Finding and doing what matters most: Five productivity strategies for physicians in academic medicine

Abstract

While structural change is needed to address the burnout epidemic among healthcare workers, it is important for physicians to avail themselves of the many productivity strategies that can help them succeed in navigating the multiple responsibilities of academic medicine. We present here 5 key strategies within our control that can help increase productivity in the pursuit of work in academic medicine that is meaningful and sustainable: (1) Clarify Priorities, (2) Track Tasks Systematically, (3) Focus and Monotask, (4) Invest in Timesavers, and (5) Celebrate Successes. The specific tools listed under each strategy may help academic physicians feel grounded and maintain our focus on doing meaningful work. While system-wide culture change around expectations, and institutional support for physician wellbeing, is more critical than ever, individual physicians can still benefit from learning strategies to prioritize, track, focus on, delegate and celebrate the work that matters to us in our lives.

Introduction: Practical strategies for balancing the demands of academic medicine

After a series of back-to-back meetings or clinical encounters, an academic clinician finds themselves deciding whether to open their email inbox, check their clinical messages, or respond to that text, and potentially feeling overwhelmed. As academic physicians, the tasks that demand our time and attention can feel unending. Technological conveniences, such as access to electronic medical records available from home and work email from our smartphones, may cause us to feel that we must be always available. The pandemic era has exacerbated these stressors; increased clinical and care-giving demands, and the abrupt adoption of telemedicine and virtual modes of interaction, have further eroded the boundaries around our work. Many of the solutions to these increased pressures are structural; mitigating the crisis of physician burnout requires institutional investments, robust resources, and culture change (National Academies of Sciences Engineering and Medicine 2019; Murthy 2022). Nevertheless, key strategies within our control as individuals can help mitigate feelings of overwhelm and enable greater success in the pursuit of work in academic medicine that is meaningful and sustainable.

Despite the importance of productivity and time management skills for physicians, these strategies are rarely formally taught within medical training programs, as they are in other professional sectors (Lowenstein 2009; Porta et al. 2013; Gordon and Borkan 2014; Schrager and Sadowski 2016; Pitre et al. 2017; Pipas 2020). As a result, we often hear our trainees and mentees conceptualize productivity, organization and time management as innate strengths that they either do or do not possess, rather than skills that can be learned and continuously improved upon over time. As academic physicians who are clinicians, educators, and parents, among other responsibilities, we strive to adopt a growth mindset as we continually develop our own ability to manage the many responsibilities in academic medicine (Dweck 2006; Theard et al. 2021). We continually try new tools and conceptual frameworks that help us navigate competing demands and cultivate wellbeing during challenging times.

While this paper offers productivity strategies for academic physicians, it is not about ‘work-life balance,’ a term that implies that priorities ought to exist at an elusive point of equilibrium on a precarious scale. Rather, our work lives may more accurately resemble a pendulum, swinging at times from one area of high priority to another and back again (Federico 2015). This paper is also not about ‘efficiency,’ which is an ingrained aspect of medical culture and can be important to effective clinical work (Elliott et al. 2014). Efficiency alone is not the ultimate goal. Rather, this paper is about frameworks and tools that help us accomplish high-priority work that matters to us and to the institutions to which we contribute (Lowenstein 2009). With this goal in mind, we present five strategies and accompanying tools from the productivity literature that we have found helpful in our own work and lives (Table 1).

Table 1.

Productivity tips and strategies for academic physicians.

Tip			Challenge	Tools and strategies
1.	Clarify what matters		Pulled in multiple directions Too many tasks	Priority matrix (Gordon and Borkan 2014) Maximizing versus satisficing (Schwartz et al. 2002)
2.	Track tasks effectively		Multiple to do lists Juggling many projects	Getting things done (Allen 2015) Bullet journaling (Carroll 2018) Research Pipeline (Lebo 2016)
3.	Focus and try to be fully present		Constantly multi-tasking Hard to focus	Deep work and mindful use of technology (Lowenstein 2009) Pomodoro technique (Cirillo 2018)
4.	Take advantage of timesavers		Too many emails Administrative burden	Efficient e-mailing and text expanders Effective delegation
5.	Celebrate successes		Feeling overwhelmed Unending to do lists	“Think, Act, Be”(Gillihan 2020) Tiny habits (Fogg 2019) Think of a peer

Icons licensed to Andrea Schwartz from the nounproject.com.

