Host Erik talks with Dr. Angela Sturm, a facial plastic surgeon based in Houston, about a kind of burnout the surveys don’t capture. It’s not bad EHRs or staffing shortages—though those matter. It’s something quieter and more corrosive: the erosion of autonomy. Dr. Sturm calls it moral injury, and she’s seen it from both sides—inside large health systems and now running her own practice.
In this conversation, Dr. Sturm shares how she’s built a practice and a life where boundaries makes her better at surgery. She also shares a refreshing perspective about AI adoption in medicine (she’s a Claude and Cowork user), the peptide rush that mirrors the AI rush, and why physicians have to be the guardrail when patients want something just because it’s possible.
Dr. Sturm also shared her perspective on using DocBuddy Op Note and how instant operative reports solved problems that transcription never could.
Links from the show:
Listen to Dr. Sturm’s podcast.
Click to expand and read this episode's transcript.
[00:00:00] Erik Sunset: You became a doctor to make decisions, to walk into a room and have people listen. That’s the job. So what happens when the job stops feeling like that? Today, we’re talking about a kind of burnout that doesn’t show up in the big surveys. Not staffing, not clunky software, but something quieter: moral injury.
Knowing the right call for your patient and watching a system override you anyway. Our guest has seen it from both sides, inside the machine and outside it, running her own practice and doing surgery that changes how people see themselves in the mirror. Here’s the thing nobody tells you about facial plastic surgery.
Sometimes you fix the nose, and the patient still sees the kid who got teased for it. That’s not a technical problem. That’s a human one. Carrying that every day with no switch to flip it off, that wears anyone down. We’re also getting into where AI actually earns its keep in medicine right now, and a very honest gut check on peptides.
This is the difference between we could and [00:01:00] we should. Burnout, boundaries, and why the status quo might just be the old way dressed up as normal. Let’s get into it. I’m Eric. This is the DocBuddy Journal, and today my guest is Dr. Angel Stern.
Erik Sunset: all right. Hello, and welcome back. I’m your host of the DocBuddy Journal, Eric Sunset, and I want to introduce a very special guest today. We’re joined by Dr. Angela Sturm. Dr. Sturm is a facial plastic surgeon based in Houston, Texas. She’s also a DocBuddy Uh, so Dr. Sturm, we’re really excited to get you onto the show today. Thanks for joining us.
Dr. Angela Sturm: Thank you so much for having me. I’m excited to be here
Erik Sunset: Yeah, it’s absolutely our pleasure. I’m excited about our run sheet. Uh, but before we jump into our topics, uh, maybe give our listeners a, a, a firm footing to stand on here. What should listeners know about you before they get your perspectives today?
Dr. Angela Sturm: So I’m a facial plastic surgeon. Like you said, I’m based in Houston. I’ve been doing this almost 15 [00:02:00] years. I specialize in rhinoplasty and facelifts, but I also like to talk about everything about medicine, ’cause I’ve been employed and have my own business and all… lots of different perspectives, so
Erik Sunset: Well, one of the perspectives we’re really excited to get and right out of the gate we’re gonna dive right in, and that’s around burnout and the specialty of plastic surgery. That’s, uh, uh, as you pointed out before we recorded, there are a lot of permutations when it comes to plastic surgery. The permutations with burnout are a little bit different compared to a general practitioner as well. Um, give us the scoop. What are you seeing? What are you experiencing among your peers, with yourself? Uh, what are you seeing happening to plastic surgery?
Dr. Angela Sturm: Like you said, there’s so many different ways that you can practice in plastic surgery. You have from academic, total insurance-based, you know, in a, a system, all the way to, you know, owning your own practice and making all the decisions, but having the stress of hiring and firing and paperwork and all these things.
Dr. Angela Sturm: And so [00:03:00] your s- your source of the stress can be different. And with physicians, I like to think of it more of like moral injury, especially in the systems, because you’re trying to do the right thing for the patient, but the insurance denies it, or you can’t do it in the system that you’re in, or you’re, you know, you’re fighting the system where it feels like the administrative part overrides what your clinical decision is, and it takes away, like, that autonomy that, that we all, you know…
Dr. Angela Sturm: We’re all very autonomous people. We like to make decisions. We like to, you know, we walk in the room, and we’re the ones that are, everyone’s listening to. And so whenever you’re not able to do that, it really takes that part of the job away, and it’s, it’s, that’s where the burnout comes from. And o- on one end, and then on the other end, when you’re fully cosmetic like me, luckily, we don’t have that part of it, but I do have all the running the business and having to hire and fire and find the right people and, you know, all the, the parts that I didn’t ever learn in medical school.
