Questions for Dr. Sullivan: Medicine, Coaching, and Training

[Suboptimal]

Hi Dr. Sullivan.

I'm a first year medical student interested in emergency medicine and strength training. I’d like to know more about how you balance your coaching practice with your medical practice, and how this affects your own training. I put together this barrage of questions below. Any answers you could provide would be very valuable to me in trying to plan out my own career.

What is your balance of shifts in the ED, academic responsibilities, and coaching/managing Grey Steel (i.e. time spent on each per week or month)? Are you satisfied with this balance?

How does the rotating shift nature of emergency medicine affect your training? Do you eventually adapt to it?

How does the rotating shift nature of EM affect your availability as a coach? Are you able to meet with trainees several times a week at the same time each session? Do you have a lot of input into your scheduling at the ED?

If you were to go back in time knowing that you’d be a strength coach in addition to a physician, would you consider a sports medicine fellowship after residency? Would you consider another specialty altogether?

Do you think you could have your coaching practice (or something like it) if you had chosen another specialty?

How did you get started in coaching? Where did your first trainees come from? And at what point in your medical career was this?


Thank you!

[Jonathon Sullivan]

What is your balance of shifts in the ED, academic responsibilities, and coaching/managing Grey Steel (i.e. time spent on each per week or month)? Are you satisfied with this balance?

Until about a year ago, I was working half-time in the ER and half-time at Greysteel. 80 h/month in the ED, 60 h/month Greysteel, and some teaching time. This got pretty rough after a while. BUt the coaching business grew and had room to grow more, so about a year ago I went in to see the chief and requested at-will status. And a few months after that I went inactive staff. Still on staff, but not on shift rotation.

IOW, I don't see patients anymore.

And no: I don't miss it. I practiced emergency medicine for more than twenty years. A good career. But, as Uther Pendragon said, I'd grown weary of battle.

How does the rotating shift nature of emergency medicine affect your training? Do you eventually adapt to it?

It doesn't anymore (O Frabjous Day), but it sure as hell did. I'm pushing 60, and one midnight trauma shift would clobber me just from the perspective of conscious daily functioning for a week....and heavy training? Fuggedaboutit. My recovery would be FUBAR for days and days. My training has gone so much better over the last year. I'm getting PRs again. Midnight ER shifts in your late fifties don't just wreck your training....they wreck your health.

How does the rotating shift nature of EM affect your availability as a coach?

It did. Not any more.

Are you able to meet with trainees several times a week at the same time each session? Do you have a lot of input into your scheduling at the ED?

Before I quit seeing patients, I had certain days that I just scratched off the schedule requests. They were almost alwasy honored. Most ED groups give their dox some degree or other of input into scheduling, within reason.

If you were to go back in time knowing that you’d be a strength coach in addition to a physician, would you consider a sports medicine fellowship after residency? Would you consider another specialty altogether?

No. It's because I went into EM that I became a coach and was able to become a coach. EM allows practitioners to control their time better than almost any other specialty. And it was my EM-related research (brain ischemia) that led me to strength and Rippetoe. Long story, that.

Do you think you could have your coaching practice (or something like it) if you had chosen another specialty?

No.

How did you get started in coaching? Where did your first trainees come from? And at what point in your medical career was this?

Late in my career, and, again, LONG story. BobG carries a lot of the blame though; I will say that.

Thank you!

My pleasure.

[SteveL]

That was really interesting!

[Suboptimal]

Midnight ER shifts in your late fifties don't just wreck your training....they wreck your health.

This is my biggest hesitation about choosing emergency medicine as a career. Another ER doc who I badgered with questions said he feels a little bit tired all the time. He's dealing with it by stepping down his hours in the ED and taking on more academic duties. He talks about other ER docs finding their "way out" of EM through academics, fellowships, urgent care, etc. But, he also says he has the best job in the hospital.


If you ever find the time to chronicle your coaching origin story, I'm sure there are more than a few people (myself included) who would be interested in reading/hearing about it. Thanks again for your responses.

[Cheesepuff]

I'm sure we could get Hugh Jackman to play Sully. =)
Of course, Hugh would have to quit skipping leg days. LOL.

[doublenaught]

Hello Sub - congrats on your looming career and especially your interest in strength training. You are following in very large Sully footsteps but I have no doubt you will persevere.

Here are a few observations from one who is anything but a Doc. When I started going to GreySteel three years ago, Sully had few inmates, I mean clients. He seemed to have plenty of time for his medical pursuits. When he worked nights, he looked like he was drug through a knothole. But, and this is a large but, he kept his commitment to coaching his geezer crew. This was to our benefit and his detriment. At one point Sully said he was worried he was not going to be able to attract enough clients to keep the gym going. Ha! That worry quickly evaporated as word-of-mouth spread the Legend of GreySteel. It didn't seem to take long before Sully had more and more client requests for gym time.

