I am sitting at my desk today, a typical clinic “good day.” My EMR is open. I have several active messages from my secretary, several messages from patients, appointment requests, pending consult requests, medication refill requests, insurance requests, hospital emails, medical students, medical student schedule change, an email from a resident, several hospital emails, and a hospital schedule email, all needing my attention at the same time. And this is a “good” morning without any surprises like a police or hospital call, invites for unpaid talks or committee work, let alone any personal events like my kids’ school communication or actual business communication or management or any texts from family or friends.
As physicians, we have a highly complex relationship with time. We are constantly swamped with various time-consuming tasks (each email, each note or prescription refill has a time cost) yet most of us do not realize the time cost of each task, let alone our patients or administration. By the time I click through several tabs to complete a prescription request, that is likely 5 minutes per script. My hour, just like everyone else’s hour, has 60 minutes and my day has 24 hours. The other day I spent over 25 minutes on the phone with IT addressing the freezing and slowing of the EMR, meaning that 25 minutes were taken away from my clinic day and direct patient care. A recent report estimated that Canadian doctors spent 18.5 million hours a year on needless administrative activity, and that primary care physicians need about 27 hours a day to provide guideline-based care and administrative tasks. Yet, very few of us are taught how to manage time or even value time in our medical career, let alone in our life.
In business and wellness circles, it is a well-established concept that time is our most valuable and limited resource. We cannot regenerate time. Some define financial wealth as the amount of money that allows one choice and freedom over how we spend our time. Time is a resource. Time is a limited resource that we continuously spend. We are here on this planet for a certain amount of time, a limited, unpredictable amount of time that no one can guarantee.
What is your relationship with time in your practice and your life? How trapped are you in a realistically impossible number of tasks, committees, roles, and obligations? Are you being blamed by patients and your employer for being “late,” “overwhelmed,” and “disorganized” when you are actually expected to work 27 hours in a 24-hour day, missing out on time for your wellness and health, and the maintenance and building of your personal relationships that actually value you as a person rather than a useful object?
Every few weeks, I ask myself, “What is my relationship with time this week? What is actually needed and what is optional?” You may have had a schedule for the day or week, yet other people’s needs or unplanned events appear outside of that schedule and demand your time or cost you time. Life never stops. Various demands are only added with each hour to our schedule and our lives. You may have booked 10 patients today, yet you have a patient in crisis, or you yourself are having abdominal pain that requires medical attention, or your child is sick, or your EMR is down and costs you hours of clinic time or IT intervention. Where does this extra time come from within the same 24 hours? It doesn’t. Something has to give, and usually physicians accommodate other people’s time needs by skipping meals, staying up late or pulling all-nighters to catch up, or delaying personal needs like their own medical care. What if we started to intentionally select what we give time for and what we cannot, disappointing others? What if we realized that time is precious and limited and everything we do has a time cost? What are you paying in time cost for every request that comes your way all day, every day?
What you booked or committed to weeks or months ago, does it still fit your needs and abilities, or are there activities in your day and week pushing you to work 27 hours in 24-hour days? What can you declutter, offload, delegate, or cancel to regain your time? What do you need to say no to when you may have said yes previously? What can you do with that extra 30 minutes or 60 minutes that you may gain back from a meeting that doesn’t meet your needs? What can you gain from creating better templates to manage the administrative load? What can you gain from reducing your work hours (yes, you may lose income, but do you even have time to enjoy your current income)? What if working fewer hours allows you to take a course, do a business degree, or learn other skills that you may enjoy outside of medicine? What if extra time will enable you to get to know you as a person and not just your physician’s obligatory daily grind? How much of your life, in hours, are you trading for your physician title and not even getting paid for? What can you change, whether templates, participation, duration of time on task, or prioritizing? Will you care about that unpaid or paid committee, title, form, or whatever else that you gave your precious 30 minutes of life to 10 years from now? Will the opinion of a disappointed peer for not taking on some role that means nothing to you matter 10 years from now? When you look back on 10 years ago, what do you regret? What will matter to you 5 or 10 years from now? How will your body feel in 5 years if you take the time today to integrate your own physical activity and medical care versus if you do not, versus another obligatory and often unpaid role or email or event?
Just like any relationship in our lives, from work to personal, we do need to reflect on where our relationships stand, how healthy or unhealthy they may be, and what changes or growth may be needed. What does your relationship with time look like, and what do you want it to be?
Maryna Mammoliti is a psychiatrist.