Dr. Angela Sturm: But I think it’s kind of fun and a challenge, but not everybody loves that part of running a business. Um, [00:04:00] but then you also have, like, the emotional part of it, and doing just face, it’s a lot… It ties into, like, who we are as people, how people from the outside see us, how we want them to see us. You know, who, who, who do they see when they look at us, and does that align?
Dr. Angela Sturm: You know, like, I feel like I’m 20 until I’m around people that are 20, and no, I’m not. You know? No, I’m not. You know? You look in the mirror, and these things happen overnight, and you’re like, “Oh, my gosh. Where did this come from?” Or, or you have that conversation with someone of, like, they were teased about their nose their whole life, and so it can be life-changing to have this rhinoplasty, but also, you can always sort of see yourself as that person with a big nose, even though it’s not anymore.
Dr. Angela Sturm: And so there’s a lot of psychology that goes into that, and even whenever it’s, like, a really good conversation with patients and you’re getting into who they are and all these things that I love about it, it, it does emotionally take a lot out of you, and at the end of the day, you feel just, like, drained.
Dr. Angela Sturm: So it’s hard to do that all the [00:05:00] time, um, if you’re not making it like, “Okay, I turn off. I turn off at this hour of the day. I’m not… You know? I need a break.” And, you know, doing that every day can take a lot from you if you’re not really as aware of what it’s doing.
Erik Sunset: Well, that, and that’s, that’s really poignant, and I just wanna flash back to sort of the, the pre-COVID markers of burnout. And you, and you mentioned working for the health system, your autonomy is stripped away. Like, you treat patients how we tell you to treat patients. It doesn’t matter what you think you should do, you’re gonna do it how we say to. So
Dr. Angela Sturm: Mm-hmm.
Erik Sunset: to COVID, it was these very clunky softwares that physicians are, you know, effectively forced to use if you’re a, a, a Medicare provider. You get through COVID, that’s its own type of burnout. You know, in the middle of COVID, you’re, you’re essentially risking your life. Nobody knows what’s happening in the early days of COVID, but you’re still suiting up and going to treat patients.
Erik Sunset: Amazing work, by the way. And then post-COVID, it boils down to [00:06:00] staffing. When you look at the data across all the numbers of different survey, uh, uh, providers and respondents, it’s the staffing. So you go from EHRs to a global pandemic to staffing, and
Dr. Angela Sturm: Mm-hmm.
Erik Sunset: of burnout are not, uh, the same day over day.
Erik Sunset: Um, by and large, burnout is still very much happening. It’s still af-afflicting the entirety of the profession. But w-with what you just shared, the, the moral injury and the moral weight that you carry, I don’t think you’d classify it as baggage, but that’s very different than bad EHRs, lack of staffing.
Erik Sunset: Although you may be experiencing a lack of staffing at, at your practice. I don’t know. I hope not. But, uh, tell– Give us, give us a little bit more there because that’s, that’s very interesting to me, and that’s not data that’s pointed out in the big survey providers
Dr. Angela Sturm: You know, ’cause it’s, you, you have to make connections with the people, with the patients that you’re, you’re treating, you know? And so the better I can make a connection with somebody and figure out what’s going on with them, the [00:07:00] better I can get to the endpoint of how can I help you and, and help you feel better, you know.
Dr. Angela Sturm: Um, and sometimes it’s obvious, and sometimes it not. Sometimes it comes out later where you’re like, “Oh, okay, this person isn’t feeling better because you’re still that person that they’re making fun of.” You know, you’re still that person. It’s like a person with a big mole, like if you take it off, it’s still kind of part of your identity.
Dr. Angela Sturm: And so just try, you know, picking out, okay, what is your identity and can… How much of that changes whenever we changes that, change the outside, and how can we get to that place? And so it’s, it’s mentally a lot, you know, and, and we have to be on. You know, like, there’s no bad days. You know what I mean? You have to be on.
