Our Blog

Cadence Kim

Episode 37: How Technology Is Contributing to Physician Burnout

Good afternoon everyone my name is Lynn S. Evans and I am the host of Power of the Purse Podcast. There was a time in my life not long ago when I believed three things about money. Number one, women are not supposed to talk about or be included in any conversations about money. Number two, women don’t have the natural ability to understand anything about money and three, men know best how to manage money. Those truths I made up about money guided me for years until I realized money was not a foreign language or some other obscure academic exercise. It was something I could not only understand, but teach to other women. Too many times I’ve heard stories from women who ought to know better but didn’t until they were forced to, because of divorce, widowhood, job loss, or the approach of retirement.

This podcast will add another chapter to a rich history of successful women who when faced with some personal challenges, found the ability to step beyond them. We’ll examine some of the truths they made up about money from their life experiences and how that shaped the paths they choose. My mission is to help women have a healthy, positive relationship with money. With that in mind my guest today is doctor Cadence Kim. She grew up just outside of San Francisco. Her father was a surgeon and mother an artist. Before she was 10, she knew she wanted to be a physician. Her parents instilled in her the idea that she could do anything if she worked hard enough and that’s been her motto ever since. She completed her undergraduate degree at the Colorado College and attended the University of Rochester, where she obtained her medical degree and, oh, picked up a husband, by the way. (That’s me adding that.)

She moved back to California and did a residency in urology at UC Davis. She subsequently moved to Boston for urology fellowship in minimally invasive surgery at Boston University. After fellowship, they moved to Philadelphia where she joined a wonderful group practice Urological Associates PC. She’s been with the Urological Associates for over 20 years, where she specializes in stone disease, but she sees and treats most other urological conditions. She’s also very involved with the Philadelphia County Medical Society and is currently the president-elect. Her goal is to attract more members especially women and young physicians. She wants physicians to realize that this is a society that advocates for both them and their patients’ rights. She’s especially concerned with women’s health issues. Although not a Philadelphia native, she loves it there as do her two children who’ve been raised in the city. Welcome Dr. Kim.

Thank you so much for having me.

I think this is going to be fun. We’re going to get some great questions going here. Let’s start first with, when did you know that you were going to be a physician?

I was very young. I was one of these children that just was magnetized by medicine. My father is a surgeon, he loved what he did. He sometimes spoke about his patients and it was very attractive and appealing to me.

Build your career around something that magnetizes you. Click To Tweet

Did you spend time in the hospital with him?

Yes. I made him take me to the hospital. He would take me on rounds where normally I would just end up in the nursing station and the nurses were just wonderful, and fed me, and cuddled me.

You would meet the patients?

Yeah. That was great. You would meet the patients and they couldn’t have been nicer and it was just all very exciting. I thought to myself, yes I’m going to be a surgeon just like my father and then I’m going to join him and practice. He didn’t know that plan.

It’s going to be a father-daughter thing?


How did that work out?

That didn’t work out quite according to my plan. In my third year of medical school when you have too much for your residency, I was speaking to him over the phone about residency positions and where to go. He probably didn’t know it himself shattered my dream by saying that, “I don’t think it’s such a good idea for you to go into general surgery.” I needed a very clear explanation of this because I had not yet fully appreciated this work-life balance thing that, he clearly understood way before I did. He explained to me that there are indeed gender differences between men and women. That males have, at least in the old days when he was born and raised, and you had the more traditional family that I had, where he worked and my mother took care of us…you had a wife, but he was in a very nice way he was trying to explain to me that being a female and having a family and not having a wife but a husband, is often different and more difficult and not always doable and maybe I should reconsider, think of another career path.

You mean totally outside of medicine he wanted you to consider that?

No, no. He was thinking of doing something else and maybe a subspecialty like ophthalmology. I thought to myself, I like urology. I’ll do that. The conversation, it was really a wonderful conversation in a certain sense, because as a child you heard the person who was your hero praise his wife for all of the incredible hard work she did, and made me, who up to that point probably just because I was a normal teenager not so appreciative of everything my mother did for me, appreciate it. He said that everything she did was just as valuable as what he did. Even though she didn’t get financial reimbursement for being a housewife, her role in the family was equally important. It was really just wonderful to hear that from your father and it was also just really nice to know that after all these years that, he really loved this woman. That was nice.

