_34_ You Dont have a time management problem - you have a priority system failure
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[00:00:00] I work with a lot of amazing physicians and get to coach. Many of them, and most of them don't have any problem with time. They have problems with priorities, with boundaries, with figuring out what to do when they are amazing people, amazing physicians. They take great care of patients. They take great care of colleagues.
Their clinics are full, their operating rooms are full. They win awards, but their inbox is never empty. Somehow it feels like all the time is getting away from them. Their goals are not getting where they wanna be. They keep working hard. They keep thinking that the brass ring is coming and they handle everything that comes up them.
There's so many things that come at us, the inbox, the EMR, the results, the never ending patients, and yet the things that really are supposed to move us forward. The manuscript that doesn't get written or the research direction that's not clear or the niche, which we can't clearly articulate or we know, but we haven't done enough so that other people can [00:01:00] see it.
And we haven't built the national reputation that we hoped would start take shape, but somehow has not yet. And we assume that the problem is time. Everyone says it. I say it. I don't have the time. I didn't take the time. I didn't prioritize the time. It doesn't matter how enlightened we are about time.
We all think it's about time. I need less clinic. I need to take more vacation. I need things to slow down. Or next year, it's just this year, it's a phase. I have said this so many times. I can tell you the people in my life have told me it's not a phase. It's the way you've built your life. But I didn't believe them.
It's a phase. It's not a phase. And my calendar tells the story. If I look at it and I do a time audit and I see where do I spend my time? My days are full, but my priorities are not on there. So if it turns out that what I really wanna do is build a national reputation in orthopedic surgery, being a left thumb doctor, I know I just put up my pinky, but you know.
Then I need to actually write about the left thumb and do [00:02:00] my research about the left thumb and give my talk about the left thumb instead of doing stuff that's about every digit and every appendage and all the things you can do in orthopedic surgery. That's how you're gonna figure out who I am, but I need to decide what my priority is, and then I need to set my calendar so that those things are reflected.
And if I have an academic day, I need to use it for academics instead of giving it up to see one more patient because my wait list is six months. But you know what? Seeing one more patient does. It makes my wait list five months and 30 days. I mean, it doesn't help. You cannot fix the system by giving up your discretionary time.
And so the way to move forward, the way to love this career, the way to enjoy what you're doing is to take the time that we're given. Back to the original premise, which is, how do we make sure that we get our priorities taken care of? It's not really just about the time, the problem's, not the work.
It is the priority system. And so when we get into academic medicine, we learn how [00:03:00] to be great doctors. We hopefully learn how to be great colleagues, great team members. Maybe we learn to be great educators, but what we don't learn is how to limit things and how to set boundaries or priorities. One of the best examples is this was somebody I was talking to the other day and they were absolutely using their inbox as their to-do list.
They would accept meetings, they would, run off to the latest concern that somebody had. They would answer the list, patient call, and maybe that they worked on the paper that somebody else thought was a priority, but not the one that moved their career forward or really was interesting to them.
I have another client who is fantastic and he is writing this guideline that he feels obligated to write, he knows is important. It's not what you would love to do, and it's hard to make it so that you really wanna spend your time on the things that you don't enjoy as much. So your administrative time gets repurposed and you do more patient care than you want to, and then that little time that you have, which should've been administrative time now, gets gobbled up.
And so then you take personal time to do some of that administrative stuff for the [00:04:00] academic stuff, and then that feels bad. And none of this happens in isolation. Nobody ever gives us the opportunity to step back and ask a different question. What am I doing right now that will move my career forward?
Is there one thing I could do every day that would keep this whole thing moving in the direction that I care about? That gets me excited, that makes me wanna wake up in the morning. That makes me wanna write the paper or do the research or just see the patient In clinic, without a priority system. Everything feels urgent, and that's the reason we don't have that priority system is that everything is urgent and we don't realize that we can take a minute and step back and find the time to work on the things that are important. Now, I work at a job right now where we work in an insurance field, and I can tell you so many urgent things come down the pike.