Dr. Angela Sturm: Um, ’cause, uh, every day is a huge life-changing day for our patients, and I don’t, I don’t take that lightly. I know this is a big deal, you know. A rhinoplasty can absolutely change your life, and, um, in the best way. And on top of exactly what you’re saying, like changing EMRs, and then you’re… The staffing changes, and you’re going through changes with [00:08:00] the different surgical centers, which has been something for us is this surgical center opened and this one clo- we had clo- one just closed overnight, you know.
Dr. Angela Sturm: And you had to move all your cases and, you know, it’s something that we’ve all dealt with of all of that all at the same time of the chaos of, “Oh, okay, well, this is, this is not staffed. That isn’t there anymore. This one opened. This…” You know, “Where are we gonna move our cases?” And, you know, all of those things together is a lot.
Erik Sunset: Well, and one of the things you mentioned, uh, prior here before I, uh, uh, s- uh, stepped on your point, so to speak, was you have to turn it off. So what do you do to say, “All right, we’re done with the day,” or, “We’re done with the week. That’s enough of this for now. I have got to think about something else”? I mean, that’s, that’s easier said than done.
Erik Sunset: Not everybody can do that, or people know they should, but maybe can’t. What would be your words of wisdom to somebody hoping to do better there?
Dr. Angela Sturm: I, I just think you have to be very aware of it and of what bothers you. And, you know, it’s a, it’s a [00:09:00] hard line for me, and I work with my spouse, and he has no off button. He … All the time, all day or night, talk about work does not bother him at all. But I, I’m okay. After 5:00 we’re at home, and we’re home with the kids, and this is, you know, this is what we’re doing and being very intentional and present in the moment.
Dr. Angela Sturm: And that’s something I’ve worked on, is being present in the moment with my kids, and this is what I’m doing. And, you know, you’re always on call whenever you do this, ’cause like, you know, we’re always on call. But knowing that’s in the back of your mind, but everything that you can do is what you’re doing right now.
Dr. Angela Sturm: And we’ve had to have discussions of home is home, and work is work, and we have to keep it that way. And, you know, you’ll go to a dinner party and people are like, “Oh, do you just analyze everyone’s face?” I’m like, “No.” No. Maybe some people do, but I’m like, “I’m off, I’m off the clock. No, I … If you want a consult, you can come in
Erik Sunset: Yeah,
Dr. Angela Sturm: I’m happy to.”
Erik Sunset: for that
Dr. Angela Sturm: But yeah, you know, we, uh, we’ll make it really [00:10:00] easy, but like I’m at a dinner party, I don’t really wanna do that right now. And, you know, I’m not gonna look at the, the mole on your left little toe and you know, I have to have boundaries of like, “No,
Erik Sunset: Yeah.
Dr. Angela Sturm: can talk about that later.”
Erik Sunset: You’re, you’re not just a surgery machine, you’re a person, and you’re such a good surgery machine because you take time to unwind and relax
Dr. Angela Sturm: Right. It makes you better and, you know, you have less burnout and you have less mistakes if you’re able to turn off and like, okay, I’m doing the, you know, work at work and home at home, and that’s what we’re doing
Erik Sunset: Well, and on, on that topic, and we’ll pivot away from burnout here quickly, I promise, but one of the, um, recent studies that has come out around burnout for your more, um, I guess your, more of your general practitioner is the ambient, uh, AI note taker. So you open
Dr. Angela Sturm: Mm-hmm.
Erik Sunset: on your phone, maybe one like DocBuddy, and it listens to your conversation with the patient and then extracts, uh, what would be the clinical note, and that’s been a boon for those that have [00:11:00] adopted it to reduce their feelings of burnout.
Erik Sunset: So as far as, uh, the profession of plastic surgery goes, Dr. Sturm, whether we’re talking about an AI tool for you, the surgeon, something for your staff, or something for your patients, what are you seeing happen in your space with AI? Is it useful? Is it useless? Too early to tell?
Dr. Angela Sturm: Well, um, I was actually on a call with some other female facial plastic surgeons on Sunday, and we’re putting to- they’re putting together a panel, uh, about AI, and we’re all talking about the different things we use it for in our practice and it’s so many different things. You know, from the administrative perspective, like organizing our emails, coming up with a job description.
