Time Mastery for High Achievers

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Time Mastery

Our most valuable resource is time. It cannot be renewed or replenished. Once it is gone, it is gone forever. No amount of money can buy back wasted time. Let’s focus on how to use this precious resource.

You have already mastered many of the skills required for effective time management. This article highlights some aspects that you may not have considered. We can improve our skills.

Why Bother?

Calculate your compensation per minute. This analysis can be detailed or a simple back-of-the-envelope estimate. Take your entire annual income and divide by the number of work weeks. Fifty-two weeks minus two weeks of vacation minus two weeks of continuing medical education equals 48 weeks. This results in your weekly net earnings.

Divide by your average hours worked. Include administrative work, clinical education, and teaching. You may or may not choose to include commute time.

Many surveys show the average physician works at least 60 hours per week. An income of $250,000 divided by 48 weeks equals $5,208.00 per week. Divide that by 60 hours per week, which equals $86.81, and divide by 60 minutes in an hour, which equals $1.45 per minute.

Every Minute Counts!

You now have a value placed on each minute. Is it worth spending 10 minutes talking to a drug representative or two hours in a committee meeting? It would help if you weighed this against the value received.

“Does thou value life? Do not squander time for that is the stuff life is made of.”- Benjamin Franklin. 

Historically, food and money have been scarce. In the modern era, time is the scarcest and most valuable of all resources, whether at home or work. It pays to assess its value and monitor where it goes.

Multitasking

There are limits to multitasking. Some studies show that women are better at multitasking than men. A University of Michigan study showed that multitasking reduces efficiency. Switching between tasks takes time and mental energy.  Instead, focus 100% on a single task and then move on. The efficiency of multitasking is a myth.

Delegate

Professionals and other experts often have a tough time with delegation. They tend to be perfectionists. Giving a task to another individual may result in an inferior product or service. Because of this, they feel compelled to do everything themselves. The problem is that they may obsess and spend too much time on a trivial task. They also may increase their stress and lead to burnout.

Another more general principle behind this comes from David Ricardo. He was the economist who explained the concept of comparative advantage. It states that you should be doing only what you are best at. Although you may be a better typist than your scribe, you should still let them type. Even if it is slower and has more errors, it allows you to perform a detailed history, physical exam, or surgical procedure. You may be twice as good at typing but 50 times better with medical evaluations and procedures.

You and Only You

Do only tasks that need a physician with your expertise. It is tempting to want to make your photocopies, for example. This behavior is undoubtedly encouraged by office staff who see you as “down to earth” and not too much on a high horse. It is not that the task is beneath you. Focus on tasks that can only be done by a specialized physician.  You should work to the “top of your license.” Staff often misunderstand this concept.

Get Some Help

Full-time employee (FTE) can be expressed as a ratio per doctor. For example, your practice may have two FTE per physician or three, four, or five. What is the correct ratio? This depends on whether each added employee improves the efficiency of your work. Seeing patients with two nurses may improve your patient volume. It likely covers the extra overhead.  If only one LPN could perform all the tasks, then two R.N.s would reduce your efficiency. See  MGMA reference guides for more information.

APP (Advanced Practice Providers)

Physician’s assistants, nurse practitioners, scribes, and room fillers may improve your efficiency.  If you are doing things that others could, then stop. Find someone else to do them. Let’s say writing prescriptions takes three to five minutes per patient. You are seeing 40 patients per day, so that takes 200 minutes per day. At $1.45 per minute, this results in a $290 daily expense that a medical assistant might better perform.

Injection supplies and other materials should always be available. A nurse or clinical assistant can draw up medications, which saves time.

Corporate Culture

It pays to have employees who are self-motivated and value time. A physician and office administrator serve as leaders and role models for the rest of the staff. Encourage your workers to improve the current processes. Include a reward for innovation.

Measure Results

Relative value units (RVU) can be used to look at individual or practice output. There are other methods of practice output, many of them financially based. An RVU is the best accepted and uniform method to help quantify production. One should review RVU per hour and how they change over time. Look at process improvement that could increase productivity.

Adding patient rooms often improves efficiency. Working out of one room is likely to be more costly than working out of two or three. Several studies have been done in this regard. The office can process several patients at once. Motivated employees can boost patient volumes. This is true for both office and operating rooms.

Scheduling

Several scheduling issues can help with time efficiency. Consider a modified wave schedule. This groups patients rather than seeing all rechecks or all new patients. For example, try double or triple booking slots. You can book a new patient with a recheck and then two rechecks followed by two new patients.

