Finding Purpose: Dr. Jordan Grumet on Burnout, Meaning, and the Deathbed Test

This transcript has been edited for clarity and length.

Mike Sacopulos: My guest today is Jordan Grumet. Dr. Grumet is the associate medical director of Unity Hospice. He started the Earn and Invest podcast in 2018, which is an award-winning podcast. Dr. Grumet is an author. His most recent book is The Purpose Code. Dr. Grumet, welcome to SoundPractice.

Jordan Grumet, MD: Thank you so much for having me.

Sacopulos: Dr. Grumet, as you know, this is the podcast of the American Association for Physician Leadership. I'm interested in your path to becoming a physician leader. Can you describe your journey?

Grumet: Certainly. I have always thought I was going to be a physician. My father died when I was seven years old. He had a brain aneurysm, and he was an oncologist and was literally rounding at the hospital when he got a severe headache, collapsed, and died. And being a seven-year-old, I figured somehow, I was at fault because that's how seven-year-olds think. They think the world revolves around them. And so, at some point, I decided if I just became a doctor like him and saved lives, it would make everything okay. And that's exactly what I did. I had a learning disability when I was little. I had trouble reading. I kind of blew through that, made it through high school and college, became the perfect student, right? When my friends were all going to the football game at University of Michigan on Saturday morning, I was at the law library studying. I became that physician and it was very joyful and very purposeful until I realized that it didn't really solve the essential problem. My father was still gone and I couldn't save everyone. And so, I did what a lot of people do — I burnt out. Like I got tired and exhausted. And that led me to finding the financial independence movement. I thought, well, I just have to leave medicine because this is so exhausting and there's nothing else in the world I could possibly do. I learned about my finances, realized I was probably much better off than I thought because my parents had modeled such great behavior. And on the cusp of thinking about leaving medicine completely, I realized I loved working in hospice. And so, I kind of created a dual world where I spent some time working in hospice, doing the piece of medicine that still felt really unique and wonderful. And then I started a financial blog and podcast and eventually wrote books about things like purpose, because when you're dealing with the dying, they really question their lives. They start talking about regrets. And I realized that the dying have a lot to teach us about things like burnout, money, and life. And that led to the book, The Purpose Code.

Sacopulos: Brilliant. So, for whom did you write The Purpose Code?

Grumet: So, The Purpose Code is for everyone. And here's the reason why. And it's a funny story. It actually stems from my understanding of finances. When I realized that I was getting exhausted as a doctor and I was looking for a way out, I realized I had no idea how finances worked. I had no idea what financial independence was. And it was this big, ephemeral, difficult thing to understand. It was very nebulous. And I thought, there's no way I'm ever going to get this. I'm never going to figure out how to invest. I'm never going to figure out how to manage my money and taxes and all those things. And then this guy, Jim Dahle, the White Coat Investor, he sent me a copy of his book. He had written it in 2014, and I was writing a medical blog at the time and he wanted me to review his book for my medical blog. And I read his book and all of a sudden it was like the heavens opened up and I totally understood finances. It was that straightforward. Something I thought was so nebulous and difficult was actually very understandable. I just had to have the right words and vocabulary. Fast forward to dealing with money and being a hospice doctor, and I realized that there were a lot of people who got money right but couldn't say why they were doing it and didn't know what it was in service of and didn't know what enough looked like. And strangely enough, I was finding my hospice patients were addressing these very issues that titans of industry and the finances couldn't. Because on their deathbeds, dying patients would say things like, I really regret that I didn't do X, Y, or Z. And so, I started realizing that the dying can really teach us about money and life. I started thinking about money, and it all came down to purpose. But the problem was, when I talked to people about purpose, a lot of them would tell me that it made them feel anxious, and they didn't really know how to approach it. And the alarm went off in my head, and I said, aha, that's how I felt about finances. But all I had to do was read this one really great book that spelled it out much more easily, and I could figure it out. And so, my aim for writing The Purpose Code was to do the exact same thing. So, there's studies out there that show that up to 91% of people at some point in life have something called purpose anxiety. It means this idea of purpose and finding their purpose makes them depressed and frustrated, and they can't quite figure out how to do it. And so my goal was, since 91% of people have this feeling at some point, how can I actually elucidate this idea and really build it out so that that 91%, at some point when they're really struggling, would have something to look at and understand.