Dr. Angela Sturm: How do you come up with, you know, your KPIs for this position? And so it’s so many things like that. And then like you’re saying, if you have a AI scribe, like that’s something we used to have to pay someone to do. But if you can have a AI scribe and help knock out your notes, ’cause I know that’s one thing, is like you work all day and then you go home and you have to finish your notes and then you’re, you know, put kids to bed and then finish the notes and you’re working [00:12:00] till all hours of the night.
Dr. Angela Sturm: So if you can eliminate those parts of it, it’s huge. And like we were talking, I’ll… I have a morph program where I will take someone’s picture and morph it into what I think it would look like for surgery and, um, something… The patients will take it and they’ll put it into an AI program and come back with a picture, and sometimes it’s really good and then you’re like, “Oh, I like that.”
Dr. Angela Sturm: Uh, like, okay, that’s our surgical goal. And sometimes it’s way unrealistic, you know? And so I think it’s really good with the human guardrails of, okay, here’s what’s realistic, here’s what we can do. This is great. And, and then here’s what you can draw with a computer, but it- we’re not gonna be able to do that with surgery.
Dr. Angela Sturm: So I feel like being able to take some of more of those administrative tasks is huge for us. And then there’s space for in those morphing programs to be able to put some AI in there and so it, it can do some of that a little bit more automatically with us adjusting it with what we know we can do. Um, so I think there’s a lot of opportunity.
Dr. Angela Sturm: Now I’m excited about it. I said as long as we keep it [00:13:00] within the guardrails of what we want
Erik Sunset: Yeah, that’s, that’s the key. Um, it has been fascinating to me. I mean, I have– like I mentioned before we recorded, we have done a lot of these podcast episodes now. Going back through time and looking at the earlier, uh, episodes that centered around just AI, um, it has been fascinating to see how all of medicine has rushed to embrace AI. Whether that’s a good or a bad thing, I think probably good on the whole if you’re doing it the right way. There, there are some kinda sketchy uses for AI that we’d advise folks to steer clear of. Um, but for a profession or for an industry, I should say, that is not always the quickest to grab new technologies, and probably rightfully so, it is amazing how much the, the industry’s clamoring for AI
Dr. Angela Sturm: I feel like it’s the timing, you know, of like our, because of the staffing issues we’re like, how can we do this in a more consistent way, you know, knowing our [00:14:00] staffing may turn over or may not have enough people for this? How can I replace, this person leaves, what can I, what can I use instead that I know is gonna be consistent, you know?
Dr. Angela Sturm: It feels like the timing is right for us
Erik Sunset: I think so too. And, uh, the, the staffing crunch, you know, I had expected post-COVID we’d kinda get back to equilibrium, but it’s tough to hire, it’s tough to retain, and I think you’re totally right that, uh, AI is being adopted, not maybe ’cause there’s a bunch of tech-savvy physicians that have entered the field, but because you have to.
Erik Sunset: You have to do more with less staffing than you’ve ever had. Um, are you seeing the same in your– either at your practice or in your area, Dr. Sturm?
Dr. Angela Sturm: Yeah, and it, like I said, even at that conversation, these doctors were all across the, the US, and we were all kind of having that same conversation is how can we do more with less? How can we… You know, I have friends that they’ve replaced their front desk and their patient coordinator, and one doesn’t have a office manager anymore because she has all these things that are running, and [00:15:00] I’m not there.
Dr. Angela Sturm: But I, I do use it more and more for different things to help just streamline those things and, and make it easier. So I think, you know, it’s probably both. Like, people are more tech-savvy, you know, the younger physicians for sure, and then it’s, it’s a need, you know?
Erik Sunset: Well, I think that’s what’s exciting for medicine. I, I have to pick on it a little bit. You know, the federal government is still a big user of fax machines, and certainly not your practice, Dr. Stern, but other practices might still be pretty reliant on fax machines too.
Dr. Angela Sturm: Yeah
Erik Sunset: adopting AI somewhat out of necessity, but I think there’s a realization that maybe the status quo, we just, “Ah, we’ve always done fax.
