Amanda: Hey guys, welcome back to the podcast. I am Amanda.
Laura: I'm Laura.
Kendra: I'm Kendra.
Amanda: And today we have a special treat. Dr. Betsy Grunch is joining us today to talk about medical culture, social media, and whatever else comes up. She's a board certified neurosurgeon in her hometown of Gainesville, Georgia.
You might know her better, though, as LadySpineDoc on Instagram and TikTok where she educates and entertains her more than 3 million combined followers. We met Dr. Grunch at a recent spine conference in Chicago, and we knew you'd love her as much as we do. So, thank you Dr. Grunch for joining us!
Dr. Grunch: Thanks for having me.
Kendra: I'm super excited to have LadySpineDoc here with us. We know you, but tell our audience a little bit about you: who you are, your training, your family, and of course, your successful TikTok.
Dr. Grunch: So I'm Dr. Betsy Grunch. I am a board certified neurosurgeon. I've been in practice in my hometown, Gainesville, Georgia, for about 11 years. I went to Duke for my residency and my spine fellowship, and I do mostly spine surgery and trauma. We are a level one trauma center where I'm at. So I do all those things. And married. I have two kids, six and nine, and I have two dogs that are whining right now. And , I started social media in 2021, just kind of out of boredom during COVID, and it spun into this wild, wild thing for me.
So, yeah.
Laura: Didn't you train at MCG too?
Dr. Grunch: I went to medical school at MCG.
Laura: Yeah, I just had to say that. That's, that's where I went as well. Probably a lot earlier than you did.
Dr. Grunch: No, what year did you graduate?
Laura: 2000.
Dr. Grunch: Oh, 2007 here. So, yeah, not too far.
Laura: Yeah. Yeah.
Kendra: Just a shade under a decade.
Laura: That's all right.
Kendra: Oh, well, that's awesome. And did you always know you wanted to be in neurosurgery? We met you at NASS. And last year, you told an incredible story of how you kind of wanted to go into neurosurgery or maybe how your path got steered in that direction. Are you, could you share that?
Dr. Grunch: Yeah, of course. So, I didn't really know what I wanted to do when I was little. My mom was a police officer, which was a highly male dominated field. It was in the nineties. And I really wanted to be like her cause I thought she was a badass. And I just really like, we, she raised me as a single mom for the first seven years of my life.
So like growing up, I just saw her. I'm like, wow. So I wanted to do that. And right before I started high school, she was involved in an on-the-job injury, car accident. And, she suffered a C4 spinal cord injury and was quadriplegic. And that was kind of at the time, you know high school, you're starting to think of, "Okay, what do I want to do in my life?" And there's just such a monumental event in my life where we went through rehab. She was in, obviously, a very extended period of rehab. And we were with her and helping take care of her and all those things. So, I was just surrounded by a health care team that really just, I thought, embodied helping people and helping families.
And, I just decided that I wanted to do that. I wanted to help people that had neurological injuries like her. And I felt like I could potentially, you know, save people that have injuries like that. So it drove my passion for neuroscience and for wanting to potentially be a surgeon.
So I started shadowing her neurosurgeon. Who just so happens to be my partner now, or he used to be, he just retired. And yeah, so that, that was kind of the spark for me. I think a lot of people in healthcare, you know, they have something. They have their story. We all have our stories as to what sparked your interest, and that was it for me.
Kendra: Inspiring. So tell us about your Tik Tok. We love that we get to follow you on Tik Tok and you have such relevant content, but it's for everyone, not just physicians. So tell us about that.
Dr. Grunch: Yeah, I mean, I started doing social media during the pandemic where like healthcare professionals at that time were seen as healthcare heroes. And we were all celebrated and like, there was a lot of folks posting on social media and a lot of, you know, a lot of misinformation out there too. So I thought, well, I, there's nobody in neurosurgery on social media really. So I thought that I would just start posting content. And I posted one video that really gained a lot of traction about just being a female in surgery. And it was just, it was really cool to see just kind of the engagement, what people wanted to know. They were thirsty for information. Not only educationally, but just like young kids like, oh, wow, I've never seen a neurosurgeon.