Sacopulos: Do you think it's because there's not a metric? When it comes to money, there's a metric, right? We've got dollars. We can adjust. And it's the same metric for everyone. A little bit different when it comes to purpose, is it not?

Grumet: Well, here's the thing. I think the real problem comes from this idea that we actually define purpose incorrectly. And so most people think that purpose is their why in life. Like it's why I do what I do. And the problem with that is it makes it this big audacious thing that you either find and get correctly, or you don't find it and everything is lost. And it can't be just something minor. Like, I love to help people and I love riding horses. So, I'm going to teach disabled people how to ride horses and make their lives better. That doesn't feel like enough because when we're talking about our why for existence, we feel like it has to be even bigger, right? We've got to be a seven-figure businessperson, or we have to cure cancer, or we have to travel to the moon. Like our why has to be this really big thing. And so, most of us don't have the agency to actually, for instance, travel to the moon. Most of us, you know, we're not the right people at the right time saying the right things with the right knowledge and the right amount of luck and genetics. So most likely one of those isn't going to work for you, and you're never going to really meet that big, audacious version of purpose you think you're supposed to have. What I try to argue in the book is that purpose has nothing to do with your why. Purpose is actually just the actions you take in the present and future that light you up. It's doing things that are exciting to you. It's a great way to spend your days. And so, when you start looking at purpose that way, you realize that it's not this all-or-nothing huge thing that you have to get right or everything is lost. It's much more abundant than that. It's like, well, what are the 10 or 15 things I could really enjoy doing today? And how do I build a life around those things? And that's why I think, I don't think it's exactly that we can't measure it. I think we definitionally set ourselves up for anxiety and failure.

Sacopulos: So, am I understanding that it's the process or the activity rather than the goal?

Grumet: Correct. And when we're talking about our why, that's actually something completely different. I usually talk about that as our sense of meaning. So, meaning and purpose are two very different things. Meaning is how we cognitively look at our past. It's all about thoughts and it's all about our past, while purpose is about the present and future and it's all about our actions. So, when we start thinking about our why, like why are we doing what we're doing or what is our why for living, it's actually much more of a meaningful discussion. Like what are the stories I tell myself about myself? And was I a hero or was I thwarted and a victim? And I'll give myself as a perfect example. My why was becoming a doctor. Why was that? Because my father died. I felt out of control. It was a major trauma in my life. I felt like I was responsible. So, my why, my sense of meaning became, you can become a doctor and that'll take away this tragedy in your life and cosmically make everything better. It was a very big, audacious version of purpose. It was a why-based version of purpose. And it didn't work because guess what? I became a doctor. Now, not everyone can become a doctor. Some people aren't going to have the grades, the luck, the time, the energy, or the money to go to medical school. So, there's a good chance I could have just failed. In this case, I was successful, but it didn't solve the problem. It didn't bring my father back. I had to go back and realize that I was not the cause of my father's death. I was just a good kid in a bad situation. And so, it became a much more heroic story. I was in this bad situation, I never asked for this, and yet look what I made of myself. The reason why that sense of why or meaning was so important to me, because it gave me the strength to also realize that medicine was no longer fulfilling me and pivot. And because my whole sense of self wasn't based on being a doctor, I can now see my sense of self being based on the hero who could accomplish what they needed to in a difficult situation. I could even step away from medicine, use my financial wherewithal, and go into other things like writing, podcasting, and blogging.

Sacopulos: But did it also make you a better clinician to realize the meaning?

