Freeing Up The Right Kinds Of Time Can Reduce Burnout


All busy professionals understand that time pressure creates stress and stress leads to mistakes. For physicians in particular, these mistakes can be very costly. Yet physicians often make poor – and avoidable – decisions about marginal time and marginal cost by underestimating their time. Fortunately, simple strategies and a new way of thinking about spending money to save more time can improve well-being and work performance.

While the concept relates to spending money to buy more aid, it is more nuanced: the key is that (extra) free time is more valuable in both reducing stress and increasing stress. happiness and therefore worth spending more money to find. Understanding this concept is essential for mentoring young faculty, managing physicians, and designing programs to support their career goals.

I began to think about the value of marginal time when advising beginning teachers on childcare options. My advice was quite simple: spend more money on spending more time on childcare than you think you need. For example, if you leave for work at 7:30 a.m., ask your caregiver to come in at 7:00 a.m. – not at 7:15 a.m. or 7:30 a.m. There is always something going on in the morning when you are trying to have children. outside. Someone is vomiting; the authorization forms must be signed; you need to find $ 2 for the bake sale. And you also want to spend time with that caregiver to plan the day. If by any chance you find yourself with 15 minutes of stress-free free time to have a cup of coffee or talk with your kids, that’s a win by any means. But if you haven’t incorporated marginal time, everyone will be in a rush, and that’s when mistakes – and stress – happen. Errors range from irrelevant to potentially significant, and include forgetting homework or not properly buckling the car seat. But even though they’re not important, they leave everyone in a bad mood.

More recently, I extended this concept to a series of interactive questions, designed to get my audience to think about time-money trade-offs and reducing physician burnout. As I delivered this exercise to several audiences, some interesting themes emerge. Loss aversion – the disproportionate fear of losing something compared to the value of winning something – seems to play a role in how people think about these tradeoffs, and most people don’t make rational decisions. when a loss is involved.

Time for money

Put yourself in the following situations. How much are you willing to spend?

1. You are at the airport. Your flight leaves in three hours, but for a change fee, you can catch an earlier flight now and catch up on the work you need to do in the office. What is the maximum price you would pay to change? $ 5 $ 25 $ 75 $ 125 $ 250

2. You are at the airport. Your flight is in three hours, but for a change fee, you can now catch an earlier flight. You’ve been gone for a week and if you get on a plane now you can come home to see the kids before they go to bed. What is the maximum price you would pay to change?

3. Your commute to work generally takes 20 minutes. But about once a week, and you can’t predict when, it takes 45 minutes. Sometimes this delay stresses you out because you have to pick up your children from their sports activities. What is the maximum amount you would pay per week to make it a predictable 20 minute daily commute?

4. Your mother-in-law is calling you. She’s fine, but if you’re the one answering the phone, it’s almost always a 45-minute conversation in which the condition of the living room upholstery returns. How much would you pay the most to have your spouse answer the phone every time?

5. You apply for a passport and the form asks you to fill in every country you’ve visited and every place you’ve lived in for the past 20 years. Your trusted assistant is sick and it will probably take you at least an hour and a half to complete the boring form. How much would you pay to have someone else review your files and fill in the information for you?

6. You really like your monthly book club; they are a bunch of friends and the conversation is always interesting and satisfying. The group decides to move to a place where you will have to pay for the space. What is the maximum amount you are willing to pay per two hour session to continue participating?

Time for money: the answers – and what they mean

Rational choices around marginal time and marginal money are not intuitive and to some extent explain why some physicians and their organizations may be slow to realize their own level of burnout symptoms and how to treat them. Whether I’m giving this quiz to doctors or executive groups, the answers have been consistent. In almost no case were participants willing to spend what is probably a rational amount of money for the value of their time; However, as we examine the answers to each quiz question, some important observations become clear about what people value most:

1. Most of the time people say they are willing to pay around $ 50 to $ 75 for a flight change that gives them a few hours to complete office work, which by the way is less than what. most airlines charge (at least before COVID) to change a flight. Even $ 100 is probably too low compared to the value of a doctor’s time, especially since getting home on time on a plane ahead of you is safer than a plane that isn’t even yet arrived to pick you up.