Erik Sunset: It’s, it’s okay.” I think there’s a realization across the country that the status quo might actually be the really old way. Like, there’s a lot of good
Dr. Angela Sturm: Right.
Erik Sunset: things.
Dr. Angela Sturm: Right. Lots of
Erik Sunset: that’s fine. Yeah. Sorry I stepped on you there. Go
Dr. Angela Sturm: I’m hearing noises in my head whenever you say facts, you know, like, “Here, you can get that.”
Erik Sunset: Yeah, the 56K modem, the fax machine, all the good [00:16:00] ones.
Dr. Angela Sturm: Right. Yeah
Erik Sunset: before we move on here, you gotta tell me, what’s your favorite LLM?
Erik Sunset: Are you a ChatGPT user? A Claude user? Do you have a favorite?
Dr. Angela Sturm: I’m a Claude user. I– Chat’s okay, but it, I, I like Claude ’cause I can do the co-work, like go in and do this, find this document, you know, organize, give me a to-do list. I’m like, “This is amazing.” I love Claude
Erik Sunset: I th- I think you might have been being a little modest. You’re way ahead of the curve talking about cowork in your practice. Good for you. Yeah, I’m a, I’m a Claude fan myself
Dr. Angela Sturm: Yeah
Erik Sunset: So coming back to, uh, you know, the, the, the reason for the whole discussion, you know, patients. Um, what do you think patients should be most excited about for the near term future of plastic surgery?
Dr. Angela Sturm: I think there’s a lot of technology on the horizon. I think we’re, like, right at the edge of it. Um, we’re seeing a lot with, you know, the anti-aging and, uh, things like the peptides, [00:17:00] which there’s not a lot of data for, but there’s some promise, like some of ’em. Like the GLP-1s, there’s a lot of data for that, you know, but a lot of the other peptides maybe not so much.
Dr. Angela Sturm: And so I think there’s a lot that we can be using. You know, in our practice we do things like exosomes and things like that, that have growth factors in it that there’s more data with. Um, but what… How can we, how can we use these things to age slower? You know, um, we’re not gonna live forever, but how can we have the best lives that we can while we’re here?
Dr. Angela Sturm: You know, look the best we can and feel the best we can. And I, I think there’s a lot in, that’s coming that’s gonna be good, but, um, we ha- we need a little bit more science behind it before we get there. But I, you know, that’s the most exciting thing to me is, like, what, what anti-aging things are out there, you know?
Dr. Angela Sturm: And, and even surgical techniques are always advancing. We’re getting better [00:18:00] results with less downtime and, you know, combining some of those things together. How can we use some of the, for recovery and for, you know, for maintenance after surgery
Erik Sunset: Yeah, the, the, the rush to peptides, that’s kind of the same parallel. Medicine is rushing to AI, patients are, are rushing to pept- rushing to peptides, excuse me, and it’s, it’s kind of the American way in a way, right? Like, just take this pill or just get this injection and it, and it fixes you. And I don’t, I don’t mean to sound cynical, but there’s, there’s real power in these peptides.
Erik Sunset: So does it look like where we wanna be sure we’re, uh, taking good care of our patients, not, uh, causing no harm, uh, but still, I don’t wanna say pushing the envelope, but making as rapid of progress with peptides and understanding them as we can. That’s gotta be a really fine balance.
Dr. Angela Sturm: Yeah, and I think it’s the people that are dispensing them being conscious of what is the science and what, what, like you said, do no harm above everything. That we’re making [00:19:00] sure that we’re not pushing things just because people are asking for it, and it’s out there, and you can do it, but making sure it’s actually gonna be efficacious for them, that it’s not gonna cause side effects that we’re unaware of.
Dr. Angela Sturm: And, uh, I think a lot of it is on the, the physicians and the providers making sure that what we’re offering to patients is the best, you know, that we have done the, the research ourselves and, you know, and being able to do the actual, like, lab research and that sort of thing to make sure this is safe for our patients.
Dr. Angela Sturm: Um, knowing people are asking for it. They want it. You know? We need to keep up. We gotta keep up.