Grumet: I think when we have a good sense of meaning, we become better at everything. And the reason is this: when you don't have a good sense of meaning, so when the story you tell yourself about yourself, about your past, is more of a victim story than a heroic story, what you're really saying is, I didn't feel like I was enough, I was thwarted. And so, in the present future, when you dive into purpose, you're going to have that sense of not being enough, and you're going to feel like you have to prove yourself. And I think this is where people get stuck as physicians. They suffer some hurt, some trauma. They become physicians to quench that pain and that difficulty, but they then have to continuously keep proving themselves worthy because they haven't gone back and dealt with that trauma. They're just trying to fill that hole with something they're doing in the present future. And so, what we get on is we get on this big treadmill of trying to accomplish more and more thinking we're going to finally feel good, like that big trauma of my childhood. I thought becoming a doctor was going to fix that. It didn't. So now I'm going to have to be the best doctor. And you go out and you try to become the most successful doctor in your area. You have the most patients. And then you accomplish that. And it still doesn't fill the hole. So, you're like, well, now I have to head the Department of Internal Medicine. And so, then you lobby for that and spend years getting yourself in a position that you can run and be the head of internal medicine. It becomes a never-ending treadmill. The better story is to go back, relieve yourself of some of that trauma, realize that you were just a good person in a bad situation, and therefore you can joyfully jump into the present and future. So, if I joyfully find a sense of purpose in helping people, in my case, for instance, doing hospice work, I don't worry about the goals anymore. I'm not worried about becoming chief of medicine or being the most successful. I'm just worried about doing something I love and enjoy, and therefore my brain can be there to treat my patients and connect to the nurses and the chaplains and social workers and be intentional and in the moment, which is exactly what those people need. So, you just get better at what you do either way.

Sacopulos: Is purpose immutable? Does it change over time? And are there certain societal factors that impact it?

Grumet: What I love to tell people is there are almost no rules for purpose. Your purpose could be big or small. You could have one purpose or many. Your purpose could change the world, but it certainly doesn't have to. There's only one rule. And I use my experience as a hospice doctor when I say what the one rule of purpose is. The main rule of purpose is if you can imagine yourself on your deathbed saying, "I really regret that I never had the energy, courage, or time to..." If you can fill in that blank, then that's the only rule. Is if you know that you would regret not spending the time doing this thing on your deathbed, then it's probably a pretty good version of purpose for you. So, what that means is we can have multiple versions of purpose going on at one time. Some versions of purpose can be more important than others. And after a week or two, a month or two, or a year or two, you can decide that version of purpose no longer works for you and move on to a different version of purpose. And all of that is okay. And so, I like to say purpose should mostly be process-oriented and not goal-oriented. But ultimately, we have this gift of memento mori, this idea that we can carry the idea that we're dying with us at all times during life and act as if we were aware of that at all times. And so, the question is, you know, if you found out tomorrow you weren't going to be around, what would you regret never really putting that energy and courage into? And hey, let's start doing those kinds of things now.

Sacopulos: On a, and I know this would be difficult, but on a percentage basis, Doctor, how many patients do you believe have those types of regrets at the end of their life that they just didn't do X or Y or wish they'd spent more time doing A or B?

Grumet: I think it's very common. So, could I give you a number, 50% or 75%? It's probably more than half. But what I always tell people is, and this is a hospice saying, I say we tend to die the way we lived, right? So, if you want a peaceful, regret-free, comfortable death, you've got to kind of live a peaceful, regret-free, comfortable life. And this is the whole idea of why figuring out what purpose looks like in our life now and pursuing it, why it's so important. Because it's practice for when we hit that really difficult time. If we die like we live, the best thing we can do now is start understanding purpose now and start pursuing it with honesty, integrity, intentionality. But if we do that, the likelihood that we're going to die fairly at peace goes up quite a bit.

Sacopulos: Do people confuse purpose with passion?

Grumet: Here's where I really see purpose and passion getting in the way of each other. And it actually has to do with work. So, there's this whole argument right now in pop culture. Half the people say you should work at what you can make money doing, whether you like it or not. And the other half says, you should work at what you're passionate about, regardless if you can make money. And the truth is somewhere in between. You should probably, especially at the beginning of your career, do what you can to make money. But in the meantime, if it's not purposeful at work, you should be building purpose and passion outside of work. And as time goes on, that eventually becomes your work, or at least you feel like you've really built purpose in your outside life. Now, when it comes to purpose and passion, are they the same thing? Well, purpose are the things we do in the present future that light us up. Passion is the way you feel about it. So, they're intimately tied, but passion is much more of an emotion. It's, I feel connected to this thing. Whereas purpose, as we talked about before, isn't really about thoughts. It's about actions. So, purpose is the actions you take about things you are passionate about, if that makes sense.

Sacopulos: Do you find that people have a difficult time, or some people do, finding the thing that lights them up?

