For physicians, some of the most dramatic consequences of chronic disease are seen at the end of the road: a myocardial infarction, stroke, organ failure, or an admission to the intensive care unit. The clinical event may feel sudden. The processes that contributed to it often were not.
After more than 25 years in healthcare, Dr. Tessa Damm’s experience treating critically ill patients led her to look further upstream at insulin resistance and healthspan — and at what physicians can do to support their own long-term health and career longevity. Her experience in Internal Medicine, Critical Care Medicine, Neurocritical Care, and Lifestyle Medicine eventually led her to focus more of her professional life on metabolic health and prevention. During a recent episode of Pacific Companies’ The Doc Lounge Podcast, she spoke about insulin resistance, mitochondrial health, nutrition, healthy aging, and the personal experiences that changed how she thought about medicine.
But there is another story running alongside the metabolic one.
Dr. Damm also reconsidered what she wanted her own career in medicine to look like. She reduced her full-time ICU workload and began dividing her time between critical care and preventive metabolic medicine—a change that raises an important question for healthcare professionals: Can the principles we apply to healthspan also influence how we think about the longevity of a medical career?
For physicians who spend their working lives caring for others, the intersection of metabolic health, personal wellbeing, and career sustainability may be worth examining.
What Is Insulin Resistance and Why Does It Matter?
Insulin resistance occurs when cells in tissues such as muscle, fat, and the liver do not respond to insulin as effectively as they should. As insulin sensitivity declines, the body may compensate by producing more insulin to maintain glucose homeostasis. Over time, insulin resistance can contribute to metabolic dysfunction and increase the risk of developing prediabetes and type 2 diabetes. (NIDDK)
For Dr. Damm, however, the importance of insulin resistance became much more personal.
She describes a convergence of three experiences: decades of caring for critically ill patients, dramatic changes she noticed in her own health after modifying her nutrition, and the loss of her mother after years of declining health. Together, those experiences prompted her to look at chronic illness through a different lens and ask how disease might be addressed much earlier in its progression.
That shift—from treating identifiable disease to identifying risk before a major clinical event—sits at the center of preventive medicine.
Rather than thinking only about whether a patient currently meets diagnostic criteria for diabetes, cardiovascular disease, or another chronic condition, the broader question becomes: What metabolic processes may already be moving that patient toward disease?
The distinction matters because insulin resistance can exist before diabetes develops. The National Institute of Diabetes and Digestive and Kidney Diseases notes that insulin resistance is an important risk factor for type 2 diabetes and metabolic syndrome, even among individuals who do not yet have diabetes.
For clinicians accustomed to treating what can already be diagnosed, this earlier window presents an opportunity to think more proactively.
Looking Beyond Glucose: What a Lipid Panel May Tell Us
One of the more practical parts of Dr. Damm’s conversation centers on laboratory data many patients already have.
She discusses fasting insulin and fasting glucose, which can be incorporated into measures such as HOMA-IR, but also points listeners toward the familiar lipid panel. In particular, she highlights the relationship between triglycerides and HDL cholesterol, referring to the combination as a patient’s “metabolic signature.”
The triglyceride-to-HDL cholesterol ratio is calculated simply:
Triglycerides ÷ HDL cholesterol
Research has explored the TG/HDL ratio as a potential surrogate marker associated with insulin resistance and cardiometabolic risk. It should not, however, be treated as a universal stand-alone diagnostic test for insulin resistance. Associations and useful thresholds can differ across populations, and interpretation belongs within a patient’s broader clinical picture.
That nuance is particularly important for healthcare professionals. The value of the conversation is not necessarily in replacing established screening or diagnostic criteria with one ratio. Rather, it is in encouraging clinicians and patients to consider what routinely collected laboratory information may reveal about metabolic health before disease becomes more advanced.
Dr. Damm’s larger message is to look upstream.
Healthspan vs. Lifespan: Living Longer Is Only Part of the Goal
Modern medicine has become increasingly effective at extending life. But additional years do not automatically mean additional years of good health.
That distinction is behind the growing interest in healthspan.
