'm like, “No, that's it. Then you are going to go to the beach, or you're going to go on an excursion, or you go take a nap. And all of that is just fine. And you have my permission to do all of it. But what I don't want you to do is be in this conference room anymore.” It's funny how much it can be a real shock to people when they come for the first time. But I love that. I love seeing that. And like, “Oh, I'm just going to go to the beach now.”

Kristi: Aw, so good. Alright, when you made the shift and you started being entrepreneurial, what surprised you about being an entrepreneur compared to your life as a physician?

Erica: Oh geez. Okay, a couple things surprised me that just come to mind right away. The first thing was that it's a really creative thing, running a business.

Kristi: I was curious if you're going to mention creativity, because you’ve talked about it. Yeah. But tell me.

Erica: Yeah, it's often trying to think outside the box. Like, “Okay, so this, the first way of doing things, didn't work. My attendees didn't like it. We need to think of something new.” There's a lot of creativity in it, which is really fun for me. Actually, I didn't realize how much I missed that in medicine. So, I would definitely say that.

And the second is how powerful it is to just do a little bit every day, and how much that can change your business over time. So, this is best emphasized as a concept, as a graphic. Have you seen that graphic before, where it's like X to the 365th degree? Doing a little tiny bit, or 0.1 to this 365th degree, which is basically just doing a little bit over 365 days, gets to some infinite number. As opposed to trying to do a lot just a few times.

And that's kind of how I started, because I was still full time clinical. I had not planned on stopping practicing medicine. The WPW just kept growing and getting bigger. I couldn't continue to do both. It was a blessing, for sure. But I couldn't continue to do both at the same rate anymore, and I really wanted to see where WPW went.

So, it started off with me, in the evening time, I had whatever question had popped up that day or that week, I would just write down the questions. It started with, “How do you start a business?” So, I Googled ‘how do you start a business,’ and they're like, “You have to get an EIN.” Okay, so that's what I need to figure out, what an EIN is. It's a tax ID, just so you guys know.

And so, okay, today, I am going to go on irs.gov and look at how you get a tax ID for business. And then, tomorrow, I am going to call the bank and ask them what they need for me to get a bank account. And then, the next day I might go in and start a bank account.

And every day was just answering a question that I had. So, I would write these questions as they popped up. And let me tell you, I know that if you're starting a business out there, there's a thousand of them to start with, that's okay. Write them all down. And then, each day try to just get an answer. It doesn't have to be the whole answer. But try to learn one little piece of information more about what you're trying to do.

And that just built and built and built over time, and became the business that it is today. And so, I continue to try to do that every day. “Okay, what can I address about the business today? What do I need to think about? What do I need to explore? What can I do better?” And just each day, “Okay, let's look into that. Is that a possibility? Should I go down this route? Should I…? Let's explore and answer some questions down here, or down there.”

That has served me really well. So yeah. What about you? I’m curious what you have to say here.

Kristi: Okay, so I don't know that I really appreciated some of the difficulties that would be in it. I just kind of had a notion, just like in medicine, you just pick, you're going to do it, and you go kind of do it. I really felt compelled to go do this thing. It just felt really good. It felt right. I was going to go do this. I don’t know if I was surprised. Like, “Oh, that's interesting.”

But it was like a slow surprise of realizing that, I mean, I can't speak for anyone else, but realizing that there was tedium and there was sort of a slow build of finding clients, connecting with people. In ways that as an OBGYN you don't really do, right? I didn't have to go find people. People just show up at your door. Right?

So, I think a part of me found it surprising that there was so much effort. Not so much effort just for small business. I understood, “Ooh, you start a restaurant. You have to…” I mean, what goes into that and you're in... But I think it was surprising to me, because I saw that there's such a vast need for people to understand themselves and to think about their thinking. Seeing the vast need.

I think it was surprising to see the work and the tedium that went into just making a business in that area. I think that's probably one of the things. And honestly, I'm delightfully surprised by the curiosity, the creativity; the other C word. The creativity that I get to play around with all the time.