Grumet: I think they do. And I always tell people, people tell me I can't find my purpose. And I always tell them, well, you don't find your purpose. You build or create it. But it is true. You have to have some inklings, some beckonings, some things that light you up so you can build purpose around that. I call those purpose anchors. And so, I've done a lot of purpose coaching. And what I found is with a few exercises, most people can identify 10 to 15 purpose anchors without a problem. So, the hard thing is not to decide what's exciting to you. The hard thing is having the courage to then build activities around those things. And so how do we find what lights us up? How do we find our purpose anchors? Well, one way is what we've been talking about, to ask yourself that difficult question about end of life. I call it a regret audit. If you found out you were dying tomorrow, what would you regret never having the energy, courage, or time to do? Well, if you can answer that question, you can actually turn that around into a purpose anchor and start building a life of purpose around it. I did that with book writing. About 10 years ago, I said, wow, if I was going to find out I was dying next week, I'd really be sad that I never traditionally published a book. Well, right there, I had a purpose anchor, but the hard part then came is I had to build a life of purpose around that. I had to learn how to write. I had to meet people who had published books before. I eventually had to get an agent and then a publisher. All these things were actions I had to take. They were purposeful actions, but they started with that easy thing, which is the purpose anchor. Now, there are a bunch of other exercises you can actually do to find your purpose anchors. I'm happy to talk about a few of them if you'd like, but the regret audit is one I often talk about.

Sacopulos: I think the regret audit is very helpful, but maybe for some audience members today who are feeling that they're struggling with this, maybe you could give another idea or two.

Grumet: Sure. So, there are a few other easy ways to start looking at purpose anchors. One is what I call the joys of childhood. So, most of us, if we can think back to our childhood room, we had posters up on the wall. Maybe we had won some awards. There were drawings there. So usually what kids find as purposeful doesn't go away. It's just we get busy with this idea that we have to now go to school and build an occupation and become adults. And we let go of those things we love. But if you think about it, kids actually are wonderful at purpose, especially before the digital age. Kids would get excited by building a fort, playing basketball, or going out on their bikes all day and they would literally disappear all day. They'd forget time. They'd come home late for dinner. It's what I call a flow state. Something as adults we're always trying to get to is a flow state, kind of losing track of time, doing things we love. Kids innately know how to do that, but we get less and less so as we get older. So, a great way to start thinking about purpose anchors is look back and what excited you as a kid? I'm again a perfect example. As a kid, I loved baseball cards. It's like I spent countless hours buying, going through, collating baseball cards. Now as an adult, I let go of that years and years ago. But every time I'm on Facebook and I see something about baseball cards pop up, my brain literally lights up. So, if I was looking for a purpose anchor, that's a great way. Another really good way is a lot of people don't love their jobs. So, I say, write down on a piece of paper all your roles and responsibilities at your job and take a pencil and let's start scratching out everything you don't like and let's see if there's anything left on that list. I call this the art of subtraction. And when you subtract out all you don't like, is there something that maybe feels exciting or purposeful? When I did this in my own career and I got rid of everything I didn't like, I didn't like running my own practice. I didn't like my hospital work. I didn't like being in nursing homes. In the end, the one thing that I couldn't scratch off was hospice work, which I really loved. Well, that became a purpose anchor. And now I'm like, okay, well, I can then build a life of purpose around that thing. So that's the art of subtraction. One last easy way to start thinking about purpose anchors is if everything else fails, you're like, I wouldn't regret anything. I don't like anything about my job and I didn't have any joys of childhood. If you can scratch all those off the list, then the last thing is to try the spaghetti method. You throw a bunch of spaghetti against the wall and see what fits. That means saying yes to things you normally say no to. It means hanging out with people you don't normally hang out with. It means maybe spending an afternoon doing something that feels a little uncomfortable and seeing if any of that excites you or lights you up. And so, using those four techniques, I haven't found a single person who couldn't identify at least a bunch of purpose anchors.

Sacopulos: Very interesting. Now, we're with the podcast today, American Association for Physician Leadership. So that leads me to an obvious question about physician burnout. Maybe, and you alluded to it a little bit with striking things off of, subtracting off of a list, but it's clearly a problem for the physician community. What does your book, The Purpose Code, offer to your colleagues who are facing some burnout issues?