Although researchers do not use one universally standardized definition, healthspan generally refers to the portion of life spent in good health and free from significant disease, disability, or functional limitation. Lifespan simply describes how long a person lives. (PubMed Central (PMC))
The difference becomes meaningful when considering what most people actually want from longevity.
The goal is rarely to accumulate years for their own sake. People want the ability to remain mobile, cognitively engaged, independent, energetic, and capable of participating in the activities and relationships that make those additional years valuable.
That makes healthy aging much broader than the absence of a single diagnosis. Musculoskeletal function, cognition, metabolic health, cardiovascular health, independence, and physical capability all contribute to how those later decades are experienced.
For physicians, it also offers an interesting reversal of perspective. Much of healthcare necessarily focuses on diagnosing and treating disease. Healthspan asks what can be done before the patient reaches that point.
As Dr. Damm describes it, our healthcare system has become extremely good at assessing and treating disease once it is identifiable, while leaving less room for helping people optimize health before disease develops.
Mitochondrial Health and “Speaking the Language” of Metabolism
Mitochondria are central to cellular energy production, converting nutrients into energy that cells can use. That biology is familiar territory to physicians. Translating it into behaviors patients can understand is more challenging.
Dr. Damm approaches the subject through what she calls “speaking the language of your metabolism.” (Pacific Companies)
Her point is that metabolism is extraordinarily complex, but everyday behaviors still provide signals that influence it. Nutrition, movement, muscle use, and other lifestyle factors do not operate independently of physiology; they interact with it continuously.
That framing helps bring an abstract discussion about mitochondria back into everyday life.
Patients may not be particularly motivated by mitochondrial function itself. They are more likely to care about maintaining energy, preserving physical capacity, remaining metabolically healthy, avoiding preventable disease, and continuing to do what they enjoy as they age.
The clinically useful question then becomes less “How do I optimize my mitochondria?” and more “What repeated behaviors support better metabolic and physical function over time?”
Three Practical Strategies for Supporting Metabolic Health
One strength of Dr. Damm’s discussion is that she moves quickly from physiology to practical behavior. Her recommendations are not framed as a complicated biohacking regimen. Instead, she focuses on several changes that can be incorporated into everyday life.
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Prioritize Protein and Protect Muscle
Muscle becomes increasingly important when the conversation shifts from weight alone to healthspan.
Skeletal muscle supports strength, mobility, physical function, glucose utilization, and the ability to remain independent with age. Preserving muscle therefore requires more than simply watching the number on a scale.
Dr. Damm emphasizes adequate protein intake alongside resistance exercise as part of maintaining muscle over time. Protein supplies the amino acids necessary for muscle protein synthesis, making nutrition and physical activity complementary components of healthy aging.
For physicians counseling patients, the larger takeaway is useful: body composition and functional capacity matter. An aging strategy focused exclusively on body weight can overlook one of the tissues most important to maintaining physical resilience.
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Minimize Ultra-Processed Foods
Dr. Damm’s views on nutrition were shaped partly by her own experience during postgraduate medical training.
Like many physicians, she found that demanding schedules made convenience an important factor in food choices. Foods needed to last, travel easily, and fit into long days at the hospital. When she later shifted toward less processed foods, she noticed significant changes in her own health and laboratory results.
That experience will likely feel familiar to many healthcare workers.
Telling a physician working nights, weekends, 12-hour shifts, or unpredictable call simply to “eat better” ignores the environment in which those decisions occur. Convenience is not an abstract preference when someone has limited opportunities to eat during a shift.
For clinicians, sustainable nutrition may therefore require designing around reality rather than chasing perfection: making minimally processed foods easier to access, planning protein-forward options, and reducing dependence on foods chosen primarily because they can survive indefinitely in a work bag.
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Walk After a Meal
Perhaps the simplest recommendation in the episode is also one of the most actionable: move after eating.
Dr. Damm recommends a short walk after the largest meal of the day. Research supports the broader concept. Systematic evidence suggests walking soon after meals can reduce postprandial glycemic excursions, with timing after a meal appearing particularly beneficial. (PubMed)
Other controlled research has similarly found that postprandial walking can improve glycemic responses following meals, including among individuals with impaired glucose metabolism.