Strategy 1: Clarify what matters

As academic clinicians, many different responsibilities and opportunities compete for our limited time and attention. This means that we must intentionally and iteratively plan how we invest our energy in order to accomplish the things that need to be done and the things that bring us meaning and fulfillment. This requires reflecting on the aspects of our work that inspire in us a sense of passion, curiosity or urgency, and striving to align our day-to-day work with our core values. In addition to setting aside time to reflect on a regular basis (Ship 2018), it can be helpful to call upon frameworks that allow us to visualize our priorities, including the Eisenhower matrix (Covey 1991; Gordon and Borkan 2014). The matrix is a 4-quadrant grid that traditionally maps projects and tasks on the two axes of importance and urgency; these axes could also be reconsidered as ‘things I love to do’ and ‘things that are required or vital to my career’ (Table 2). Creating a priority matrix on a regular basis can help visualize the areas of our work that are important but too frequently deferred (quadrant B). We can then intentionally schedule time to accomplish the work in this quadrant, seeking opportunities to build on existing successes when possible (Lessing et al. 2022). The priority matrix can also help us prioritize which things need to be done thoroughly and optimally, such as patient care (quadrant A), and which things can be done in a satisfactory way, even if imperfect (quadrant C) (Schwartz et al. 2002). This technique, known as “maximizing” versus “satisficing” can help identify areas, such as necessary but ‘non-promotable tasks’ where aiming for perfection may not be necessary (Schwartz et al. 2002; Babcock et al. 2022). Quadrant D contains work that is neither very fulfilling nor important to one’s overall career, which can often be delegated or reduced. Mentors, including peer-mentors and colleagues (Cree-Green et al. 2020), can help us further reflect on our prioritization and support us in making decisions aligned with our larger goals, including declining opportunities that are not aligned (Stine 2020; Babcock et al. 2022).

Table 2.

Priority matrix, adapted from The Eisenhower matrix (Covey 1991; Gordon and Borkan 2014).

		Do you love doing it or feel passionate about it?
Your work:		Yes	No
Is it required or essential to your career?	Yes	A: Do more of this - devote time to prioritize deep work, full presence.	C: Make it as painless and efficient as possible, automate or delegate if possible
		Examples: clinical care, academic work	Examples: required administrative work
	No	B: Be intentional about how much time is spent here. If desired, can you realign to make this more of your career focus?	D: Delegate or drop this if possible. Do at the minimum level if possible.
		Examples: mentoring, teaching	Examples: non-urgent administrative tasks

The green shade is area A where people spend more time, red is area D where people should spend less time, and yellow is areas B and C where people should be intentional about time spent there.

Strategy 2: Track tasks systematically

Once we have prioritized what we need or want to spend our time on, we need an efficient and organized system that tracks the tasks we juggle in a given day or week. Time spent looking for a misplaced to-do list (or not having one at all) can create a sense of ambient stress, whereas an effective tracking system can save time and cognitive effort both by moving the task list out of our immediate consciousness and by lending structure and direction to the day’s work.

The ‘Getting Things Done’ approach is a practical example of a tool-agnostic system that suggests setting aside regular time to process tasks, and then organizing the resulting list to differentiate between ‘next actions’ that can be sorted by context (e.g. phone, errand, e-mail, charting) and larger multi-step projects that need to be broken down into actionable pieces (Allen 2015). While many digital tools exist to track tasks, analog tools such as Bullet Journaling may provide those looking for greater freedom from technology with a systematic method involving a notebook with an index and a notation system to link and track connected tasks (Carroll 2018).

Larger projects can be tracked using a ‘research pipeline’ tracker such as an excel or wipe-board using a points system based on the seven stages of a project, beginning from idea, to IRB, to draft, to presentation, submission and publication (Lebo 2016). Project management software or GANTT charts may be helpful, but may also be able to be delegated. A reliable reference manager is a must to avoid wasting time; we favor Paperpile as it allows for searching and inserting references efficiently and is cloud-based so works easily across multiple devices (Paperpile). Tracking tasks efficiently is a critical skill; though it may take several tries to find the right tool, digital or analog, it is worth finding or developing a trusted system that enables you to track tasks reliably outside your head.

Strategy 3: Focus and monotasking

Our medical training in pressured clinical environments teaches us to multi-task (Chaiyachati et al. 2019). Yet a growing body of literature on cognitive load theory has demonstrated the harms associated with multitasking, including impaired performance (Skaugset et al. 2016). Accordingly, there is growing recognition of the importance of devoting full attention to one task at a time, as often as possible. While the nature of our work does not always allow for this – there will always be some interruptions when urgent and unexpected issues arise – we can build habits of work that make monotasking the norm, rather than the exception.