And finally I realized I just had to change my mindset. I work in a trauma center in my brain and I expected the emergency every single day, and so I just planned for it. I know that what I have to do is [00:05:00] start the day with the thing, which is important but not urgent, or else it will never get done. And then if I get to the end of the day and we haven't had an emergency, it's amazing.
I'm so excited. It's a mitzvah. And if you know the emergency shows up at 4:47, then you take care of it at 4:47, you say, oh. There you are. Okay. This is how it's supposed to work. And why all this matters is that if you do not set those priorities, your reactive work becomes all of your work. It's what's visible.
You answered that EMMR message. You finish your clinic notes, you answer the email. It fixes the immediate itch, right? It rewards what everybody else is looking for. You got asked to do something and you delivered, but strategic work or that work that gives you priorities that's different. It's quiet. It takes time to show results.
It doesn't get fixed today. I can do a step today. I can be showing you that there's progress over time, but it's unlikely that whatever I do today is the end point. [00:06:00] And so if you're really highly motivated, you may be delaying this. You cannot see the immediate dopamine hit. And people will tell themselves like I did.
Oh, this is a season. It's gonna slow down. I'll have time. It's very uncommon for that to happen. And the people who are most successful are those who say, research is my priority, or this clinical outcome stuff is my priority, or these educational curricula are my priority. But whatever it is, you need to take the time to do it.
And the thing to know too is that delay is not neutral. That means that over time it's gonna cause problems. It's gonna be the reason that your promotion doesn't happen in the timeframe you thought it would, or your CV isn't as focused as you hoped it would be, or you just feel frustrated and you can't articulate.
You feel like you're not moving forward, but you can't say what the thing is. And maybe you don't like research, you just like teaching or you like academics because you really enjoy administration or just helping patients in a way that's complex. All of that can be scholarship, but you need [00:07:00] to be intentional about it or else all of that is reactive work.
On paper, physicians can look very successful, but internally feel like something is completely off. They may be in leadership positions. They may be on all the committees, but they may not feel like they're going to the place that they want to go. And this is exactly where my team comes in and helps work with people to find the thing that got them excited in the first place.
What's the niche that you want? What is the thing you wanna be known for? What's the problem you want to solve? Why did you get into academic medicine in the first place? If it's 'cause you love teaching, let's get you teaching. If it's because you love research, let's give you time to do and answer the questions that you wanna answer.
If it's 'cause you wanna take care of the most complex patients, then take care of them and write up the experience. And that's what keeps us really successful in academic medicine, is connecting the thing you love with the thing you're doing. Commitment accumulates. We're on the committees, we're writing the papers we don't care about
we're mentoring the people in the wrong area, [00:08:00] or the wrong discipline, or doing the wrong thing, the thing that doesn't feed our soul, and it's not because we're careless, but it's because nobody gave a framework to protect what matters Most. Burnout often shows up in this place, but it's not the root problem.
The problem is that our time being spent without strategy and priorities. So the framework that I teach is that we're juggling three kinds of work now. The first is deep work. I think we've all had this, hopefully you probably experienced this in medical school. It's when you really got in the zone and you were able to study and learn and think.
It's writing, it's data analysis, it's strategic planning. It's getting that curriculum going. It's making the perfect presentation or medical student lecture. The work matters, but it needs boundaries or expounds endlessly. Collaborative work is the other thing. It includes teaching and mentoring and working with colleagues.
And here I'm gonna say again, work with the people you like or else you're not gonna wanna do the collaborative work. But this work matters. And again, it needs to be limited. And then there's reactive work. That's the emails, the [00:09:00] EMR messages, administrative tasks, you know, your to-do list that comes from your email list or your tasks that come from your texts if you still get texts.
It's necessary, but it is dangerous when it is all that you're doing because you lose your purpose, you lose your vision, and you start forgetting why we did this in the first place. Now most of us are amazing at this reactive work. We can take care of that gutless like there's no tomorrow. And collaborative work that gets scheduled may happen, but oftentimes it gets pushed off because then you have to coordinate schedules and that deep work, writing, synthesizing, creating that, you know, magnum opus, that is what usually gets deferred.