That’s really nice. How did you reconcile all that then? Was he trying to tell you that, it’s virtually impossible for you to have children and be a wife and also be a physician?

He said that it is very difficult and it’s more difficult to be a surgeon than maybe an internist. It was only based on his own experience. His life was honestly always working. He went in to the hospital in the middle of the night almost every night that I can think of.

He was on call every night?

He was on call every night. He worked every weekend, he never took any vacations, he was always working. He seemed to love it. He really did love it. He thrived on it. He was a workaholic. He really could not have had a family without my mother. I didn’t appreciate it but now I look back on it and I was like, yes she did everything. In that day and age a lot of general surgeons were divorced males as well. It wasn’t just difficult for a woman to be a general surgeon and have a family, but men were getting divorced too. There was a high divorce rate. It wasn’t a great lifestyle to be married to. These were very difficult people.

How did you come up on urology? Why did you pick that one?

When I was rotating through pediatrics I stumbled on just a wonderful pediatric urologist at the University of Rochester named Ronald Rabinowitz. He was such a wonderful doctor and he opened up this new world that I had never even considered or known anything about.

Are you practicing pediatric urology now?

No I don’t do any pediatric urology now.

It begs the obvious question why? If Dr. Ronald Rabinowitz was such an inspiring person to you and he was. Was he in pediatric urology?

He was a pediatric urologist.

Then where did you lose the love affair with pediatric?

I honestly did not. It’s just that I fell in love with adult urology. During our residency pediatric urology was not a great percentage, because you did so many other rotations. I found that the older male patient was just wonderful to take care of, they’ve lived life, they’ve had their spouses maybe go through menopause, and their children become teenagers. They’re often kind of laid back and very agreeable. Most of my patients were older male patients in urology at that time. They were a great patient population to take care of and it was also nice to be able to talk to the patient and relate to them. It’s not that I fell out of love with pediatric urology, it’s just that I fell sort of more in love with adult urology.

When you left, was it Rochester where you left?

I went to school at University of Rochester, yeah.

You came to Urology Associates in Philadelphia. Were you hired as a pediatric urologist or were you hired as a general urologist?

I was hired as a general urologist but there’s a hitch to this. I did a fellowship training at Boston University Hospital with Richard Babayan. In May, he will become the president of the American Urological Association. He helped me hone my skills with minimally invasive surgery, laparoscopic surgery, and endourology. I was hoping that would be really my subspecialty and do that urology. I really fell in love with this group in Philadelphia Urological Associates. I went there and they really were excited that I was a woman. I was the first woman in the group and because I was a woman, I had plenty of stones waiting for me, very large stones. I had a lot of stone cases. Where the normal urology practice is maybe 70% men and 30% women, my practice was probably 30% men and 70% women.

The typical urology practice is 70% men and 30% women. Click To Tweet


Yeah. It was really disproportionate. I felt like I was always seeing incontinence, recurrent urinary tract infections. Things of that nature. I was like, “Where is my BPH?” No, it was all good. I was shocked at the amount…until that time I really had no idea how much people suffered from incontinence. What is now termed the overactive bladder and how it truly affects your quality of life. It was a very good education and it was a pleasure to see them and to have them be so excited that they had a woman to help them with their problems.

Was that true now? Your practice personally is still the same percentage of women to men?

No. I would say it’s probably now more 50-50. It’s probably just changed just because I see a lot of couples. It’s very interesting. When I was younger I might see the spouse and her husband might see one of my partners and they’ve aged, they bring the spouse to me because they’re not going to see a male, but women are much more particular about who they see I found out than the men are. Also, the men know me because they’ve been coming with their wives.

You’re not getting any kind of resistance from the men who come in? They’re not uncomfortable with you examining them or treating them?

