I see this pattern constantly.

Clinically excellent physicians. Well respected by colleagues. Busy clinics. Full operating rooms. Teaching awards. Committees. An inbox that never empties.

And somehow, every quarter ends the same way.

They worked hard. They showed up. They handled what came in. And yet, the work that actually advances their career never quite happened. The manuscript is still half written. The research direction is still vague. The national reputation they hoped would start to take shape somehow did not.

They assume the problem is time.

“If I just had one less clinic day.”
“Once things slow down.”
“After this year.”

But the calendar tells a different story.

Their days are full, but their priorities are invisible.

This is not a discipline issue. It is not a motivation problem. And it is not burnout. It is something much more predictable.

What’s Actually Missing

The problem is not the work.

What’s missing is a priority system.

Academic medicine trains us to be excellent clinicians and reliable colleagues. It does not train us to decide, explicitly and defensibly, what deserves our limited time and attention.

So priorities default.

The inbox becomes the to-do list. Meetings get accepted because they feel important. Requests get handled because we are capable. Administrative time gets repurposed for patient care because that feels more legitimate.

None of those decisions are wrong in isolation.

The problem is that no one ever taught us how to step back and ask a different question:
Which activities actually move my career forward, and which ones simply keep the system running?

Without a priority system, everything feels urgent. Everything feels personal. And the work that requires thinking, planning, and restraint gets pushed aside.

Why This Matters More Than You Think

When priorities are implicit, reactive work always wins.

Reactive work is visible. It is rewarded socially. It generates immediate relief. Someone needed something, and you delivered.

Strategic work is the opposite. It is quiet. It takes time to show results. It often feels self-indulgent in a culture that values service, availability, and responsiveness.

So even highly motivated physicians delay it.

They tell themselves they will write when things slow down. They will define a research niche after this clinical push. They will think about leadership when they feel less behind.

That delay is not neutral.

Over time, it leads to stalled promotion, diffuse CVs, and frustration that is hard to articulate. On paper, the physician looks successful. Internally, something feels off. Leadership wonders why progress has plateaued. The physician assumes they just need to push harder.

This is how overcommitment accumulates. Not because people are careless, but because no one gave them a framework to protect what matters most.

Burnout often shows up here, but it is not the root problem. The root problem is time being spent without strategy.

The Framework I Teach

Time is not something to manage. It is something to align.

Every academic physician is juggling three types of work, whether they name them or not.

Deep work is the work that advances careers. Writing. Data analysis. Strategic planning. Thinking about where your work is headed and how it fits into a broader narrative.

Collaborative work includes teaching, mentoring, and meetings that require judgment and synthesis. This work matters, but it needs boundaries or it expands endlessly.

Reactive work is email, administrative tasks, and fire-fighting. Necessary, but dangerous when it dominates.

Most physicians manage reactive work well because it demands attention. Collaborative work gets scheduled because it involves other people. Deep work is what gets deferred.

A real priority system does three things.

It names what actually matters this quarter, not just this year.
It protects time for deep work before the calendar fills itself.
And it creates rules for what gets a yes and what gets a no.

This is why protected time fails when it is not paired with priorities. Time on the calendar without clarity gets reclaimed by urgency. Good intentions are not enough.

A functional priority system is explicit. It is written down. It is defensible. And it is revisited regularly.

This is not about doing less. It is about doing fewer things on purpose.

A Real Example

K is a fantastic surgeon. He is deeply dedicated to patient care and genuinely loves teaching.

But everything in his inbox instantly became his to-do list.

Consults. Emails. Requests. Each one felt reasonable. Each one felt necessary. And each one pulled time away from thinking about where his career was actually headed.

He had administrative time built into his schedule, but he never felt comfortable using it for planning or writing. There was always one more patient. One more case. One more consult.

And yet, in a single coaching session, something interesting happened.

When I asked him what he actually cared about academically, he had no trouble answering. He could clearly articulate his niche. He knew the type of Grand Rounds talks he wanted to give. He could describe the reputation he wanted to build.

None of that insight was new. It had just never made it onto the to-do list.

The issue was not clarity. It was permission.

Once we reframed administrative time as protected deep work rather than leftover time, his behavior changed. He stopped apologizing for thinking. He stopped treating strategic work as optional. He began aligning his weeks with what he said mattered.

Nothing about his workload changed. His priorities did.

How to Apply This Now

If you are heading into Q1 already feeling behind, start here.

Stop asking how to fit more in. Ask what actually deserves space in the next 90 days.

Write down three outcomes that would make Q1 feel successful if nothing else happened. Not tasks. Outcomes.

Then look at your calendar. If those outcomes do not have protected time attached to them, they are not priorities. They are aspirations.

Next, decide what you will stop carrying forward. Many Q1 calendars are overloaded because last year’s commitments quietly rolled over without a decision.

You do not need permission to stop doing everything. You need a framework to decide.

Finally, remember that priorities are not static. They require revisiting. The goal is not perfection. The goal is intentionality.

This is the difference between being busy and being strategic.

The Truth

This is not about working harder or becoming more disciplined.

It is about recognizing that without a priority system, time will always be consumed by what is loudest, not what matters most.

If you do not decide your priorities, you inherit them.

The start of a quarter is one of the few moments when that pattern can be interrupted.

What to Do Next

If Q1 already feels full and you have not clearly decided what actually deserves your time, pause before momentum takes over.

The beginning of a quarter is a brief window to reset priorities instead of inheriting them. That is what we will work through together in the upcoming 90-Day Strategy Sprint.

This is not a productivity session.
It is a working session focused on deciding what moves forward, what does not, and how to protect the work that actually matters in the next 90 days.