The clinical analogue of this scenario is the scribe. Many places suggest that doctors should either pay for a scribe’s fees or increase productivity to cover the expenses. At around $ 20 to $ 25 an hour, if a scribe allows a doctor to finish outpatient session notes an hour earlier, he probably should. Yet in the face of this compromise, in my experience, many physicians decline. Loss aversion, the concept that the negative impact of losing money outweighs the enjoyment of winning for the same amount of money, probably plays a big role in this choice.

2. For most people, a change of flight to see their children before bed is worth a lot, and certainly more than scenario one. (Although some joked that they were in no rush to get home!) A year ago I was at the airport and faced this scenario with a two hour gain and the possibility of having dinner with my family. The attendant looked at me when I asked if I could change and, shaking his head sadly, said, “It will be a $ 75 change fee.” I smiled with pleasure and to his surprise handed him a credit card. I guess most people rate this time differently.

The clinical scenario is similar to the first with the scribe, but the perceived value of time is higher due to the possibility of spending it with your family.

3. The scenario that consistently generates the highest willingness to pay is the possibility of having a predictable ride, and people typically price it between $ 125 and $ 250. This prioritization highlights how stressful the unpredictability of clinical practice can be. Doctors volunteer their time, but they also need boundaries that protect them. If you have to pick up your child from daycare before it closes, the prospect of seeing the urgent additional patient, who also really needs you, becomes very stressful. I would also note that while doctors could previously sign their beeps to someone covering them, the ubiquity of email and text messages has melted those boundaries. I received urgent clinical emails several times while on vacation. What if I didn’t see or respond to them? The expectation of always being available, even when you shouldn’t be, adds to the stress.

4. The question of how much you would appreciate having someone else take care of the time-consuming interactions for you, described in this scenario as taking calls from your mother-in-law, illustrates the meaning of “marginal value”. Depending on how often you find yourself on the phone with your mother-in-law who hears about Helen’s gout and Geraldine’s dog incontinence, or if your mother-in-law usually calls to offer help with the children because she made an appointment for a massage. for you, will mean a very different value of having someone else answer the call.

As a clinical corollary, some patients, as might be expected, have difficulty recounting their experience and synthesizing their story into a brief account. Another similarity is the appeal of the patient whose clinical condition is unpredictable but who is emotionally tiring to deal with. Having a trusted intermediary, such as a nurse or advanced practice provider, who can help manage the emotional aspects of the patient’s needs and condense relevant clinical information, can speed up the conversation more productively, and in some cases, resolve. completely the problem.

5. Most of the people who take my survey are willing to pay a moderate amount of money to help with a very technical and time-consuming task, like applying for a passport, located. In the era of EHRs, this scenario highlights the level of data entry that physicians are currently tasked with managing. Part of the hesitation is probably due to the fact that there are some things that only the attending physician can reliably know or interpret. However, scribes, voice dictation, and automation are all areas that can reduce the burden of this type of data management, even if the doctor has to review the record after it is entered.

6. Typically, participants are not willing to spend a lot to make sure they live up to their book club, with a maximum of around $ 25. But this compromise can also be a big mistake. Numerous studies have shown that time spent with colleagues, continuing medical education activities, and learning more material are very protective against burnout. Doctors and their organizations might want to invest more in their well-being, which in this case doesn’t cost a lot.

Conscious use of marginal time to combat physician burnout

Simply engaging in the above exercise initiates a conversation about avoidable stress and changing the way we think about the value of our time and, more importantly, the value of certain types of time. Once we are aware of our choices – some that we were making without even realizing it – we can change the choices we make. That’s fine if your organization recognizes this as well, but even if it doesn’t, it’s worth considering the choices you control as well. Spend the money to have your nanny arrive half an hour early – if all is quiet, you can still spend that half hour with your kids, which will be money very well spent. Pay the scribe (or housekeeper, laundry delivery service, etc.). Finding areas where we can control stress – and properly valuing our time in deciding to pay to create more – are essential skills that make us more productive, happier, more efficient, and better doctors – not to mention better parents, spouses and friends.

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