No, I’m not. It’s made very clear when they make the appointment that the pronoun “she” issues quite a bit by the front staff, but most of them know me. It’s not a huge surprise. I would say you are always going to get a few people who are surprised, but it doesn’t really happen that often anymore. It certainly happened when I was younger. I think it’s because I’m getting older. Somewhat stressing.

It is because they probably figure if you’ve been doing it for this long there must be something okay about who you are. It’s a new kid on the block issues as well. You don’t have that anymore.

I don’t know about that. I think maybe it’s like you see this young women who are just…


Attractive and sexy. You’re thinking, I’m a middle-aged mom and I’m okay with it.

How many women urologists are there in the United States? Is it still a very small percentage?

Women in urology they make up I believe 7% of the total workforce. The number of female urologists is still quite small.

Why do you think that is?

I actually don’t know.

I’m just thinking like what your father had mentioned to you that it’s one of those things that is pretty much and I don’t mean this to minimize its value, but more of a nine-to-five thing rather than a surgeon who’s on call all the time. It’s one of those few specialties that you see the people during the daytime and you have a life. so I would think that something like that would be appealing to women, but maybe it’s the issue that we talked about before, if they are young and attractive it’s a very difficult thing for them to get into urology practice because of the stigma of that, of being young and attractive. I don’t know. Maybe there’s another answer.

I can understand other subspecialties having a more difficult time because certainly when you think of neurosurgery, it’s a very tough lifestyle. The neurosurgeons just have this reputation of making it—it’s very tough and without as many role models, it might be more difficult. There certainly weren’t any role models in urology when I was going through. I don’t know with mentoring. I don’t know how much mentoring does affect it. I’m sure there’s a great deal to be said for that, because there is a possibility in all of academic medicine of women and leadership positions. If you look at the total workforce for all physicians in the United States, 30% are women, 70% are still men.

We have a long way to go. It’s probably—

We’re getting there.

I was just going to say it’s probably better than it was 20 years ago. That’s a good thing. Let me switch this around now. Before I get there, let’s talk about your role as the incoming president of the Philadelphia County Medical Society. How many women have been presidents of the Philadelphia County Medical Society before you?

I don’t know.

I’m guessing it’s probably less than a handful.

There is a wonderful doctor—Dr. Lucas-Fehm is on the board and she was a former president of our society, she’s currently a trustee.

That works.

I would say you’re correct. It’s mainly men.

The Philadelphia County Medical Society is, interestingly enough, it’s in a position now where you’re going to assume the reins here in a couple months. I mentioned before in the introduction that one of your goals was to increase the membership and to make sure that especially women and young physicians know, that it’s a society that advocates for both them and their patients’ rights. Tell me a little bit more about that. What is it that the people expect? Why do physicians join the county medical societies? How do they benefit from that relationship?

It’s just as complicated as you can possibly imagine. My main goal as the president is actually to get more members. Trying to obtain more members is difficult because all the medical societies, not just out county medical society, are losing members. The goal is to really let the physicians that are currently practicing and the new physicians that are coming into practice recognize what the medical society does, which I don’t think they know and how important it is, because it is essential to have a medical society that supports the physicians, so that we have a voice and autonomy to actually practice our trade. In a day and age where I think a lot of us as physicians are spending more and more of our time in doing administrative tasks that used to be done by the hospital clerk, who would enter the orders and do all the data entry…now, you don’t need that because everything is done electronically by the physician.

You do your own order entry. Your task list where all of the results of your patient studies come to your computer’s task list at the end of the day, which used to be faxed to your office or, in the old days, mailed. During the course of a work day, you had a nurse that could go through those and side line you as you were seeing patients to say, “What do you want to do with this one? What do you want to do with that one?” The flow of your work was all done before you left the office. All of these things have contributed to what is called physician burnout, where everybody is spending so much more time in front of their computer and not in front of their patient, that they’re frustrated. I want people to know that the goal of our medical society because this is what it does, is it advocates for the physician. We’re involved in local politics with regard to medical problems. Then we also have report of the state medical society.