It pays to have a policy for lateness, implement it, and enforce it. If the staff and patients know you will not see a late patient, you won’t run behind because of a tardy individual. Starting early encourages efficiency.

Many patients like to be seen at seven or 7:30 in the morning, before their workday. When they come, they tend not to be late and enjoy a rapid visit since they are eager to get to work. You can see more patients in less time, early in the morning. There are also fewer interruptions at that time of day.

Charting

Dictating in the presence of a patient in the room is practical. Many skilled and experienced physicians have begun to do this. In our training, we are always dictating or charting outside of an office after seeing the patient. That’s how we trained.

It is better to dictate in the presence of the patient. They can correct any errors in your understanding. Ambient A.I. technology (e.g., DAX-E) is making this easier. You spend more time with the patient. The patients often are impressed that you are using such knowledge to help them.

Procedures

It would help if you did a Pareto analysis using the 80/20 rule. If you look at how you spend your time, one-fifth of the time likely accounts for 80 percent of your income. For example, it may be one procedure that accounts for 55 percent of your income. Adding one or two of those cases can likely double your income. Further information on Pareto analysis and the 80/20 principle can be seen in Mr. Koch’s book “The 80/20 Principle”.

That analysis will encourage you to focus on what you enjoy and are good at. This will lead to a more outstanding quality of life and more income. Focus on the area of your comparative advantage. That will benefit all who interact with you.

The Vital Few 

A Pareto analysis will show that a handful of activities account for most of your income. It pays to focus on those services. It may mean you need to increase your charges on other services that are not yet as rewarding. Those services could then become more rewarding.

Or the extra cost may discourage others from referring those procedures to you. This allows you more time to focus on your high-yield prospects.

Off Work

It is important to use time wisely off the job as well. It is important to schedule activities that you find enjoyable. List the top five or ten activities that you enjoy. What have you found fun in the past or recently? Schedule more of those into your weekly calendar. 

You will see a spike in your quality of life. We often think that we will do fun things automatically. But often, work, life, kids, or fatigue interfere.  We function best by scheduling the fun as well as the work.

Having an inbox at home can help to be a collection point for various activities. This can include bills, thank-you notes, and other projects. Many people use a home office or a desk as an area to work on side projects. Without an outbox and inbox, information gets scattered. It ends up across the top of the desk.  It becomes a time waster to search for items.

File Well

It is helpful to have a filing system at home and work. Process every piece of paper as it comes in. Many people find that they never refer to files. Periodically, they need to be reviewed so they can be trashed.

Having a place for every item and imposing order in your home and office will save countless hours.

Move Your Body

It is essential to exercise. Increased strength, oxygen, and energy will decrease depression. It allows you to be more effective. During exercise, you can also mentally process some of the things you have done or need to do. Some people can read, listen to audiobooks, or listen to music while exercising. This may be an exception to my advice to avoid multitasking.

Sleep, but how much?

Doctors have often cut their sleep to the bare minimum or less. Many of us now feel guilty about how little we sleep. The media belabors the epidemic of sleep deprivation. We know from our internship and residency that we can make do on very little sleep. Recent studies have supported this.

On average, individuals perform well, without harm, in the six to seven-hour-per-night area. Sleeping more than eight hours decreases health and efficiency. Financial success correlates with a low number of hours of sleep per night. See if you can get by on six or seven hours per night.

Do it Now?

I highly recommend David Allen’s Getting Things Done.  Steven Covey’s Seven Habits of Highly Successful People is also excellent. Covey prioritizes whether what you are struggling to get done needs to be done in the first place.

Read with Speed

Speed reading course can be helpful. Evelyn Wood is the original founding course and is still available in many cities. There are many other variances thereof that can improve your reading rate. The long-term reading rates will increase modestly with these courses.

A 10 or 20-percent improvement in your reading rate will save hundreds of hours per year. You may find an app like Speechify that helps you read faster. The average clinician spends nearly four hours per week reading. Many spend more than that.

A 10 percent improvement in a 240-minute-per-week activity results in 24 minutes. When converted to our $1.45 per minute, it equals $34.08 per week times 48 weeks, which equals $1,670.00. This is well worth the cost of any speed-reading course.

The Three D’s

When you grab an item, decide which D to apply. Do it, Delegate it, or Dump it.

Miscellaneous techniques and tips include the “only once” method. Touch a piece of paper from your inbox or a piece of incoming mail only once. This is better than looking through it and setting it aside for later. Often, setting it aside will be the first of many times to pick it up, looking at it, thinking about what to do about it.

