Beyond the to-do list: 8 strategies for physicians

While apps and tech tools such as AI scribes are getting glowing reviews for helping physicians save time, some of the most transformative time strategies aren’t tech-based at all, but involve personal awareness, shifts in mindset and adopting new behaviours.Chris Bailey is an Ottawa-based productivity consultant, and the author of The Productivity Project, Hyperfocus and How to Calm Your Mind. While acknowledging that physicians have particular time-management challenges due to patient load and life-and-death decisions, he believes where possible the more intentional we become with how we spend our time, the more productive we are.“Productivity and time management are both about intentionality. There is usually some autonomy within the constraints that we’re operating inside of. Productivity is about becoming more intentional with how we spend that (autonomous) time, shutting off autopilot and putting more thought into what we spend time on in the first place.”With that in mind, here are some time management strategies from mainstream time management consultants as well as peer physician coaches. Dr. Mamta Gautam is a psychiatrist at the Ottawa Hospital, physician coach and president and CEO of PEAK MD Inc., which focuses on enhancing leadership development. “There is no one size fits all,” when it comes to time management hacks, she said. “Discovering the strategies that work for you is based on reflection, assessment and self-awareness of what takes up much of our time and understanding why.” 1. Simplify, scale back“Everyone will ask you to do more, it’s up to you to guard your time fiercely,” said Dr. Sarah Smith, a rural family physician in Edson, Alta., who runs a business called the Charting Coach and speaks on time management for physicians. “Try to simplify each requested task, fewer words, fewer clicks. Shorten meetings. Ensure there is an agenda ahead of time. What are the questions that need answering? Could this meeting be an email exchange instead?”Part of simplifying is automating repetitive tasks and standardizing repetitive decisions—for example, using templates, wearing the same kind of scrubs every day, eating the same thing for breakfast and lunch, etc. This saves time and helps with decision fatigue.“The most productive professionals consistently push themselves to simplify tasks, and guard themselves from the temptation to over-complicate. They consistently scale back, streamline and seek help,” said Ann Gomez, speaker, time-management consultant and author of Workday Warrior: A Proven Path to Reclaiming Your Time. “You can scale back by deferring certain decisions to others, saying no to certain events, and resisting the temptation to read everything.” Skimming books, papers and blogs is not only OK, it is advisable, she says.2. Single-taskingWhile multitasking can seem efficient, it’s been proven to diminish focus and productivity. Some productivity gurus recommend “task layering” as a safe alternative: for example, reviewing journal articles while on a treadmill, or listening to lectures during a commute. The key is to pair one low-focus task with one passive or high-focus task.“This can work for some people; we need to be careful that we are not actually multitasking,” cautioned Dr. Gautam.“Protect your focus by turning off alerts, minimizing e-mail, setting a timer, and committing to single tasking,” said Gomez. “These focus bursts can be as short or as long as you like.”3. Timeboxing and offloadingAs an extension of single-tasking, timeboxing allocates a fixed amount of time for specific tasks, with no intrusions allowed. For example, a physician could put 30 minutes in a calendar for triaging labs, set a timer and move on when the time is up. This curbs perfectionism and helps avoid burnout by creating mental closure.Dr. Smith recommends creating a task list, which could include, for example, script refills, lab results, patient messages, consult letters, etc.“Keep focused—it’s so easy to be pulled into a rabbit hole of the patient chart when trying to finish a note or do that script refill. If you notice something else while doing the task, make a note and keep going in the task list.”Bailey is a strong advocate of time-boxing for the periods of your day when you aren’t in appointments. It creates an artificial deadline, forcing you to expend more energy over a shorter period of time to meet a set deadline.“One of my favourite tactics for deepening focus is to keep a distractions list. You keep a little notepad by your side, and if you’re hunkered down and focusing on something, whatever else comes to mind, you write it down. If you remember somebody you need to follow up with, or you need to send some email or you need to pick up cantaloupe, write it down to keep your focus and deal with it later.”This strategy is in line with what time gurus call “cognitive offloading.” Use checklists, whiteboards, sticky notes or a simple notebook to externalize your mental load. This helps reduce anxiety and ensures follow-through on tasks that can slip through the cracks in a busy day.Bailey also talks about doing email “sprints.” When you get a pocket of time, set a timer for 10, 15 or 30 minutes, and “blow through as many emails as humanly possible.”Because physicians often don’t control their time, this is a good way to gain back a feeling of control, he says.4. O-H-I-O (Do it now!)