Podcast 47 You dont have a time problem_ you have a decision problem
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[00:00:00] Hello and welcome back to the Academic Medicine Strategy Podcast. Yes, I said it slow because I wanna make sure I don't say the wrong name, which it used to be the Medical Mentor Coaching podcast, and I said that for almost two years, and that is because my 60th blog came out this week and my 47th podcast, and I am super excited that I've had that many, to be honest
I also realized. Looking at this camera that I think I have eyeliner on one eye and not the other. So if anybody else pulled it together better than me today, don't feel bad. And I'm still doing a podcast, without knowing how to put my own makeup on. Welcome. And today we're gonna talk about decision problems instead of time problems.
So almost every single one of us has felt like I don't have enough time. I need to find more time, and I want to talk to you about why it's not possible, but there are ways to address it. If this is you and you're working 78 hours a week and your outcomes are good, you work well with your colleagues, your residents like you, your patients like you, [00:01:00] you're doing well by all of the productivity terms, and yet you feel like you're falling behind.
In fact, when you look on your to-do list, you're absolutely falling behind because the stuff that's on there is not. Finish my EMR notes. See a lot of patients in clinic. Go to the operating room, get along well with the staff. Like those don't make it to my list at least. But what you have there is the manuscript draft that's been sitting there for months or the grant that you think you might wanna write, but now you're not even sure you wanna write anymore.
And you haven't necessarily figured out if you've got a national reputation or a local reputation or how the heck to get either of those. And so every week you think I'm gonna work on these things. Every week consumes your schedule. I work with a physician coach who is my business coach, and I love the fact that she asked me.
And the whole room, what we were lying about in our schedule, and I was lying about things for sure. Every week I wrote this one thing down that I was gonna get done, and I never got it done. I just moved it to the next week and moved it [00:02:00] to the next week. And every week I assess what'd I do, and every week I'd be like 0%, 5%, 2%.
Like I'd finish other things really simply. Like the three things are supposed to be the three things you get done every single week. And I just kept lying to myself about it. So if you're finding that it's the manuscript or the grant, or. The curriculum that you're lying to yourself about, then this is the time to say no more.
And I really wanna make sure that you understand that you are not the problem. We are great at working hard. I am sure you're working hard. I've not yet met a doctor. Even the lazy ones or the ones people think are not committ. BS. By the way, every single one of 'em had to work their butt off to get to where we are.
And whether they have your idea of what a schedule should look like or not, there are no lazy doctors. But there is so much to manage. There is complex care and teaching people and sitting on committees and finishing the EMR and getting the notes done and making sure that your staff feels [00:03:00] supported and bringing the brownies for whatever you're doing on Tuesday.
It's what also on top of that, somehow keeping our lives going outside the hospital. And so the prayer problem is not that we're not working enough hours or that we haven't found the time, the problem is we're not working on the right thing during those hours or figured out how to prioritize the work that's gonna move our careers forward.
And that's 'cause most of us are constantly working in reactive mode. We are doing all that reactive work and we're great at it. So I talked about the Eisenhower Matrix last week. It's the stuff that's urgent and important. It's the patient questions, it's the clinic appointments, it's the procedures that we have to get done.
Those are important. There may be some meeting requests that creep in there or some administrative demands, and it's the stuff that's due today. So we do department coaching and we need some data in order to figure out like, what do you need? And are we adequately giving it to you? And so we have some assessments, so we ask people to fill out, and we have a couple people who haven't filled them out yet, and it was [00:04:00] hilarious.
My chief of education today said, oh my gosh, I sent this to somebody. And they sent it to their administrator and their administrator sent it over to 'em and was like, fill this out today. And they did and she's been sending it like every week for weeks. And it was just funny because I was like, oh yeah, the urgency like urgent, important work.
We're so tuned in to making sure that happens, that they needed to it to be urgent in order for her to get it. She's this is crazy. I gave people four weeks. I got very little. She's I gave people four days. I got a ton. Like, why do doctors need urgency like this? And it's 'cause we are stuck in this reactive mode.
'cause so much of our work lives there. But the stuff that moves our career forward, and I don't just mean promotion, 'cause promotion's great, but many of us has been promoted and we still have things that we want to do and that we want to accomplish. So it may be the manuscripts that you wanna get out in the world, it's the disease you wanna figure out.