I feel like there's a lot of creativity when you're in a surgical field, when you've got patients anyways, but this is a different flavor of creativity that I didn't really think about that much. And I love… I love it. So, I get to steal that one from you, because I, for sure, was surprised by that.

Erica: It’s its own kind of creativity. When I think of creativity, I think crafts and painting. And it's obviously not that, but it's, I don't know, it's just its own thing. And it's so satisfying. Have you heard the phrase, “Business owners are the only people that would leave a 40 hour a week job for an 80 hour a week job.” Because I will tell you, I love it. I have to cut myself off from working.

I have to be like, “Nope, it's a Saturday. You do not need to go into your office. You are fine. Everything's fine. Let it go.” Really being thoughtful about being present with family and friends, because I could just work all day long, every single day. I love it. It's so satisfying to me, which I think tells me that I'm in the right profession, I hope.

Kristi: Yes, that resonates with me so much. It's easy for me to lose time doing things that I really love. I do have to be pretty boundaried about it, even though there are things on the weekends I would really love to do. It takes some effort to be like, “Nope, this is ending at this time.” So, I can relate to that.

I know I'm looping back to something, but I think this is important to make sure people really hear. When you were talking about incremental work, doing a little bit every day, I want people to rewind, to go listen to that, because that was the quintessential sort of example of resourcefulness, in my mind.

This is how you're resourceful in the face of something that you don't yet know how to do. And this sounds like the perfectionism that can come out for some of us is, “I need to know all the things before I can start. And I need to make sure I do them perfectly.” And then bring in our inner critic, “What is my problem that I don't know what it EIN is? You mean I have to Google this? Who am I…”

Versus what you were saying. You were like, “Oh, I don't know what this is. So, let me ask them practical questions to help me take the next best step. Which is, I'm going to Google this, and then once I find that out, then I'm going to go figure out how I'm going to find out the next step. And I'll do a little here, a little tomorrow.” And then that whatever to the exponential thing. That is really how it works.

Erica: I think you're right. Especially as women physicians, we're perfectionists, I think, just by nature. Which your business is helping us all address and move past, for sure. And then, that self-doubt. The self-doubt pops in as well. And I know you've spoken on this at WPW.

But I think that so often that tells us, “What do I know about this? And what makes me think I can be a business owner and an entrepreneur? Okay, if I'm going to be, then I need to know everything about this before I even start,” which is not how we ever practice medicine. So, that's kind of ironic.

Now, I will tell you, I fully was on the flip side of burnout and self-doubt, and all of those things when I was starting the business. By that time, I kind of moved past it. And honestly, the creativity that came with running the business was a huge portion of me getting out of burnout, in addition to just building a community with other women physicians along the way. That was super powerful for me.

But in doing all that, and being on the flip side of it, I remember thinking, “Yes, what gives me the right to start a business? I don't know what I'm doing.”

But then I thought, “You know what? I'm the 1%. I'm a woman physician that has a really hard job. So, if I can be a doctor, I can sure as hell figure out how to run a business. I know there are people who maybe have a college degree, maybe not, and they're running businesses. I've seen plenty of people that know a lot less than I do, and they're doing it. So, what makes me think that I can't do this too?”

That was a really helpful thought. Just kind of reminding myself, “After med school and residency, and I’ve practiced for almost 20 years, if I can do that, I can run a business. This is fine. I just have gaps in my knowledge that I need to fill, that's all.”

Kristi: “Just gaps I need to fill,” period. Not, “There's gaps I need to fill, and therefore that means I'm terrible, broken. I’ll never make it.” Like you didn't continue on. So, good.

Erica: Well, that was the benefit too, I will say. I didn't have the lemonade stand as a kid, I didn't have those entrepreneurial dreams, I've never wanted to run a business. So, it's ironic that I'm doing it now. But I also didn't know other people who did it. I didn't know anybody who had started their own business.