For busy healthcare professionals, the appeal is obvious. Not every health intervention needs to require a gym, a 60-minute training session, or a perfectly controlled schedule.
Ten minutes of movement after dinner may be far easier to repeat consistently than an ambitious exercise routine that rarely fits into clinical life.
When Working in Healthcare Puts You in “Survival Mode”
This is where Dr. Damm’s discussion becomes especially relevant to physicians.
Metabolic health may be the clinical theme of the episode, but her experience in critical care exposes an uncomfortable contradiction: healthcare professionals routinely encourage patients to sleep adequately, exercise regularly, eat intentionally, manage stress, and maintain consistent routines—while working within systems that can make those behaviors remarkably difficult.
Dr. Damm describes full-time ICU work simply as “survival mode.”
The description is easy to understand.
Critical care can involve long hours, weekends, overnight work, rapidly changing sleep schedules, emotionally difficult cases, limited opportunities for regular meals, and days structured around the needs of acutely ill patients rather than the needs of the clinician. Dr. Damm specifically discusses flipping between days and nights and struggling to optimize her own nutrition while working that schedule.
The issue extends beyond the ICU. Emergency medicine, hospital medicine, surgery, obstetrics, and many other specialties can create similar challenges depending on call expectations, staffing, workload, and scheduling structure.
Physician wellness is therefore not only a question of whether clinicians know what behaviors support good health. Most physicians already do.
Sometimes the more important question is whether their practice environment makes those behaviors realistically sustainable.
Leaving the ICU Without Leaving Medicine
Dr. Damm ultimately did not choose between critical care and preventive medicine. She redesigned her relationship with both.
She continues to practice in the ICU, but on a reduced basis, while devoting more of her professional time to metabolic health. She describes the contrast as “survival versus thriving.”
That distinction applies to her patients, but it also offers a useful way of thinking about physician careers.
Medicine does not have to follow one predetermined path from residency through retirement.
A physician’s interests at 35 may not be identical to their interests at 50. The call schedule that once felt manageable may become less appealing later in life. Family circumstances change. Professional priorities evolve. Some physicians discover new clinical interests, while others decide they want more teaching, research, administration, leadership, telemedicine, locum tenens work, or simply fewer shifts.
Changing the structure of a career does not invalidate the years invested in building it.
It may be what allows that career to continue.
Physician Career Longevity Is Part of the Healthspan Conversation
At Pacific Companies, we spend a great deal of time talking with physicians about what they want from their next opportunity.
Compensation matters. So do specialty resources, organizational reputation, patient volume, location, and opportunities for growth.
But increasingly, the details that determine whether a position actually works for a physician’s life can be just as important:
- What does the call schedule look like?
- How many weekends will be required?
- Is the physician able to control or predict their schedule?
- Does the organization have enough clinical and administrative support?
- Is part-time or flexible scheduling available?
- How much autonomy does the physician have?
- Does the position leave room for life outside of medicine?
Those are not secondary questions.
They can determine whether an opportunity remains satisfying and sustainable five or ten years later.
The healthcare industry often discusses physician burnout after it has already occurred. There may be value in applying the same upstream thinking Dr. Damm brings to metabolic health.
Instead of waiting until a physician reaches the point of complete exhaustion or leaves clinical medicine entirely, what could change earlier?
A different call structure might help. A four-day clinical week might help. Locum tenens could offer greater control for some physicians. Another healthcare organization may provide better support. A hybrid career could create room for teaching or leadership. A move to a different community may align better with a physician’s life outside of work.
There is no universally ideal physician career model. The goal is alignment.
Is It Time to Rethink the Way You Practice Medicine?
Physicians considering a career change do not necessarily need to ask whether they still want to be physicians.
A more useful set of questions may be:
- Is my current schedule sustainable for another five or ten years?
- Which parts of my work still energize me?
- Which parts consistently drain me?
- Has my definition of professional success changed?
- Would less call, fewer shifts, or more schedule control improve my quality of life?
- Am I still choosing this practice model, or have I simply never reconsidered it?
- Could another setting allow me to practice medicine in a way that is more sustainable?
Dr. Damm’s story is a reminder that a career can evolve without being abandoned.