It's the clinical questions you wanna make better. It's the patients that you wanna say, here's a better way to take care of things. Maybe you do wanna build your promotion case and you want to have that narrative story that you can explain to somebody. But [00:05:00] when you're in reactive mode all the time.
It's so easy to postpone that strategic work. Not 'cause you don't value it, but because those urgent demands always feel more pressing. I worked on whatever felt most urgent. And I'm gonna tell you, early in my career, I did not have a systematic approach to this.
I couldn't figure out how to use my time. And some days I felt so productive, but it was oftentimes, 'cause I finished the notes and I responded to the emails and I got to all the meetings and I felt like I accomplished something, but none of that was gonna get me promoted.
And I don't think I even understood that at the time. And other days I worked just as many hours but couldn't point to anything meaningful that I had completed. And maybe there was some research stuff I did, but maybe it was just me doing all this reactive stuff and entering your email box.
Sounds great. It never gets you promoted, and so I see a clear pattern. I was confusing motion with progress. I was working hard but not strategically. And the breakthrough came when I realized that time management is not actually about managing [00:06:00] time. You cannot create more hours in a day, and I'm gonna say that again.
You cannot create more hours in a day. All you can do is manage your own decision making and where you put your energy so you can decide to advance whatever deserves your limited cognitive energy at the time you have it working best, and I've talked about this before for me, I know that I am at my sharpest in the morning and that is sad 'cause I am not a morning person, years of surgery I've had to get there.
I've also realized I can get more done in that time than I can in other times of the day. I used to spend an hour and a half working on something at night that I could get on done in 30 minutes in the morning. So save those 30 minutes, savor those 30 minutes. And that shift allowed me to build a body of work that got me from, assistant professor to full professor in 10 years.
But it got me from associate to full professor in three because I had figured out how to plug into that and to gear up. And I was getting 20 to 30 papers out a year, and I was still seeing patients and I was still doing administrative [00:07:00] work and I still had children and I still had a spouse. And I saw my friends and I had a drink every once in a while.
But without that structure, I would've been stuck in that reactivity forever and not gotten that done. And the real crisis for me and for I think for many is decision load. So I know even now, I hit a point in the day where I have decision fatigue. I've made more decisions than I can actually, comprehend.
And the worse my decisions become as I move through that day and I feel more and more over overwhelmed or full. In terms of brain power, because there's emails that require responses and patient questions and EMR like chats and there's all kinds of ways to get in touch with me and there's just so many of them.
And I love the dopamine hit of zero, but really I get more and more tired. And every request that needs some evaluation is an interruption from whatever the big task is that I'm trying to get done. And it drains your cognitive resources. An academic medicine [00:08:00] maximizes decision load by design.
Clinical work is externally scheduled. Everything else requires constant micro decisions. Should I respond to this hour or later? Should I do this test or that test? What should I do with this result? What's the newest antibiotic? Is there some research I should do to figure this out? Should I work on that manuscript?
Should I write the grant? Should I get, finish my notes? Should I prepare for tomorrow? Like it's never ending? By the end of the day, you were exhausted, not just from the work, but all the decisions you had to make. In fact, I'm gonna tell you, sometimes I could barely decide what I wanted to have for dinner, and I know it frustrated the people in my life.
What do you wanna do? Where do you wanna go? What do you wanna eat? All I wanted was not to make a decision. Like I literally, and it's interesting, I used to say this, my wife is you say you don't wanna make a decision, but then I make a decision and you're like, no, I don't want that. And I think all I was able to come up with was veto power.
Like I just didn't have the energy to make a decision, but I knew what I didn't want and it wasn't very fair to the people around me, but I just couldn't make another [00:09:00] decision. And so the physicians who advance strategically are not working harder than you. They have built systems that reduce that decision load.
If you've seen some of the papers out there, they talk about men and women and how men actually spend less time in the EMR. One of the reasons they think that happens is 'cause they have more help. So there's fewer of those decisions they have to make, which means that by the end of the day, they might have a little bit more capacity to send that one more email that's gonna help move their academic life forward.
Or to do a paragraph of that paper they've decided in advance that gets their best cognitive energy. And hopefully they've designed their schedule around a time that they can use that cognitive energy when they're at their best. They protect that strategic wa time. The way we protect clinic time.