“Only handle it once”: It’s not a new concept but one that can be so effective in saving time it’s worth repeating.For example, if you choose to read an email, do the associated task right away. That could mean:Complete it now (if it only takes a few minutes).Delegate it now (if someone else is better suited to handle the task, forward that email, or leave them a voice memo)Schedule it now (if the task requires more time, put it on your task list and/or schedule time to do it)“Busy doctors need to do countless small tasks each day and it’s tempting to defer non-urgent tasks to later. But this approach can quickly lead to a lot of redundancy and wasted time,” said Gomez. ”If we read an email and determine we don’t have time to complete it now, we need to read it again later. This redundant reading can easily cost us an extra 30 minutes a day, 2.5 hours a week, 10 hours a month and 120 hours a year.”Gomez, who has consulted with healthcare professionals, notes that physicians are most effective when they fully focus on updating charts in real time between patient visits. Trying to recreate this thinking at the end of the day or week will take far longer and can feel both overwhelming and less enjoyable.5. Align tasks with energyUltradian rhythms are the cycles our bodies go through: We have periods of alertness followed by a dip in energy, when the brain needs to rest and recover. Those periods of alertness are usually about 90 minutes, although knowing your own rhythms is key. Physicians often override these dips in energy but honouring them with short breaks can restore mental clarity.Consider when you are most alert (e.g., 8 a.m. to 10 a.m.) and reserve that time for critical thinking tasks like documentation, diagnoses or challenging conversations. A 10-minute pause every 90 minutes to hydrate or breathe deeply can dramatically improve cognitive performance.“Ultimately, we all benefit by understanding our unique chronobiology,” says Gomez. “Then we want to match our work with our energy fluctuations. Specifically, we want to match our hardest tasks with our peak energy. Early birds want to protect focus time early in the morning. Night owls may shift their clinic hours to start slightly later than others, then protect time later in the day for their deep work.”Dr. John Crosby, a retired GP who coaches physicians on time management, is a strong advocate of getting up early to get in exercise and tackle things like paperwork before appointments and other distractions and demands begin. “Getting up early is the biggest time-saver for me,” he said, “because no-one else is around.”The notion that early-risers are more productive has gained popularity recently, with people embracing the “5 a.m. club.” However, Bailey says research shows there is no difference in productivity and success between early birds and night owls.“We all have different energy peaks. There truly are some of us that are natural night owls. There’s some who are natural early birds. It’s a normal distribution, with most of us clustered in the middle. So work around your own rhythms and your own constraints.”6. Setting prioritiesSetting priorities and routines keeps us focused and helps to manage expectations with others. But of course, physicians need to be flexible when urgent needs arise.“The most effective professionals create a plan for their week, with time protected for clinical work, practice management, team support and focus work,” said Gomez. “They are also realistic about the number of tasks needing their attention each day and avoid overscheduling themselves. There will always be exceptions and unexpected curveballs—especially in medical practice. But even if you have a few ‘off’ days, once you have a routine in place, you can always get back on track.”And remember that unplanned tasks will come up each day, so your actual discretionary time is quite limited. Leave yourself some breathing room.7. DelegateMost physicians know they should delegate, but sometimes it is easier said than done.Dr. Crosby suggests delegating administrative tasks as well as psychological or marital counselling to social workers or psychologists where possible. He recommends knowing and using services to refer patients, such as diabetes programs, COPD and CHF clinics, where patients can get information and support.Says Dr. Smith: “Recognize the ‘non-physician’ tasks you are asked to do and see if you can hand these back to the appropriate team member. “For instance, ‘Mr. Jones is asking for an earlier appointment.’ Give the front desk staff permission to let him know that you are fully booked, he has the earliest appointment. Alternatively, if they have a wait list, they can put him on it. You don’t need to hear about this request.”While physicians can often take an “It’s faster if I do it myself” approach, Gomez says, “Remind yourself that the upfront investment in training quickly pays off.”And of course, Dr. Crosby recommends outsourcing home cleaning, getting a nanny and delegating other home tasks, either to a hired professional or even to kids.8. Take breaks/self-careMany physicians push themselves a lot each day, commonly skipping lunch and breaks. The reality is we all function better when we take breaks, which allow us to come back to work more refreshed and focused.“Take a break at 10 a.m. and 3 p.m. and go for a walk around your building. Or get up and stretch and shake your sillies out. Do yoga and meditation,” said Dr. Crosby. “Take a weekend off alone once a year. Go to a nice hotel, order room service, turn off your phone, laptop, text and emails. Watch TV until your eyes turn square. Get a manicure and pedicure and massage. Sleep PRN and read fat books. Do nothing.”Dr. Gautam agrees. “Make sure that you prioritize self-care. This is an investment in yourself that allows you to be better available for everyone and everything else,” she said, adding that research says for well-being we should be spending at least 20% of our time doing something we love. “It’s important to regularly review this and ensure that we are making it happen,” she said.In conclusion, for physicians, effective time management is less about doing more and more about doing what matters most—with clarity, intention and energy. Through awareness, tasks or processes that don’t work can fall away, and a new habit or two can help physicians work a bit smarter, protect wellbeing, and sustain meaningful patient care.

Beyond the to-do list: 8 strategies for physicians

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