Physicians are spending more and more time in front of computers instead of their patients, leading… Click To Tweet

We’re also part of a larger political system. I think that that’s very important. Unfortunately, the problem with membership just as you said is that, everybody is so tired by the end of the day that they don’t feel that they have enough time to participate in another activity. That is our goal. Doing this, it’s like I want to get more women involved and for that I started a women’s forum. My goal there is to really help promote gender equality in medicine and really advocate for equal pay for equal work. These are all things that I’d love to get started and make it a forum that we can help women to network and be supportive of each other, and to help men and women to balance work-life issues as well.

All laudable goals. Well done. If you can get all that done in your 10-year shift or whatever they call that, then more power to you. Those are ambitious goals and I hope you get even some part of it would be great. You mentioned to me in a conversation we had off-air or so to speak that there were some issues that you know that the Philadelphia County Medical Society, you would like to see them get involved in. One of them you mentioned, I love the idea of gun violence and trying to make people aware of that issue, and how the medical society can play a role in helping to minimize some of that. You see the effects of it, most people don’t. It’s whitewashed so to speak by the time it hits the news, but you see the ugly side of it. What is it that you think the Philadelphia County Medical Society can do to help with that issue?

With regard to gun violence, it’s just such a huge issue in the news constantly. We see it all the time. There’s a whole bunch of things that at least we can start to do. The first thing we need to do is to educate people about gun safety. I’m not an expert in this field. One of the things I’m really excited about is that we do have experts in it, and they are going to give a presentation too. That’s one of the things the medical society does, is we are going to have a program on gun violence for people like me and other physicians to learn more about it, and how it impacts society. Basically, there’s a lot you can do with it if you think about just anger management control.

What you said that’s important is that, you as a part of the Philadelphia County Medical Society, you would like people to become more enlightened, more educated on what the issue is, and how to deal with it. That’s a role that I don’t know too many other entities have taken on. Hospitals may do some of that work, but to say across the board we’re going to let everybody who is a member and maybe even non-members come in and listen to something about, what do you do about this. How do we make a statement that says, “Philadelphia County Medical Society takes this position on the issue?” Letting people know that there is some training, there is some awareness that needs to be had. When you see patients come in that are victims of gun violence, you might have some idea of what to do. Maybe there’s a protocol, maybe there’s something.

That’s excellent. What we can do is have protocols in line for training by standards and basically how to stop bleeding with just manual pressure tourniquets, just easy first aid. Then also, instructing us in things that I am not so familiar with because they talk about this bill and that amendment, and so that we do understand what these are and are people getting necessary just basically background checks and what everything is. There’s probably a lot of details that people don’t understand, and maybe we should advocate for this and that that is allowing people more easily access to guns, and do people really need assault rifles and military weapons? That is actually scheduled for the beginning of June, that talk, I’m looking forward to going to it. This is the educational program that the Philadelphia County Medical Society offers its members. Oftentimes we are also involved in public health issues.

That also involves the public and they could be potentially something that is open to the public. Another exciting thing since I’m doing this and I’m on a roll here with the society.

You go girl.

We supported the sugar-sweetened beverage tax, which I know has been controversial to a lot of people who I know. But I think that it’s also important to remember that before the dangers of smoking were really outlined by the surgeon generals that initiated it and physicians, smoking was very popular. To tell people and to change the public’s perception on smoking was really a huge shift in public policy and was very unpopular. It’s some of the most important things physicians have really done for public health if you think about it. The sugar tax, the sugar beverage, I learned so much from that. I learned that one 12-ounce can of soda has eight teaspoons of sugar. I don’t like diet drinks, but now it’s really hard for me to drink a sugar… We have a lot of scientific evidence that demonstrates that our consumption of sugar is just too high and that this is contributing to obesity, to diabetes, to cardiovascular decay, to disease, to tooth decay. It’s not good stuff. We need to cut down.

Those are all good reasons to become a part of the medical society.

Yeah, I’ll stop.

No, it’s okay. The sales pitch is over. Let’s shift this. I’d like to ask you a couple of questions about your relationship with money. I know you’ve had a chance to see some of these questions before. Let’s start with the first one. What was your family like when you were growing up?