So it's not about discipline, it's about structure. And here's the other thing I wanna tell you. Finding time. I hear it all the time. I just need to find time to do this. I just need to find time to write. I just need to find time for strategic planning. I just need to find time to work on my grant. You will never find time.
Time [00:10:00] is not lost. It is allocated. Every hour of your week is already spoken for. I bet you could look at your schedule and be like, I'm trying to squeeze some little time here or there. Meetings happen, teaching happens, procedures happen, your clinic happens, and we don't even have email time figured in there results time necessarily.
So the question is not how to find that additional time, but how to allocate the time that you have to the things you find most important. And you need to do three things in order to do that. Identify what actually matters for your career trajectory.
Is it the grant? Is it the paper? Is it the teaching schedule that work before reactive demands? Fill your calendar and while I do this every Sunday, you might need to do it a month ahead of time so that there is some time in your calendar and protect that time the same way you would your clinical time.
Now, most physicians never do the first step. Just figuring out what matters for your career trajectory. And that is the first step in the framework that I teach so that everybody understands in our academic Kickstarter, [00:11:00] what's important for you, what do you need to do that's gonna move your career forward?
And then you need to write it down and develop a plan. But many of us have not identified what needs to happen, and those vague intentions are gonna fail because they aren't concrete plans and there's so much reactive work. So let's talk about the three types of time that determine your career.
We've talked a lot about reactive work, and this is responding to all those incoming demands. We are used to this. We're great at this. It feels urgent because someone else is waiting for a response. But most of it is actually not critically important. No one's gonna die in the next two hours if I don't look at the pathology report for the normal tonsil.
Okay. And if it's important, like if there's a cancer diagnosis, if there's, a metabolic disorder, it depending on what you're looking at, sure. Some of that's very important, but are you the only person who can look at it and figure out? Probably not. Now the next time a work is collaborative work and this needs real time interaction 'cause it's involving other people.
It's collaborative. [00:12:00] And this could be teaching or mentoring or research meetings. It is valuable and necessary, but it is externally scheduled for many of us unless you are the one driving all that. So it does involve coordination with other people's schedules and you wanna be careful with this, that you don't take your best time and give it away for collaborative work unless that's really where you spend most of your deep work.
And then the third, and this is the most important one, is deep work. This is the stuff that's demanding that you have to think through, that you're like, Hey, I'll figure this out in the morning because I can't really think through it right now. Requires sustained uninterrupted focus. This could be data analysis, it could be writing the grant, it could be writing the paper, it might be writing the talk.
But this is what builds your academic re reputation, and this is what moves your career along. This is what gets you promoted, and for most of us. We do not have the abilities to do this in those quick five to 10 minute gaps we have between an OR case or between the clinic or after we're done with our notes, but before lunch is over.
So [00:13:00] the time crisis happens when that reactive work consumes all the hours and especially the hours that we had set aside for deep work. And I see this when people give up their administrative time for all that reactive stuff, for all that administrative stuff, for all the clinical stuff. To me, the most important thing for you to be able to accomplish and get promoted and move ahead and get the leadership position and get the grant is to block the time and defend it.
And it's non-negotiable except for genuine emergencies. And I do not mean meeting the gut scheduled two weeks ago. That's emergency. That's not an emergency. Your career, we don't want it to become one, but for some of us feels like an emergency. So deep work deserves this, really strong focus.
So one of the things I do is I put writing blocks on my calendar before I fill it with anything else, and they're at least two hours long. 'cause any shorter, I find that I end up, not getting immersed. And I've talked about the pomodora technique, which can be shorter blocks, like 25 minutes, and then five minutes break
and those can work great for some people. I find that at the five minute [00:14:00] break, I'm like, oh, I just wanna get a little bit more done. So for me, I like a little bit longer block, but if you like the shorter blocks or you find an hour is perfect or four hours perfect, play with it. Figure out what works.
And the key is not to put this at the end of your day. So some people, and unless that's your great time, okay, so I feel like I am the smartest from two to four in the afternoon, then do something else in the morning, finish your reactive stuff, and then be like, here's my block for me. I've had enough decision fatigue by then that it's not my best block.