Grumet: So, a lot of the time I talk about the difference between big-P purpose and little-p purpose. So, as I mentioned before, purpose can be associated with anxiety in up to 91% of people. And it's usually associated with what I call big purpose. This is goal-oriented, audacious purpose, the kind we see on Instagram, right? When we see these people running these seven-figure businesses and traveling the world and wearing the nicest clothes, these are things that most of us actually can't achieve. And so, if we work really hard towards those things, we burn out quickly and feel bad and give up. Contrast that to what I call little-p purpose. Little-p purpose is process-oriented. It's not goal-oriented. It's process-oriented. So, what can we do that lights us up, that excites us and fill our days with these little things that are just very joyful? So, what is burnout, whether it's for a physician or anyone else? Burnout often is pursuing big-P purpose and one of two things happening. Either you're trying to get there and you can never make it because you're not the right person at the right time doing the right things with the right genetics. So, it's failure. And that feels really bad. Or better yet, sometimes it's success and realizing that it doesn't really answer the problem you had. So again, I'll go back to myself. Becoming a physician was big-P purpose for me because I thought I could make up for the trauma of the death of my father. When I got there, I got burnt out because I realized it didn't solve the problem. To solve the problem, I needed a better sense of meaning, which means I had to go back and realize that I wasn't at fault for my father's death and let go of that so that I could realize that no matter how much I achieved as a physician, it wasn't going to fill me up and there were other things that could. And so, burnout for physicians often is a version of big-P purpose. It means they're going after these big audacious goals. Again, whether it's saving the world, whether it's getting to be the chief of internal medicine, whether it's making millions of dollars in your practice, whatever it is, it's realizing that you're trying to make up for a feeling of insecurity, something that doesn't feel good. And the answer is not to achieve all these things, but to go back and figure out why you're feeling insecure and not so good and addressing that issue. And so, in that framework, when we can let go of these versions of big-P purpose and we can start asking our questions like, well, what really lights us up and excites us? A lot of times it doesn't mean leaving medicine. It means figuring out what parts of medicine light you up and how that can fulfill you. I'll give you a perfect example. I was at a conference giving a talk about purpose, and a very accomplished gentleman came up to me. He was a liver transplant surgeon. And we started talking about his life. And he's like, I'm really burning out. I'm exhausted. I'm like, well, how much do you work a week? He's like, I work 80 to 100 hours a week. I'm on call all the time. These are very big, stressful surgeries. And he was in his 50s and he actually financially was very well off. I'm like, you know, and he had partners. So, I'm like, well, couldn't you take a little less call and work a little less? And he said, yes, I could, but I don't. And when we started asking, when I really started asking about him, like, well, why did you become a liver transplant surgeon of all things? And he actually relayed the story of a close childhood friend who died of organ failure. He had a friend when he was in elementary school, someone he really connected to and attached to, and they ended up having a rare cardiac disease. They never were able to get a transplant and they died on the transplant list. And the trauma of going through this at the time when his friend died, he said, I'm going to become a doctor. I'm going to do transplants and no one's going to ever die again like my friend did. Literally, these are the exact words he used. And so now, 30, 40 years later, an accomplished professional, he still couldn't give himself permission to slow down at work because there were still people who needed to be saved. His sense of meaning was based on the loss of someone who was important to him as a child. And instead of going back and realizing that it was never his job to fix the world, it was never his job to save all the kids. His job was to be a little kid who lost someone important to him that was special. And look how heroically he became a doctor after this. That's not how he saw it. All he could see is more kids could die and I'm at fault if I don't fix them. And so, he was burning out because he had a big audacious version of purpose to save every child with a transplant issue. And even though he was vastly successful at doing this, it still didn't resolve the problem. What he needed to do was let himself off the hook. He needed to go back to that traumatic event in his life and deal with it and realize he was just a good kid in a bad situation. And if he could do that, he would be able to return to his current career, realize he didn't have to work that hard, find what really he loved about the job. Art of subtraction, get rid of what you don't like. You have plenty of money. Art of subtraction, get rid of what you don't like, stick with what you do like, and then build a life around that. Once you start doing that, you have a sense of agency and you find that you're spending your time doing things that actually do light you up. It's actually energizing. It's the opposite of burnout. And so that's the real goal for people is to find out what their little-p purpose is, what they really love doing, have a better sense of meaning or realize that most of burnout comes from big purpose and letting go of that and finding what parts of your job you really love, because that's how you're going to get longevity. I love doing hospice medicine. I volunteered in hospice my first week of medical school, but at some point during medical school and residency, I decided that that wasn't going to be what I did. It either didn't make enough money or it wasn't important enough or whatever it was. And I went into internal medicine and I quickly burnt out. I realized at the end of that path that I loved practicing hospice medicine. What if I had practiced hospice medicine from the beginning, something that was very purposeful and process-oriented for me? Yeah, I wouldn't have made as much money. I wouldn't have become financially independent. I wouldn't have done many things, but I'll tell you what I would have done. I probably would have stuck at the job longer because I wouldn't have burned out. I would have had a much longer career. And so, the goal is how do we move past that big-P purpose as a reason for doing what we're doing, move towards process-oriented purpose we love, and let ourselves off the hook for the traumas of our past.