When I was growing up, we were considered an upper middle-class family, and money wasn’t really considered an issue. That being said, you never took anything for granted and you didn’t waste anything. My mother is of Scottish descent and she would always call it scotch thrift.

That’s a nice way to do it.

I also think they’re just a product of the times, which both of them were born in the 1920s. It was the years after the Depression. We’re still tough and even people who were relatively well off, weren’t what we would consider today well off. Everybody really pulled together. You didn’t waste anything. Your food was meant to be eaten and if you had leftovers, you saved them. You didn’t toss them. So I was very fortunate. There’s no doubt about that. But I also grew up that I wasn’t given everything on a silver tray. If I wanted something, I got a job and that’s the way it was. That’s the way it was for all of my friends too. We all had little jobs.

What were your little jobs? What did you do?

You might do a paper route or if somebody went away, you would water their garden, take care of their dog.

Then when you got older, did you have some real jobs?

Yeah. I had summer jobs.

What did you do?

I was a bank teller one summer. Another summer, I helped somebody remodel their house. I learned how to strip wallpaper, and put up new wallpaper, and take up the carpet, and sand down the floor and finish it.

If this urology thing doesn’t work out, you could always do a fixer-upper routine.

If you really want another truth, I would love to apprentice with a really good carpenter.

All right! That’s good. What lessons about money did you learn when you were growing up?

Saving was a very big deal. You should always save your money. It’s a byproduct of definitely my parents and their generation. You know, you saved.

Did you save for something and then spend it and then start saving again or did you save just for the sake of saving?

Both. Isn’t that funny? It’s both. It was like, “It might be here today and gone tomorrow.”

Sometimes people they learn that habit, which is they save for a purpose. Let’s say down payment on a house, and then they take all the money that they saved and use it for that, and then they grow it again. Other people see the value of both. I’m just curious to see what was it that worked for you? I guess I would say then in your marriage, how did that work?

It worked well, because my husband has the same view of money as I do. When I married my husband, he had a lot of student loans. We had to pay back a lot of student loans. We did not buy a house for quite a long time, because I was very debt averse. You can say that that was a good or bad financial decision. Probably if we had bought the place we rented, we would have done well if we had later sold it, but it would have put more of a stress on me just to have that extra debt.

Your husband, as you paid off those loans, he was…is he a physician?

He is a physician but he’s an MD-PhD, so he’s a physician scientist. Physician scientists work very, very hard and very, very long hours. It’s much more difficult to become a MD-PhD. Amazingly, his salary ends up being less than mine. This is a plug for people giving to the NIH, the National Institute of Health is that we don’t invest in research and we don’t invest in our scientists. Besides that, we need to also invest in our teachers. It’s the same thing. Don’t get me wrong, he makes a very good living as do I. Initially, there’s still a lot of debt. But there’s still a lot of debt. I don’t know if people know it now, but medical students are graduating with student loans up to 200,000. I think that’s the average medical…

Yeah that’s the average. I know some people have $400,000 to $500,000 of debt.

I did too. You just have to do the math on the percentage. It sounds like you have a two-physician family making clearly a fair income and that they should have all the money in the world. If you finally do the math on just let’s say 200,000 at the average of maybe 4 percent, which would be a good loan rate.

That would be very nice.

I don’t know if you have a calculator in front of you. How much money is that a month?

I didn’t do all the math. No, I don’t have it in front of me. It’s a very hefty multi-thousand dollar piece of change.

That’s just the interest. There is a lot of financial stress on medical students and young physicians as far as money goes, in spite of our good salaries.

Yeah I know but it goes to the debt, so you’re behind just simply because you started to be in practice. Even though, it looks like a great number on your tax returns the fact of the matter is, your debt is just crashing. Which means that you don’t end up buying homes like you talked about for quite a long time, you don’t buy new cars. You don’t contribute to the economy in the sense that people who would be earning that kind of money without the debt would be doing that. So there’s a disconnect there. Let me ask you one thing about your experience with money up to this point. What would you say is the best financial decision you ever made and what do you think was the worst financial decision you ever made?

I should have an answer for you just immediately because I knew this question was coming.