I do better in the morning. And I also wanna make sure you're not giving your academic time back to clinic overflow unless there's true emergencies. Administrative B time is not a buffer for catching up on notes. You can find other times, or if you can't, let's work together and I can help you. But if your calendar says, write the manuscript, or write the grant, or write the talk, make sure it happens during that block.
It is not selfish. And if you feel like it's selfish, I really wanna reassure you. You picked this job. To be able to do this kind of work. And quite honestly, you were hired because your boss, or the dean or the [00:15:00] division director believe in your ability to do this kind of work and want you to be successful at it.
So don't feel like this is something that's hurting the department or hurting your patients. This is what you wanna do. This is strategic resource allocation. And the other thing to think about is that collaborative work. Put it in some dedicated blocks. Maybe all your collaborative meetings are all on the same day or all in a row, and try to batch them if you can.
That can be awfully useful. Or even better, if you have a lab meeting, try and get everybody to come into the same meeting so everybody can learn from each other and they can go in and go out if they don't need there to be there for the whole thing. I have at some points in my career, try to squeeze those in between cases in the operating room or in between at lunchtime.
And if that works for you, it's okay. Do what works. But it's nice if you can actually find some time that really puts it all together. And then reactive time try and contain it in specific blocks. And so the best example I can give is email. My email is not open during the day.
I actually have removed a lot of it from my [00:16:00] phone and I only check it at certain times. And the reason for that is otherwise I just live in my email and somebody else's to-do list becomes my to-do list. In fact, if they send that email to five people, oftentimes one of the other four people has finished or fixed or figured out whatever it was that got emailed, and I only have to do a limited number of things from that email list.
So I check it two or three times a day. I do it first thing in the morning. I usually do it around lunchtime. I do it at the end of the day, but I don't let it interrupt my deep work or my collaborative work. Most administrative requests can last a few hours, but the key here is to make sure if people know that if there's an urgent thing, don't send me an email.
And figure out what you want. Do you want a text? Do you want a teams message? What works in your world? Do you want a page? If you still have a pager? But the shift is not about working more hours, it's about architecting the hours that you already work around, the outcomes that matter to you. So here's what I recommend that you do this week.
If you're caught in that time crisis right now, the solution does not work harder. It's not defined the time. Again, that time is not lost. [00:17:00] The solution is to build a structure that protects strategic work. So I want you to identify one piece of deep work, an outcome that requires some deep thought that would be meaningful to advance your career.
And if you did it consistently, like manuscript writing or grant writing, or abstract creation, identify one and then schedule at least one block this week. Ideally two hours, but at least one to work on it, and then decide exactly what you work on during that block. Not work on research. Or work on grants, but draft the discussion section for the outcomes paper and then treat that time like clinic.
It's not negotiable. Put a sign on your door or tell people you're not gonna be answering for the next hour in the teams chat that you have with your folks. Or just let your admin know, unless it's really an emergency. I'm gone for an hour just like you would for a case or a clinic. And then I want you to track whether it actually happens.
If the most important thing that happens is you're like, I put this on my calendar and it didn't happen, and I'm gonna diagnose y, [00:18:00] that is valuable time for you to figure out how to make it happen next time, because you wanna build a sustainable system where strategic works happens routinely instead of sporadically.
Promotion does not happen because you work the most hours. It happens because you built the work that demonstrates that trajectory and that impact. So give yourself the opportunity to do the deep work that moves you forward. It doesn't have to be a ton of time, it just has to be intentional, and that's step number one where you figure out what you need to do in order to move your career for forward is critical.
And if you're stuck there, let me know because myself or one of our coaches can absolutely help you figure that out. And if this is a problem in your department, not just for you, talk to your chair or faculty development leadership about bringing systematic time protection to your institution. Through our faculty excellence and retention initiative, it provides department wide frameworks so that strategic work is protected institutionally, not left to your individual willpower.
And if you're a chair or a dean, learn more @medicalmentorcoaching.com/feri, [00:19:00] or a new website, which is coming soon, which is amedsg, so amedsg.com/feri For FERI, ask your leadership to implement intentional onboarding and strategic development systems that work. And if you need help, please reach out.
We're happy to give a hand. Thank you so much for joining me on the Academic Medicine Strategy Podcast, and I excited to be celebrating our 60th blog and our 47th podcast and hope that this was useful. If it was, please rate and review the show so others can find it and pass it along to a friend or colleague who might benefit.
Thanks.