A real priority system allows us to do all three. You know, you have the reactive work. You just need to find time for it to start and stop, and then schedule the collaborative time so it actually happens, and give yourself some real periods for deep work, not 30 minutes between cases, which rarely works for most of us, but some time that actually gives you an hour or two.
And quite honestly, up to four hours [00:10:00] would be amazing if you could really sit and think and get in the zone. No interruptions, no checking your email unless you have a system set up to do that too. And so time needs to be put on the calendar. It needs to be scheduled so that it's explicit and the rules around it are important so that people know, don't bother me in this time.
These are the boundaries. So I have an example, and I work with this amazing surgeon named Kay. He's deeply dedicated to patient care. He loves what he does, but he really loves teaching, whether it's teaching patients or teaching medical students or residents, but everything in his inbox. His feels like a to-do list.
It all becomes instantly stuff that he moves literally over to another list and it's consults and emails and requests, and everyone makes him feel responsible and pulls him away from the things that he really wants to get done from the academic side. So he gave up his academic day. He didn't set the meetings with the students.
They would email him and he'd say, I'm too busy, I'm too tired. I'm six months behind. I have all these people. He has the weight of all these people to take care of, and he [00:11:00] never used it. In fact, he looked at his calendar, he wasn't even using his vacation days. Those were going away. He was losing them. And yet, in a single coaching session, something interesting happened.
When I asked what he actually cared about, he had no problem articulating. He could tell me how much he loved education. He could tell me how much he loved this area that he was doing research in. And he knew the talk that he wanted to give his big signature talk. He could describe the reputation he wanted to build and the people he wanted to serve.
But none of that was new. It just wasn't on his to-do list. And the issue was not clarity, it was permission. Once we reframe the fact that administrative time was protected, deep work rather than leftover time, it wasn't optional. It's not time to give away for another patient to be seen, it's time to move forward.
The things that really drove him, and he loved, you know, he was doing the research, which maybe didn't drive him as much, but the work with the residents and the fellows and the students that did. And so if he could devote that time to things he cared about, the meetings with them, the [00:12:00] mentoring, the tutelage.
It once again gave him the opportunity and allowed him to give himself permission to stop apologizing for thinking that he was using this time as wasted time, or that it was optional, and he began aligning his work with what mattered most and moving that forward. Now, how does this apply to you? If you are headed into quarter one already, feeling behind start here.
Stop asking how to fit more in. Stop looking for more time. Actually think about what needs your time and space over the next 90 days? What do you wanna accomplish? Do you wanna finish the paper? Do you wanna get the grant written? Do you wanna work on that curriculum? Do you wanna just meet regularly with the students and the residents and fellows and move the task forward because they're the thing that you're passionate about?
I want you to think of a primary outcome, and I want you to look at your calendar and make some protected time, and then figure out how you're gonna carry it out. You don't need permission to stop everything. You just need a framework to decide where you can carve out some space and prioritize yourself.
So remember [00:13:00] that these priorities are not static. They require revisiting. You may be great at whatever you were deciding to do two years ago. It just may not fit what you wanna do now, and you don't need to work harder and you don't need to find more time. And you don't need to wait for next year when everything's gonna be different 'cause it won't be unless you change things.
So please work with me in helping create a priority system. If you did not decide your priorities, you realize you inherit everybody else's in that to-do list in that EMR box in the meetings you end up going to, so the start of this quarter is one of the few moments when that pattern can be interrupted.
If it already feels full and you haven't quite decided what you wanna do, please join us on January 12th where we're gonna do a 90 day strategy sprint where we talk about how to do this. We come up with a plan so that you can walk out the door ready to tackle this quarter. This is not a productivity session, it's a working session, deciding how to move forward and what doesn't move forward.
So you can get everything you wanna get done this quarter. So please join me, and if this was useful for you, please share this with a friend. [00:14:00] Subscribe wherever you're watching or hearing this. If you wanna get in touch with us, please find [email protected] and we look forward to talking to you soon.
Can't wait to talk to you next week.