Yeah you should!

The best financial decision I ever made was marrying my husband.

Nice. Does he know that?

He’s in Vancouver. He should be on the phone now. This is a shout out. It is the best decision I ever made.

Did you have any experience at all with investing any money?

No, I did not. My money was put in the bank but I had saved and not doing anything. When I married my husband, immediately, he helped me with the 401(k) and just taught me about index funds and just little different things. Yes, I was one of those women you spoke about that didn’t know very much at all about investing.

I think it’s most women, not just one of those women. Most women don’t know. It’s really very bad. What would you say was the worst financial decision you’ve made?

I’ve made a lot of bad financial decisions, but not anything that’s catastrophic.

You mentioned to me once before and you just said it again, one of the worst financial decisions you made was not to do anything with the money, but just keeping it in the bank.

I did tell you that and I did do that. If you can think back on worst financial decisions you’ve made, but that was kind of a safe worst financial decision.

That was a safe answer. The rest of them, I won’t embarrass you by asking you to tell me.

It’s live and learn, right?

Yes it is. Live and learn is right. Let me ask you another question, it’s a little safer. Are you ready?

Yeah, maybe.

Who was or is the most influential woman in your life and what advice does she give you?

My mother was the most influential women in my life, person in my life. It’s funny, I grew up with my dad as my hero. I wanted to be just like him. I wanted to emulate him. I’d want to go into his career. I wanted to be his partner. Then especially as I’ve gotten older, I realize just how much my mother influenced my life and how much she did do for me, and how much strength and resolve that she gave to me. To be honest with you, my dad was never home. He was really always working. It was my mother who was there. She was the rock. You knew she was always there for you. I knew that she always loved me but no matter what I did, she would support me. That’s true of my dad too but it’s very funny.

What was the one piece of advice that she gave you that really sticks in your head?

That’s so funny that you said that. She said to me, “You should never rely on a man.”

I love it. It’s classic. That is so funny.

My mother says this to us and we’re rolling our eyes because here she is married to my father, completely housewife, dependent on him for the money. Although she actually managed the money, I found out. He was just always working.

That’s very typical.

It was so funny that she would say that. She would tell us, “You should never rely on a man.” My older sister and myself, so there were two women in the family and she wanted us both, she was like, “You both are going to have careers and be successful.” She was really quite a force.

Is your sister successful?

My sister is very similar to my mother. My mother is an artist. My sister can do anything artistic. If you need something tiled, she can do it and it can look professional. She’s just as creative, really amazingly creative. She’s done a whole bunch of things in her life. She’s run a school. She’s really never done one job but she’s incredibly intelligent and gifted, and capable of doing as far as I can tell just about anything.

Well now, did she adhere to your mother’s advice?

We’ve both been very lucky. The men we’ve married, we’ve stayed with, so that’s been kind of fortunate. I’m pretty sure I can safely say this for her. She’s not with her husband just to rely on him financially, but he does have a steady income. She doesn’t have to always work but she’s always done part-time things. She was an attorney. She never practiced law. She ran a school for a little while. She stopped doing that. She sold insurance for a little while. Those were the classic jobs.

Sounds like a free spirit.

She is a free spirit. She really is though. She’s much more of an artist. They’re just very creative people. Just like my mom, they really are incredibly resourceful. It’s amazing the things that they get into and they do, and they do them so well.

You do urology really well.

Well thank you!

Or you wouldn’t have been there that long. Anyway my thanks to my guest, Dr. Cadence Kim. To all of you in my Power of the Purse community, I hope today’s podcast was helpful in enriching your understanding of money and how it can help you achieve your life goals. If you’d like to spend 15 minutes on a call with me and ask me questions about your personal finances, please go to my website, powerofthepursepodcast.com. Select the contact tab and find a time that works for you. Thanks again, Dr. Kim for sharing your time and knowledge. Until the next time, thanks for listening, and remember, money is not the enemy, your ignorance of it is.

Thank you so much.

You’re welcome.

How to contact Cadence:

Tags: , ,

This is a unique website which will require a more modern browser to work! Please upgrade today!