It is easy to spend 15 minutes on one piece of paper without putting that into the flow process. Touching it only once will avoid that.

Rip (or Clip) & Read

You can use the “rip and read” method to keep up with modern events and advances in the medical literature. After getting a journal or magazine, find one or two articles of interest and rip them out. Staple them and put them in your briefcase or other area that you can carry with you. Speed read those articles when stuck in traffic or on the subway.  Flipping through a magazine will waste several minutes on advertisements or irrelevant articles. Establish a similar process for digital versions.

Sitting in Your Car

Commute time is often overlooked. Our practices often have branch offices, and you can focus on a hospital or office nearer to your home. Consider relocating to improve your commute. The move will often pay itself many times over, and the time spent for wasted commute time. Cutting your commute from 60 to 30 minutes would result in one hour of time savings per day. This is five days a week or 240 hours per year, given that you are working 48 weeks per year. Two hundred and forty hours equals 30 days of an 8-hour workday or one extra month per year. Imagine the success, achievement, income, or fun of one extra month yearly. That is the dramatic impact that a change in commute can make.

University on Wheels

Do not overlook audio learning and audiobooks. Don’t talk or text while driving. Listening to an audiobook passively can be very useful. It is also effortless to tune out the audiobook if you need to pay more attention to the road.

With a one-hour daily commute, it is easy to cover an entire book each week. Imagine the dramatic impact that this can have on your success. You could read one book per week or 50 books per year. If done consistently, this will make you an outstanding expert and leader in your field.

Many medical organizations record their conferences and lectures on audio. Many of them allow you to get CME credit as well. Getting CME by driving reduces the cost of traveling to a meeting and is a wise investment.

Your Flying Office

When you are about to fly on a plane, plan what you will work on during that flight. Studies showed one hour of focused work on an airplane can achieve three hours of work in an office. They are focused on a single activity, and there are no interruptions to finish that task. It is best to bring a briefcase or laptop with all the files you need.

If you sit in the window seat, you often do not need to get up. Being in the aisle seat may require you to get up and stop working whenever someone needs to go to the restroom. Plane rides are an excellent time to catch up on correspondence or articles.

Leverage Technology

When buying a new technology, consider its initial cost, lifespan, and set-up time. These costs are often overlooked in the initial enthusiasm. It would be best to look at the increased revenue from its use. Technology must boost revenue.

Talk to Your Computer

Voice recognition software has gotten better over the last several years. Dragon Medical One is one of them. This can be done to dictate correspondence letters at home and work and update patient charts. If this requires physician editing, this again introduces inefficiencies and costs. Consider dictating using voice recognition and then having staff (or A.I.) check for errors.

Type it Only Once

Macros and templates are two compelling features of word processors. Learning how to do them takes some time, but using the essential functions should only take a few minutes. A macro is a recorded series of keystrokes. They are SmartPhrases in EPIC EHR. Investing time upfront to create them returns big-time dividends.  Templates can also be used for standard procedures such as injections or surgeries.

Robots Can Help

Explore using large language model A.I. such as ChatGPT. It is like having a free virtual assistant. Use antiviral software on your computer to prevent corruption of your files. These are available through simple and low-cost or free downloads from the internet.

Inbox Zero

It is vital to have a method of processing electronic mail. Have an assistant receive all your emails and then send you only the things you need to address.

Establish separate emails for junk, advertisements, new accounts, and personal or business email. The frequency of checking the email varies depending on the individual and the needs. For many people, this could be done once a day or once a week.

Check it no more than twice daily. Once you have opened your inbox, the next step is to check the spam boxes or advertisements and click spam. The next step is to click and delete any other subjects that are not interesting. Unsubscribe to those of little value. Then, proceed to advance through the rest of the email. Respond to emails within two minutes.

Map Your Mind

Mind mapping software takes advantage of our right-brain thinking. In medicine, we tend to be very left-brain oriented. Mind mapping software will allow you to map your ideas or business plans. It is also used for brainstorming activities, capturing ideas, or setting up meeting agendas.

Meet Well

If you are going into a meeting, you need to make sure that you need to be there. Ensure a focused agenda and time frame and that actionable tasks will be assigned. If these do not apply, don’t go.

I’m hoping you will put one or two of these suggestions to good use. Time is our most precious gift, so honor and cherish our moments. Please share with us any time-saving techniques that you enjoy.

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