And for me, that was just so cool because I know when I was growing up, so to speak, there was no woman. I never saw a female neurosurgeon. And so every person that inspired me throughout my journey into medicine was male. And so I thought, well, if I can put myself out here and really show other girls that, "Hey, this is a field that you can go into, you can have a family. You, you can, you know, be successful in this career and do it as a female." I thought that was really something that would be worth my time. And, and I, I, I enjoyed it too. I really enjoy posting content. So, I started posting a lot of educational content, and then just kind of like women empowerment. Like, women in surgery kind of stuff.
And then, I think to be a successful content creator, you kind of have to be relevant across the board. And also just to keep it fun for me. I'm not just a surgeon. I'm a mom. I'm a person. I'm a car lover. I'm a shoe lover. So like, I just post stuff that's just me, and I guess people like it. So, that's what I do.
Kendra: I love what you said about staying relevant because I think you relate to your patients better. I mean, there's some negative sides to social media. But I think if, you know, you put out there relevant content, not only in your field, but just like, "Hey, I'm a person too. Like, I'm a mom too. Like, I love shoes. I love travel. I love, you know, whatever." The other sides of you that maybe when patients do come see you, maybe they're, you know, I don't know about less nervous. But just at least like you, you seem relatable, you seem like you could just have a conversation.
Dr. Grunch: I mean, it's absolutely true. I think so many of my patients, probably the majority of my patients follow me. And, I have a big team, I have some PAs and stuff. And I feel like if they hear me explain things or talk things through, they, they trust me, this almost undeserved trust. Because I mean, I may have not have seen them, but, they really, really trust me and my team to, to do the right thing for them.
Cause that's, one of my platform goals is to really, you know, to put out there that there are physicians that really want to do what's best for you. And then, you're right, it makes me relatable. So like plenty of times I'll go in, and they just want to talk about my kids, or they want to talk about the shoes I just got. Or, or whatever the case is that each patient will find something that they can relate with me with. And I feel like it drives a better trustworthy relationship because it's not just about me being their doctor, it's about me being a person that can relate to them as a person. And we can find common ground on things, which makes us have a stronger relationship. I mean, it helps them understand me, but it helps me understand them, which in some of the surgeries that we do is very important.
Most of the surgeries I do is elective. So it's not like, oh, you're coming in and you're, you know, massively hemorrhaging in your brain. I mean, yeah, that's some of what we do, but probably 95 percent of what I do is just chronic pain. And, you know, that trust relationship is super important in those cases. And I think it's, it's helpful.
It's interesting dynamic for sure that I think will only continue to grow as social media grows. I think it's the future, and it's quite fascinating. I've learned a lot in the past few years.
Kendra: Yeah. I can only imagine having, you know, the baseline trust and just being relatable and being able to talk to your patients. I think there are many confounding variables to why having surgery by a female surgeon leads to better outcomes, but I can only imagine that having that nurturing. We're kind of innate nurturers, and so just being able to showcase that. And knowing that you only get what 15, 20 minutes in a visit, if that. But then being able to have that platform where you can highlight that nurturing side, or just even build that, like you said, undeserved trust, but is it, I mean, because that's really an excellent platform to be able to showcase that.
You know, us EM physicians, we get like two minutes to build rapport, and we're trying to have it like some shared medical decision making. Like, Hey, we need to give you this medicine to save your life. I know you've known me 2 minutes.
Dr. Grunch: It's valid. I mean, even in your field, I've seen some ER doctors are really put out good content. And I can't imagine that if a patient comes in and follows them, they're like, "okay, I know this person. They're going to do what's right for me."
And it's a good platform to have, even if it's not big, like mine. I mean, even if you have, a small platform that just your patients see or something like that. It's definitely valuable, but it's a double edged sword, right? You can really lose a lot of ground by doing something dumb on social media. So it's, it's something that you have to be careful about things.
Laura: Yeah. Well, I have to say, I think knowing you the limited amount that we do, you have the combination of being awesome and being kind and humble at the same time. And that's something that people are really drawn to. So.
Dr. Grunch: It's easy in our field to become jaded and to like, just think of people as patient A, B, and C, but it's just so important to realize that each person that you see are really humans that have a whole nother side of them.