As a former LEO I have a similar perspective to an ER Doc on the algorithm of youth, energy, shift work and recovery. When young, I never had a problem working 40 hours straight on a significant case. One good homicide and I was up for two days easy. A 5 hour nap and I was up and running again. I am 69 now and I can't even imagine trying to do that now. I went back to active operations when I was 52, working 16-hour days and it damn near killed me. After the 10 hour mark, my efficacy was greatly reduced and I had to work twice as hard just to keep an even keel. Medical shift work should be no different in the long run than my former work. You can kick it in the ass when you are young, but as the years and scar tissue add up you will have a more difficult time keeping up.

So for now, you can do both medicine and strength training - including coaching if you choose to go that route. In the future, you will most likely have to limit your expenditure of effort and cut back on one thing or the other. I for one am exceptionally happy that Sully chose to cut back on medicine to spend more time keeping me and my wife fit and alive. I've seen him pull PRs at his advanced age and I have to tell you it's impressive. I doubt those PRs would continue to be posted if he kept burning the candle at both ends. At some point in life you will come to a fork in the road and you will take it as Yogi once said. If you choose to take the strength coaching fork, so much the better for your clients. If you choose to stay in medicine, so much the better for your patients. However, at some point I doubt you will be able to do both. No matter what direction you take, you will be much better off for having kept a strength training regimen.

I never thought I would get old, but somewhere along the way it happened. I've seen a lot of doctors throughout my life. I've gotten a great deal of medical help and assistance from a variety of providers. I have never previously had the impact on my health and well-being that I have received from Sully and the Starting Strength coaching he provides. My wife and I are lucky and privileged to be among the select few he coaches.

Good luck on your future and stay strong.

[JohnW]

Until about a year ago, I was working half-time in the ER

I’m not sure whether Dr Sullivan would agree but I’d say that working full time in Emergency Medicine isn’t compatible with a normal life or good health.
This will depend on where you work and your late/night shift commitment.
The thing is though, when EM is good it’s bloody brilliant. And, you can work as much, or as little as you like.

[Mark E. Hurling]

Hello Sub - congrats on your looming career and especially your interest in strength training. You are following in very large Sully footsteps but I have no doubt you will persevere.

Here are a few observations from one who is anything but a Doc. When I started going to GreySteel three years ago, Sully had few inmates, I mean clients. He seemed to have plenty of time for his medical pursuits. When he worked nights, he looked like he was drug through a knothole. But, and this is a large but, he kept his commitment to coaching his geezer crew. This was to our benefit and his detriment. At one point Sully said he was worried he was not going to be able to attract enough clients to keep the gym going. Ha! That worry quickly evaporated as word-of-mouth spread the Legend of GreySteel. It didn't seem to take long before Sully had more and more client requests for gym time.

As a former LEO I have a similar perspective to an ER Doc on the algorithm of youth, energy, shift work and recovery. When young, I never had a problem working 40 hours straight on a significant case. One good homicide and I was up for two days easy. A 5 hour nap and I was up and running again. I am 69 now and I can't even imagine trying to do that now. I went back to active operations when I was 52, working 16-hour days and it damn near killed me. After the 10 hour mark, my efficacy was greatly reduced and I had to work twice as hard just to keep an even keel. Medical shift work should be no different in the long run than my former work. You can kick it in the ass when you are young, but as the years and scar tissue add up you will have a more difficult time keeping up.

So for now, you can do both medicine and strength training - including coaching if you choose to go that route. In the future, you will most likely have to limit your expenditure of effort and cut back on one thing or the other. I for one am exceptionally happy that Sully chose to cut back on medicine to spend more time keeping me and my wife fit and alive. I've seen him pull PRs at his advanced age and I have to tell you it's impressive. I doubt those PRs would continue to be posted if he kept burning the candle at both ends. At some point in life you will come to a fork in the road and you will take it as Yogi once said. If you choose to take the strength coaching fork, so much the better for your clients. If you choose to stay in medicine, so much the better for your patients. However, at some point I doubt you will be able to do both. No matter what direction you take, you will be much better off for having kept a strength training regimen.

I never thought I would get old, but somewhere along the way it happened. I've seen a lot of doctors throughout my life. I've gotten a great deal of medical help and assistance from a variety of providers. I have never previously had the impact on my health and well-being that I have received from Sully and the Starting Strength coaching he provides. My wife and I are lucky and privileged to be among the select few he coaches.

Good luck on your future and stay strong.

This is a great post on a whole host of fronts. Youth and boundless energy, career demands, and the inevitability of aging with it's own demands and limitations.

[Keith Burnett]

In the New World Order that is modern top down medicine, you will not likely see the freedoms built in to allow your many pursuits. The fact that you are young and presumably near the height of your physical attributes, you could give it a try.....but be prepared to make some pretty hard choices.

I am just guessing, but maybe there are still opportunities to balance the pursuits in a rural or semi rural geography.

[Jonathon Sullivan]

I’m not sure whether Dr Sullivan would agree but I’d say that working full time in Emergency Medicine isn’t compatible with a normal life or good health.

Agree.

The thing is though, when EM is good it’s bloody brilliant. And, you can work as much, or as little as you like.

Yep.