That may mean leaving full-time ICU practice. It may mean accepting a permanent opportunity with better balance. It could involve locum tenens between longer-term roles, reducing clinical hours, transitioning toward leadership, or building a career that includes several different forms of medical work.
The objective is not to prescribe one version of balance.
It is to recognize that physicians have options.
From Survival to Thriving
There is a compelling symmetry to Dr. Damm’s career.
In the ICU, she treats patients at one of the most vulnerable moments of their lives. In preventive metabolic medicine, she works much earlier in the disease trajectory, when the objective is to help people maintain health and potentially avoid some of those outcomes altogether.
Both forms of medicine matter.
But taken together, they make a larger point: we should not have to wait for a crisis before asking what needs to change.
That is true when thinking about metabolic health. It may also be true when thinking about a medical career.
Healthspan asks us to look beyond the number of years someone remains alive and consider the quality and function contained within those years. Physicians can apply a similar lens to professional longevity.
The goal should not simply be to endure medicine until retirement.
It should be to build a career that remains meaningful, sustainable, and compatible with the life you want to live along the way.
Listen to Dr. Tessa Damm on The Doc Lounge Podcast
Hear the full conversation with Dr. Tessa Damm on The Doc Lounge Podcast for a deeper discussion of insulin resistance, metabolic health, mitochondrial function, nutrition, healthy aging, and her transition from full-time critical care into a blended medical career.
And if Dr. Damm’s story has you reconsidering what the next chapter of your own medical career could look like, Pacific Companies works with physicians across permanent and locum tenens opportunities nationwide. A different specialty setting, schedule, organization, or practice model may provide the flexibility you need to keep doing the work you value—without spending your entire career in survival mode.
Frequently Asked Questions About Insulin Resistance, Healthspan, and Physician Wellness
What is insulin resistance?
Insulin resistance occurs when cells in the muscles, fat, and liver do not respond to insulin as effectively as expected. The pancreas may compensate by producing additional insulin to help regulate blood glucose. Insulin resistance is associated with an increased risk of prediabetes, type 2 diabetes, and other metabolic abnormalities. (NIDDK)
What is healthspan?
Healthspan generally refers to the years of life spent in good health and without significant disease, disability, or functional limitations. Unlike lifespan, which simply measures how long someone lives, healthspan focuses on how well someone is able to function during those years. Researchers continue to use somewhat different operational definitions of healthspan. (PubMed)
Can a lipid panel provide clues about insulin resistance?
Research has investigated relationships between triglycerides, HDL cholesterol, and insulin resistance, including use of the triglyceride-to-HDL ratio as a potential surrogate marker. However, the ratio should be interpreted in clinical context rather than used as a universal standalone diagnostic test.
Does walking after meals help with blood sugar?
Evidence suggests that physical activity performed after eating can help reduce postprandial glucose excursions. A systematic review found that walking soon after a meal generally produced a greater acute benefit for postprandial glycemia than exercising before eating or waiting longer after the meal. (PubMed)
Why is muscle mass important for healthy aging?
Skeletal muscle supports strength, mobility, metabolic function, and the ability to perform daily activities. Maintaining muscle through adequate nutrition and physical activity becomes increasingly important with age as part of preserving physical function and independence.
How can busy physicians support their own metabolic health?
Realistic strategies may be more sustainable than attempting a complete lifestyle overhaul. Regular movement, resistance exercise, nutrient-dense foods, adequate protein, sleep protection when schedules permit, and even short post-meal walks can all become components of a larger health strategy. The specific approach should reflect an individual’s health status and medical needs.
What career options are available to physicians looking for more flexibility?
Depending on specialty and professional goals, physicians may explore permanent roles with reduced call or alternative schedules, part-time clinical work, locum tenens, telemedicine, administrative medicine, teaching, leadership, or hybrid careers that combine several types of work.
Can locum tenens improve physician work-life balance?
For some physicians, locum tenens can provide more control over when, where, and how often they practice. Others may prefer the predictability and long-term relationships available through the right permanent position. The best model depends on the physician’s personal priorities, financial goals, specialty, and desired lifestyle.
This article is intended for educational purposes and does not replace individualized medical evaluation, diagnosis, or treatment.