And yes, this is what we do for a living. But, the decisions that we make, even in 3 seconds, can really affect them forever. And so I try to just really remember that. Because, you know, if you don't and you become jaded, then you make bad decisions. And, is what you're doing really worthwhile, at that point. So. I don't know. It's tough.
Laura: Yeah. Well, you're doing great work. And one of your posts really resonated with a lot of docs. When you talked about medical training, you likened it to swimming in shark infested waters. And I, I think that was so on point. Would you mind just kind of explaining that metaphor?
Dr. Grunch: Yeah, so actually funny 'cause I, I still have this pamphlet from when I did that video. This was actually given to me as an intern, How to Swim with Sharks.
Amanda: Oh my gosh. Oh wow.
Dr. Grunch: Actual primer, like an actual physical thing that was passed out to us as
Kendra: Amazing
Dr. Grunch: general surgery intern. So it wasn't really a metaphor. It was, it was reality. And like, I'm a medical student starting my first day of internship and just happy to be selected to be in this elite program. And humble to, like, have been selected to be a surgeon. And so you kind of develop this attitude of I'll just take whatever they throw at me. It's no big deal. I'm strong, I'm hard, whatever. And so, day one coming into internship and being told these things, it's like, well, that's fine. I can do it. And I really didn't think a lot of it for years, honestly. I mean, obviously in, in retrospect over the years, I'm like, you know, that's kind of fucked up, honestly, but okay.
So, the gist of people that haven't seen what I was talking about is- day one of internship, we were given a presentation by the chairman. And I want to make it very clear that this was not my program. This was my internship, which was required on my neurosurgery program. So this is not representative of my neurosurgery training, because my program was great. But this was my general surgery internship.
And basically, you know, we were told that we were essentially fish that are being thrown into a shark pond. And whatever you do, there's, you know, 6 rules surrounding how to swim with sharks. And the sharks are the physicians, the attendings. And several rules, but some of the rules that really hit home are, one, don't bleed. So, if you bleed, you will attract sharks to want to eat you. So, to draw an attack on by your superiors. So, basically, don't show emotion, don't show weakness, don't let any signs of struggle out because you will then be harvested by your superiors.
One of the other ones was if someone else is bleeding. So in other words, if one of your co interns or residents is struggling, you need to get out of the water. You need to leave them alone, so they get attacked and you can save yourself. And you know, that's kind of the reality. That, that video that I made. I really didn't think much of it. Because again, I thought it was kind of normal, but I thought, okay, I'm just going to put it out here. And then just the feedback that I got from that one post was tremendous. So much, like, "Hey, you know, that's, that's how I was. That's how it was when I was trained."
And what really was hard for me is, I had people email me and DM me, like, family members of residents that have committed suicide during training. And they wanted to tell me, "we really appreciate you putting this post out there because now we understand what my loved one went through," or "you're bringing light to this very important topic because this was devastating for us." And you know just that, I get goosebumps just talking about it now because it's crazy how we sometimes feel that we need to train our future physicians by how we were trained. And it's just not right. And it's definitely changed over the years, but it's still, it's still bad. And I think just the toxicity of healthcare in general- it's not just in medicine. It's in nursing and it's, it's, it's just the way, and I don't know why it is that way.
I mean, there's lots of other fields that are like that too, but I think that if we can be the voice of change, we can make this much better for future physicians, , and just make it a more palatable experience, and attract better people into our field. One of the other things, on the contrary, I mean, it took me 11 years to make that post and really talk about my experience.
And I was still scared. I was like, what are people going to say at my program? And they did. What I was worried about happened. I had the chairman of the department. I won't say who, what department, but message me and basically give me a dissertation on why, why did I post that? And the quote from his email was, "maybe you were just having a bad day." And I was just like.
Amanda: I'm having, like, rage.
Dr. Grunch: My reply back was, "You just justified everything that I said in that video by your response. So thank you, but no, thank you."
Amanda: We noticed when you told that story, some people get so uncomfortable, and there's almost this tendency to then start gaslighting or like to, "well, that never happened to me." I just thought that that was so fascinating that you're sharing your experience. And there's like this rationalization or justification. I don't know what it is, but it's even coming from within, which is so crazy.