But that was really helpful in a way because I wasn't comparing myself to anybody, because I didn't know anybody who did it. So, I didn't have any of those voices of, “I'm not like that other person. I should be working harder, because that other person, clearly, they work harder. So, I should do it like them.” I didn't have any of that, because there was nobody else in front of me to mirror what I was doing off of. And that was actually super helpful. I was just doing it the way I needed to do it. “And we're going to see if it flies or not.”

Kristi: Speaking of doing things that seem like they're going to be doing things that you know need to happen, that you're drawn to doing. You have a new conference that… I say it's a new conference, it's not really a new conference. But it's a conference that's a little different than your other conferences. And this is Bahamas, 2025: The Women Professionals Wellness Conference. Tell me about this.

Erica: For years, I will tell you, that women would show up to my conference and many times they would bring a girlfriend, and the girlfriend was not a physician. All of our conferences before the Bahamas have been for physicians only. They would come up to me at registration, pull me aside, and say… this would happen almost every time I ran a conference…

At least one person would pull me aside and say, “Listen, I just got here. My girlfriend just flew in from a different state. She's a mess. She's just as burnt out and exhausted as I am. But she works for X, Y, or Z. She's not a doctor. Is there any way that we can get in?”

At first I said no. And then, I actually started saying yes, and we would just slip them in and they would sit alongside their physician friend. And I started thinking, “We're all going through the same thing.” I think there are aspects of what we do as physicians that are really just very specific to us as a group, and I want to protect those in that.

So, we still have our three conferences that are for women physicians exclusively. But I wanted to create something for women professionals that are in all walks of life, that are dealing with all the same issues of boundary setting and saying no, and conflict management and how do I get promoted? How do I deal with that difficult person that I have to work with?

All those same issues that pop up in the workplace. We reach out to them and have a place for them to learn all the same things that I have been taught by all of our incredible speakers over the years. And so, that's how the Women Professionals Wellness Conference got started. We're doing our very first conference in January 2025, January 9th to the 11th.

I'm excited to see what it is, and all the incredible women that are going to come in, and that we're going to learn from. I'm really thrilled to be able to do it.

Kristi: Seeing you again, you've got that very certain look or buzz to you, as you're talking about this. I mean, this seems like it's a calling for you. And this seems like the most beautiful next step. I'm so excited to see how it turns out. If somebody is listening to this, they're on the fence about going to these conferences, please just go. It is a gift that you'll never regret. So, if somebody listens to this, and it’s like, “Okay, great. I'm going. I'm planning my 2024/2025,” how do they find you?

Erica: Absolutely. So, you could certainly email me. My email is ehowe@themedicaleducator.com. Medical Educators, our parent company. And then, we have our websites, WomenPhysiciansWellness.com and WomenProfessionalsWellness.com.

You can reach out to me by email. We have a Facebook group as well, called WPW Conference Group. It's a closed group for women physicians. You can certainly join that. We have a mailing list that you can join for updates and info about all the conferences. We're on Instagram as well @wpwconference.

So, you can follow us with any of those, and DM me on any social media platform. Or just email me, I'm always glad to hear from women, hear what everybody's doing and what they're interested in. All of that.

Kristi: Well, Erica, thank you for your time. Thank you for sharing all the things about your journey. This is just amazing. I know this is part two of many conversations to come. So, anybody who wants to hear more, you'll get to hear more of Erica in the future. But thanks so much for being here.

Erica: Thank you, Kristi. I appreciate it so much. I always love talking to you. And honestly, you are my go-to podcast. You don't know how often I'm actually listening to you, and listening to this incredible podcast and learning from it. So, thank you for all you do and all your teachings. They're very, very powerful.

Kristi: It's going to be so fun when you're listening for you to listen to all the power that you're presenting, whether you can see it or not. It's going to be so fun. So, thanks so much.

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Thanks for listening to Habits On Purpose. If you want more information on Kristi Angevine or the resources from the podcast, visit HabitsOnPurpose.com. Tune in next week for another episode.

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