Practice management: Taming time

It’s a surprise to no one that most physicians are busier than ever these days: admin work, COVID patients, vaccinations, pandemic protocols, staff shortages . . . did we mention administration work? Faced with an increasing workload, many physicians, especially those starting out, simply throw more hours at the situation. The problem is, it’s unsustainable and contributes to resentment, dissatisfaction, boredom and burnout. Self-care is abandoned. Many doctors are naive to some basic time management strategies because they never had to rely on them before,” said Dr. Hema Patel, who wrote The time management guide: A practical handbook for physicians by physicians with Dr. Derek Puddester in collaboration with the Royal College of Physicians and Surgeons of Canada. Read: 6 tips for better billing Dr. Patel, a pediatrician and associate professor and division director of general pediatrics at McGill University faculty of medicine, likens it to a dimmer switch. “Doctors are, by selection, intelligent and hard-working, so many have a delayed need for task-selection skills. Faced with an increasing number of tasks, most just dial up the switch—albeit at higher use of their ‘power.’ It’s not until the switch can go no further that they are forced to triage tasks for completion—while their (non-doctor) peers may have had to do this in high school or university, and so have much more practice. Experts say the secret lies in understanding that it is all about awareness and behaviours, not finding more minutes in a day. Dr. Patel, who says she and the Royal College plan to update the 183-page, 2012 guide this year, has three key pieces of timeless advice (expanded upon in the book). Identify your priorities based on your goals and values. Proactively organize your daily operations at work and at home (to own your schedule, with your goals and values in mind). Avoid self-sabotage behaviours (like perfectionism and procrastination). Time management also means preserving your energy and taking care of yourself. For these challenging times, Dr. Patel suggests physicians: Accept the uncertainty. Deal with change, especially sudden change. Manage the many distractions of our digital world. Choose tasks that are meaningful to you, where possible. Invest in your own health and personal happiness. Find ways to experience joy daily. Admin work Dr. John Crosby, a family physician in Cambridge, Ont., has written extensively about time management and even has a video about how to love paperwork. “Many doctors hate paperwork because they don’t schedule time for it and get distracted when doing it,” he said. “The way around that is to make an appointment with yourself and do it every weekday, no exceptions. Turn off all distractions. Managing administrative work, and time management in general, can be harder for physicians just starting out, said Dr. Patel. Read: Legal column: Imaginary patients Dr. Stephanie Zhou, an FP and addictions physician, who has been in practice for two years, agrees. “Young people starting off are trying to be nice, and (are used to being a resident) when they couldn’t say ‘no.’ Especially women, they try to have good relationships with their patients and saying ‘no’ can be tough. Even now, I find as a minority woman, I am asked to do various diversity talks or workshops. Obviously, you want to try to help the team, be a team player,” said Dr. Zhou, who is also a lecturer at U of T on financial literacy for med students and residents. “But sometimes it takes up a lot of time and you’re unpaid. There are times when I’ve asked, ‘Oh, is this funded?’ And they say, ‘No, but it’s good for your CV.’ They don’t realize you have to cancel clinic (losing wages) and use up (evening and weekend) time to prepare. People don’t usually think about how valuable your time is and that your time is money." So, her advice falls into four categories: get paid, time block, get help, set expectations—and don’t buy into others’ urgency. Get paid In addition to asking to get paid for talks or workshops, Dr. Zhou advocates for paid administrative time to be baked into contracts, so admin work is less likely to creep into unpaid personal time. “I think a lot of newly graduated residents, including myself, don’t manage time well,” she said, “especially around admin work—checking labs, checking consultant reports, calling patients back, refilling prescriptions. So at least negotiate paid administrative time.” Time blocking Time blocking is not new, though it has been popularized lately by such authors as Cal Newport. Benjamin Franklin is said to be the first known time-blocker. He made a schedule every day and blocked off hours at a time to engage in “deep work” (and he didn’t have the distractions of buzzing phones and pinging computers). It’s something Dr. Zhou said has helped her, along with the book Atomic Habits by James Clear, which discusses improving small daily habits to manage time and improve your life. Get help “A lot of times new grads feel like they can do it all and they have to do everything themselves,” said Dr. Zhou. “In fact, you’re actually working as a team. There are nurses, other providers in the clinic who can help out.” Checking labs can take a lot of time, said Dr. Zhou, because young physicians have a lot of anxiety about missing something urgent. “In my practice, I have a nurse practitioner who might follow up on urgent labs. For people who don’t have someone to do that for them, they can always inform the lab to notify them if there are urgent results. Read: Solve my problem: How do I know when it’s time to retire? Set expectations When it comes to time blocking, Dr. Zhou said it is especially important to not only block out times for deep work, but to have some discipline around weekends. “On Sunday, I don’t do any work at all. I also set expectations with my patients very early on. I tell them that I’m only working at this clinic on this day and that day.” Dr. Zhou is a proponent of the urgent/important matrix (first outlined by Stephen Covey in The 7 Habits of Highly Effective People.) The idea is to create four quadrants of what’s urgent and important; urgent but not important; important but not urgent; and neither urgent nor important. The first, of course, is at the top of your to-do list, while “important but not urgent” can be put off. “Not important, not urgent” you just don’t do. What about “urgent but not important”? Those are the ones, Dr. Zhou says, to be particularly wary of: They are usually tasks that others have made urgent, but aren’t really important to you. “If someone is giving you a task and it seems super-urgent and superimportant, it’s often because they procrastinated. But it’s their urgency, so it’s not actually important to you. Similarly, Dr. Crosby advises, to save time, don’t let the patient control the appointment. “Let them talk without interruption, then direct the appointment and solve their problems together with them,” he said. And have an exit strategy. “Stand up and walk patients to your assistant to do labs, imaging, a consult or an Rx.” Dr. Patel says that physicians who are having trouble taming their schedules shouldn’t despair. “It’s never too late: Even if yesterday was totally out of control and today feels like it is off the rails, there are lots of ways that we can invest in ourselves to make tomorrow more efficient, less stressful and most importantly, more joyful. Find the methods that work best for you.” Read: Getting back to in-person

Practice management: Taming time

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