Dr. Grunch: Yeah, a lot of people trying to invalidate others experiences. I'll say things that that it happened to me and probably you guys, too. And then people will be like, oh, that never happened. No one ever said that to you. I'm like, okay, actually. Yeah, they did. I'm not trying to gain sympathy here. I'm trying to share experience.
Kendra: I mean, just don't say anything. I mean, even if it didn't happen to you, like maybe just validate by just holding space for that person to talk. I don't know. Seems weird.
Dr. Grunch: I agree.
Laura: Yeah. Well, there's a level of emotional immaturity. I would say the whole medical culture is very emotionally immature in that way. And so, they're trying to avoid being around the person bleeding or talking about it- denying other people's experiences. But we're either part of the solution or part of the problem. And when we're acting like this is okay, like actual abuse that would not ever be acceptable in most of corporate America or other professions. It needs to be acknowledged for what it is.
Dr. Grunch: Yeah. And I think it's okay for us to talk about it. I feel like we can only grow stronger if we know where we have things go wrong, and how we can make it better. And it's not necessarily us complaining about it, but if you try to dust it under the rug and act like it doesn't exist, you're just perpetuating the problem. You know, I was asked to write an article in Doximity after that post, which I did. And the comments, in response to the article was, it was even worse 30 years ago. It wasn't like, "wow, I value what you're saying. You're exactly right." It's like, "no, we have it even worse."
Laura: Maybe so, maybe so it doesn't make it right.
Dr. Grunch: And that was some people in training that replied back. And then they were quickly attacked by other older physicians in the section. And it was just like, man. You're making the problem exactly what it is, and you just don't get it. You don't get it at all.
Amanda: Yeah. There's this justification of, well, I was tortured, and so now it's okay for subsequent generations to also be tortured. But we're living in the remnants of a dinosaur created when child labor was totally cool. And everyone else has advanced and we're still clinging to remnants but it's not working.
Laura: It's just like abusive family systems. What's normal when you're in an abusive family system, you probably are going to carry some of that forward to your own kids. And maybe you won't be as bad as your parents were, but you still think it's normal. And it's like, that's the thing is like, it is not normal. It's not okay, and the evidence that it's not okay is this astronomical suicide rate among physicians, especially women physicians. It's, like, that is just unacceptable.
Dr. Grunch: Yeah.
Amanda: Why would we not want to improve?
Laura: I don't know.
Dr. Grunch: I think we also learn as we get older, like, I am not completely innocent in not propagating that behavior early on in my career. I was trained by surgeons who were mean to staff. It was normal to yell at the scrub tech, to yell at the x ray tech. And then I came out into practice and demonstrated some of that behavior and quickly realized that that's not getting me what I want. And why am I, why am I doing that?
So, maybe let's take a step back, and let's demonstrate to the x ray tech, for example, what I'm trying to see when I'm doing this case. And I want to see, you know, this view of the spine while I'm doing this case because of x, y, and z. Not like you're dumb. Get somebody else in here that knows what they're doing, which is the behavior that I was trained at.
You kind of, you learn that abusive type behavior. You propagate that behavior and then realize that maybe that's not really the best way of going about it. And, there are better ways. And I think the best people and the best humans are ones that realize that, and then change themselves. And continue to change over time and learn from things that maybe didn't go exactly how they wanted it to and how they can maybe modify if they do it next time. And really just continue to work on behavior and get it right. So.
Laura: Yeah, well, people don't do their best work when they feel scared or humiliated. And if we're trying to get their best work out of them, maybe don't make them feel unsafe.
Dr. Grunch: Yeah. And in surgery, I mean, in my profession, it's not just about me doing the case. It's about everybody in the room. So if everyone is scared of me, and they're not verbalizing when a mistake happens. Maybe they don't want to tell me something happened, contaminated on the field, because they're worried I'll yell, then that will just propagate bad outcomes. Because maybe the patient gets an infection, because the surgical tech didn't speak up when they accidentally touched their mask, or whatever the case may be so I think just being better communicators and, you know, More open and kind really just improves the patient care and the morale. And, it really just makes us all do our best work, which in healthcare's team, it really needs to be everybody doing their A game to get the best outcome. So it's important.