Sacopulos: You mentioned that you've done some coaching. Do you find that many physicians need the help of a coach to work through the issues that you're talking about?

Grumet: So, here's when people come to me. They usually come to me when they're stuck. And a lot of times they've asked their colleagues and a lot of times they've gone to therapy or even gone to other coaches. And so, no, not everyone feels stuck. Some people actually have a great sense of meaning. They've gotten past the struggles of their childhood and they start struggling with burnout or what have you. And they create their own solutions. For some people, that means working a little bit less and going part-time. For other people, it means leaving one version of their career and going to a new one. Maybe the general surgeon doesn't like being a general surgeon anymore, but loves wound care. And so, they change their practice and start doing 100% wound care and stop going to the O.R. on a regular basis. If you have a decent sense of meaning, a lot of times the purpose shift or the purpose pivot is a lot easier. But people come to me, about 50 to 75% of them, because they have a meaning problem. In other words, they won't kind of deal with the past and therefore they're struggling in the present and future. But the other 25% just don't know how to identify what's purposeful for them. And so those people who feel stuck, they've tried some traditional means, it's not working. Yeah, those people do benefit from coaching.

Sacopulos: Do you think that the medical education system is partially to blame for burnout?

Grumet: Yeah, I mean, I think we are built into a system, and maybe it's better — remember, I trained in the '90s, so things are slightly different now. But I think we were educated through a system that was not very good about talking about things like feelings or pain or trauma. Most doctors I know who trained either before me or during my era had a good deal of post-traumatic stress coming out of residency, et cetera. We all suffered through these really horrendous, difficult things. And so medical education right now is not very good at talking about those things. We're not very good about discussing how we feel, whether it's dealing with medical trauma or how we feel about our education in general. And so, what we've done is we've trained a bunch of automatons who kind of plug forward regardless of what's going on internally. We're really good at building up these walls to protect ourselves so that we can continue answering the phone calls at 3 in the morning or going to the ICU and putting in the chest tube, right? We're really good at that stuff. But we're not really good at decompressing all that pressure that builds up from very, very stressful careers. I don't think medical education has done a great job of really addressing that.

Sacopulos: Well, that's one of the parts of your book, The Purpose Code, that I think will be very helpful to your colleagues and fellow physicians, is that it puts these ideas in a great context. And I think that if nothing else, and there's certainly many more things that qualifies you as a true physician leader. Dr. Grumet, we're speaking at the beginning of 2026. And as our time today comes to a close, I'd really like to know what the year holds for you. What can we expect?

Grumet: A lot of things are going on this year. One is that I have a book coming out with AAPL called The Healthcare Heist, where we talk about how third parties have leveraged our healthcare system as well as what we can do about it. So, we all know our healthcare system needs changes. It's not working. We spend more on healthcare than almost any other advanced country. And yet maybe what we're getting out of it is not as good as what other people are in other places. And so, you'll hear a lot more from me about healthcare policy and specifically how we can possibly fix this problem.

Sacopulos: I look forward to talking with you about the new book. It's certainly a great topic and one that we need a mind like yours addressing. So best of luck with that and look forward to a future discussion. The current book is The Purpose Code. Its author and my guest today has been Jordan Grumet. Dr. Grumet, thank you so much for being on SoundPractice.

Grumet: Thank you.

Listen to this episode of SoundPractice.