Erik Sunset: Well, I, I think that’s, that’s in line with do no harm. People, people want it, and they want it– they should be wanting it safely and responsibly and, and under a physician’s care. There’s, uh, and this is so silly, maybe I should edit this out after we’re done recording, but there’s a, a recent story online of an individual who sourced their own peptide, and I believe the name of this one was Melanotan, [00:20:00] and it provides a very deep tan, like a shockingly deep tan
Dr. Angela Sturm: Mm-hmm.
Erik Sunset: all over the course of just a handful of injections.
Erik Sunset: And that is certainly pushing the envelope, but maybe not in the way you would hope for
Dr. Angela Sturm: Yeah. We were talking about something like that in the OR, and I don’t know if it was that exact one, but I know there’s one that some of the med spas here have, and it, it will give you a tan if you just do this injection and I’ll… I, you know, it seems pretty wild to me. I think I’m not gonna be rushing to that one, I will tell you.
Erik Sunset: I am not volunteering for that clinical trial, and it kind of brings to mind Jurassic Park. Just because you can doesn’t mean you should
Dr. Angela Sturm: Right, exactly. Oh, oh
Erik Sunset: So on a, on a medical note, Dr. Sturm, I should say a non-medical note, if you have a question about your health, take it up with a licensed practitioner in your state. Uh, but, uh, in terms of plastic surgery, what other kind of thoughts, uh, do you have there? Where can people [00:21:00] find out more about you? Maybe your website?
Erik Sunset: Are you big on social media?
Dr. Angela Sturm: Yeah, you can find me on any of the social media platforms at Dr. Angela Sturm. Um, I’m on TikTok, Instagram, um, and my website is www.drangelasturm.com or our, um, podca- cast is Beauty Unveiled
Erik Sunset: We’re gonna get links to all of those destinations in the show notes. But before we, uh, before we adjourn here today, Dr. Sturm, we’re together, uh, because your DocBuddy user reached out. So excited to get you on the show and wanna all thank you for your time. Um, you are a DocBuddy OpNote user, though, at a surgery center there in Houston.
Erik Sunset: Would love any quick thoughts you have on, uh, on OpNote. And as you rightly pointed out, the surgery center made a choice to deploy OpNote to its surgeons, so, um, hopefully you like it. Uh, I assume at least to a certain degree you’re on the show with us. Uh, but would love any thoughts you have on using OpNote at the surgery center
Dr. Angela Sturm: Uh, it’s been so easy. This has been one of the [00:22:00] things, like I said, the surgery centers have closed, and we’ve moved from this one to that one, so we’ve been to a bunch of different ones. And so it’s made it super easy. Like, I just did the op note for my surgery this morning on my phone before we started, you know, that I can dictate or, you know, I have my templates in there and just make a few changes and it’s done.
Dr. Angela Sturm: And so it’s done in, you know, the few minutes after the surgery’s over, and then it’s sent to my office and the surgical center, and everything’s just taken care of. And it’s so much easier than having to dictate, and then it goes off for a few days, and then it comes back, and for whatever reason, they get the words that I say so wrong.
Dr. Angela Sturm: There’s some of the other ones that I’m doing a lot of editing. And so this has just made it so much easier that I can just knock it out quickly. And, and then if the patient wants, uh, the op note or if we need to send it, is if the patient will file on their own insurance, and they need the op note, so they can get it quickly to get, send that off in, in a timely manner and everything that they need.
Dr. Angela Sturm: And so it’s really [00:23:00] been super easy and very streamlined, and I don’t know. I’ve, I’ve enjoyed using it. I was like, “Oh, this is great.” You know? Solving a lot of problems that we’ve had, um, elsewhere
Erik Sunset: That’s, uh, the kindest words we could get. Thank you, Dr. Sturm. And like, like you said earlier, there’s a lot of, uh, a lot of folks across all industries that maybe don’t realize the status quo is actually the old way. Things should be easier than they are, but they can be
Dr. Angela Sturm: Mm-hmm. Yeah
Erik Sunset: Well, with that, let’s, uh, let’s bang the gavel.
Erik Sunset: Dr. Sturm, thank you so much for your time and joining us today. We will, of course, get links to all of your, uh, destinations and your podcast into our show notes. And on behalf of the entire DocBuddy team, we wanna say thank you for listening. Be sure you’re subscribed on Apple Pods, Spotify, and YouTube so you get the newest episodes of the show. Until next time, I’m your host, Eric. Thanks for listening.