Laura: Yeah, well, you spoke at NASS about your office culture, and I'm so impressed by the way you treat the people that you work with. Could you just speak to that for just a minute? Why have you decided to create the culture that you have?
Dr. Grunch: I mean, I think it goes back to exactly what we just spoke about. I want to come to work, and I want to feel like part of a family. We spend so much of our time at work and trust the people that we work with to make the right decisions. And to come to work and work with people that are scared of you. Or that you don't like. Or maybe you don't vibe with or speak about you behind your back. It just is not a very pleasurable experience. And it doesn't really pan out too well in the long term, in terms of maintaining employees that don't burn out. And it'll increase turnover and then ultimately just make more work on you. And just retraining and retraining is just not really the best model. So I learned from one of my attendings, just watching how he worked. He would always pay for lunch for everybody in the OR.
I mean, that man's making a lot of money. And it just makes them feel good. SoI started doing that. I buy lunch for my team. We buy matching scrubs. Go on team vacations, and just really treat each other with respect. And I treat them like my family.
I know sometimes people don't like that. They call it work family. That's, kind of, can be a toxic connotation too. But in my mind, if they trust me and love me, and I love them like my family, then it's just going to make the whole work experience better. Make you be happy to come to work, them happy to work. Make them want to perform their best because they don't want to disappoint you. And really just gives the best experience across the board to your patients. And so I've just done that over the years and realize when I do have people that come into my office to work that don't really have that type of vibe, so to speak, then it's just gotta go. So, over the years I've been able to cultivate a really strong team. And it's good.
Laura: That is awesome. So if the information online is correct, only about 5 to 8 percent of spine surgeons are women. Why do you think that is? What are the roadblocks to women becoming spine surgeons?
Dr. Grunch: Yeah, to be a spine surgeon, it's either orthopedics or neuro. Those are the two subspecialties that one can perform spine surgery. And those are already extremely male dominated. Neurosurgery is, I think, 18 percent women, and orthopedics is 16 or 14, or something like that. So it's pretty low. Then you take the subspecialties of orthoneuro, so all those women, there's already not many of us. A lot of them go into pediatric ortho, pediatric neuro, tumors, you know.
Spine is so male dominated just because it does require a lot of physical strength to do these cases. And they're long and they're hard, and I think we're discouraged and told that, "you're not strong enough to do spine surgery. Why don't you just go do peds." Or, "why don't you just go do tumors?" whatever the case may be.. And so I think if you're grown and cultivated in this environment where you feel not welcome, you don't really thrive.
So you don't want to go in the spine room and do that case. Because bunch of dudes talking about stuff that's not relevant to you, and they don't want you in there anyway. So you go into a maybe another room where you feel more welcomed. And then you feel happy about that experience, and these experiences during training is so important to guide us in our decisions.
And I think it's why a lot of women don't go into these surgical specialties at baseline. If you're a medical student that's undecided and you go out in this big, wide world of medicine. And you go into your OBGYN rotation, and there's so many women, it's so kind. Love babies. It's fun. And then you go into ortho and a bunch of dudes lifting weight during their pre workout, malleting big nails into femurs, and talking about, you know, whatever. You just, maybe you feel like the other field is more like what you would like. And it has nothing to do with the field. It just has to do with the environment that you're put in. So I think that's a lot of it.
Amanda: I was just gonna say I liked how you called your, I don't know, was it a co resident your swimming buddy?
Dr. Grunch: Yeah, one of my orthopedic colleagues, who's a spine surgeon female ortho, which is pretty rare. She had another ortho Intern that was female and they called each other swim buddies. And we were just swim buddies, because we vowed to help each other and not just throw each other back in the pond, and let them salvage for themselves.
So,
Kendra: I love that. I think that is an example of just those small changes over time. We know we're not going to completely overhaul the entire situation in one fell swoop. But even having that example that you said, like, "Hey, why, jump out of the water if someone's bleeding? Let's just be swim buddies." Taking the dreaded pamphlet, turning it on its head and just saying like, "Hey, there's another way to think about things and another way, to not just survive, but thrive. I was just so moved when you showed that, I think it was one of your TikToks, how you talked about that this is a team. It's not Dr. Betsy Grunch in the O. R. You know, leading surgeon, even though by trade you are the leader, you are the The person that's in control of that situation, but just honoring that you need that whole team in order to complete the task at hand.
Laura: What's so brilliant about that kind of leadership is- it is modeling that collaboration is actually great leadership. And where we've come through this competitive culture of dog eat dog or shark eat fish. And that has left us really empty. It's no surprise that so many of us are struggling, and so many of our patients don't trust doctors. Like they're not going to trust someone who is competitive and not collaborative. So what you're doing is kind of the solution to a lot more than just medical culture problems. Imagine if we had collaborative leaders everywhere who could model that kind of behavior. It, it is world changing. So thanks for being so awesome.
Dr. Grunch: This weekend or this past weekend at a women's leadership conference. And, I initially was going to give that same speech, but it's more healthcare driven.
And I was like, I can take this narrative, so to speak, and apply it to how leaders should be across the field. In marketing and business and law and medicine. And how being an authentic leader really is so important in everything we do in life. Not just even at work, and it was really a fun thing to talk about. Because I think the things that we're talking about now are not just relevant to medicine, even though they are very relevant to medicine. It's just really relevant to how we coexist as human beings in a multitude of different ways.
Amanda: Well, that segues perfectly into my question, because , you've already given us so much information on how to make medical culture better. Is there anything else from the talk that you just gave or any other ideas? Being authentic, treating your coworkers like family, lending a hand up rather than a boot to the face. Do you have any other thoughts on how we can make working in medicine better? Cause we just have to. It's not working the way that we're doing. So what are your thoughts?
Dr. Grunch: Obviously making the work experience better in terms of our team and cultivating a positive experience. I saw something, I think it was USA Today, yesterday about how more physicians are speaking up on work-life balance, and really taking ownership of you can't let medicine be your whole life. Because it can, there's always sick people. Physicians are in high demand. There's always going to be people that need your help. And you can either run with that, and let it rule your entire life.
And I am full victim of that type of mentality early in my career. And you burn out. That's part of the reason why I started social media, cause I needed an outlet. I was just getting so overwhelmed with the redundant nature of what I did every single day. And it gave me some breath of fresh air something else I could talk about than just patient care.
And so, I think just bringing it out into the open that we do have lives. It's okay to have a life. It's okay to want to take off work to go on vacation. I've done some posts just talking about that, and they're like, "Oh, how could you do that? Who's going to be taking care of your patients?"
Well, there are other physicians. We can all function as a team to honor each other's well-deserved time away from work to keep our mental solitude together so we can continue to do what we do for longer period of time. So, not just that, but, , embracing the ability to have a family and supporting residents through that process and not making it feel like it's a bad thing to want to have a family. And to support women, , that do want to start a family in residency is super important.
Amanda: I love it. That, is so great. Well, unfortunately our time is coming to, a close, and we have loved having you. I would encourage anyone, please go on Instagram and TikTok and follow LadySpineDoc. But before we go, do you have any closing thoughts? Anything we didn't ask that we should have?
Dr. Grunch: No, I mean, I, I just enjoy talking to you guys. I think these are all such important topics that I think more and more people need to hear. Not just women, but everybody. Just knowing, you know, what we do, we really love our jobs. We, love taking care of people, and we just want to continue to make everything a positive experience for ourselves, but most importantly for patients. So.
Laura: Yeah, . Thank you so much because you are showing that real strength comes with kindness. You know, we thought that you had to be mean to be strong, but the best strength is kind and strong. So thanks for what you're doing.
Dr. Grunch: Thank you. Love that.
Kendra: Thank you, LadySpineDoc for joining us today, and thank you for your work standing up for not only the people that work for you in your office, but your patients and also your colleagues. Way to be brave and stand up and say, "you know, enough is enough." We can change this, but we can do it more if we do it together. And we are so, so, so thankful for the work you do and the purpose behind your mission, and we honor you for that bravery and that courage every day.
If anything resounded with you today, go ahead and leave us five stars and a review . And we want to tell you about our new video, How to Crush Physician Burnout (for Good) without Cutting Back Hours, Quitting Medicine, or Sucking It Up in Silence. So scroll down in the show notes and click the link and check it out.
Kendra: Until next time, you are whole. You are a gift to medicine, and the work you do matters.