To maximize focus, we endeavor to batch like tasks and then attend to a task (or batch), uninterrupted, for 25 min. Some recommend using a timer to enforce breaks between bursts of work (as described in the ‘Pomodoro Method’) (Cirillo 2018). We strive to create intentional boundaries around the use of devices, including disconnecting from technology when possible, whether for a single 25-minute spurt (Cirillo 2018) or an entire ‘digital Sabbath’ (Shlain 2019). Schedule time, however brief, and create the environmental conditions and habits needed for “deep work” (Newport 2016) or using tools outside of e-mail to allow for immersive focus (Newport 2021). We can enhance the gift of our full attention by scheduling 10 or 15 min between consecutive meetings to allow for breaks and catch-up. Create mini-rituals, such as doing a ‘Box-Breath’ (Norelli et al. 2020), before beginning a meeting or patient encounter, to center oneself and activate the relaxation response, thereby decreasing overall sensations of stress and fragmented attention (Benson et al. 1974).

Strategy 4: Invest in timesavers

Many of our trainees ask us for tips on how to do things more efficiently and seek ways to save time on repetitive tasks. Spending time setting up and optimizing one’s systems for repetitive tasks is well worth the investment, given the time and stress it may save over the years ahead. A commonly overlooked timesaver is text expander software. Many clinicians are familiar with clinical templates or ‘dot phrases’ when typing in the medical record (Bonilla 2019); they may not take advantage of similar text expanders when writing emails or papers. Time wasted typing out one’s own address or commonly used phrases can be saved by using a text expander software on all devices.

Much has been written about time-saving tips for e-mail (Armstrong 2017) and though larger cultural changes may be needed to successful manage the information overload (Newport 2021), all academic physicians should consider using e-mail filters, batching email processing, vigorous unsubscribing, and writing short ‘5 sentence’ e-mails when possible that address who you are, what you need and why, and what the next step is (Kawasaki and Welch 2013). Brief phone calls or quick in person conversations may also provide an efficient way to skip multiple back-and-forth email or text exchanges, when possible, and may improve overall wellbeing by fostering more meaningful social connections among team members (Turkle 2016).

Effective delegation is also critical to the success of academic physicians (Riisgaard et al. 2016; Edwards et al. 2018) familiar from collaborating with members of an inter-professional team so that all are working at ‘the top of their license’ (Sinsky 2006). In academic work and in our personal lives, physicians should similarly strive to delegate tasks that do not need their direct input (Valantine et al. 2014), as budgets allow, and automate repetitive tasks when possible. Though it can be uncomfortable to ask for or accept help (Babcock and Laschever 2009), particularly for physicians who may be socialized to assume maximum responsibility (Lewiss et al. 2020), a mentee or team member may appreciate being entrusted and empowered, and may in some cases perceive a burdensome or routine task for you as an exciting opportunity for them.

Strategy 5: Celebrate your successes

As physicians, we are often our own harshest critics. When operating within a system that often highlights ‘deficiencies’(Silverman 2019), we may struggle to find self-compassion for our inevitable challenges (Babenko et al. 2019). Techniques from the psychology literature may help us overcome a negative mindset that can sap energy and contribute to burnout (Sinclair et al. 2017). For instance, recognizing negative thought patterns and challenging them, as is done in Cognitive Behavioral Therapy, can improve our ability to both act in a positive manner and be more fully present in whichever activity we are doing (the ‘Think, Act, Be’ framework provides many practical examples of this approach) (Gillihan 2020). Finding ways to break down larger responsibilities into ‘tiny’ manageable pieces can make it easier to notice and celebrate small wins, transforming overwhelming or unfinished work that we seek to avoid through procrastination (Fiore 2007) into bite-size, easy to do tasks that generate a sense of accomplishment (Fogg 2019). As colleagues, we often find it easier to grant each other grace during understandably challenging times, than to extend it to ourselves: partnering up with a friend or colleague, in real time or even just as a thought exercise, may enable us to hear the compassion, empathy, encouragement and understanding advice we naturally share with one another (Mills and Chapman 2016; Shillcutt 2020).

Conclusion: Productivity strategies for cultivating calm for academic physicians

We present here strategies that we have found helpful in the hopes that one or more will resonate with readers to help cultivate more groundedness and to keep our focus on doing meaningful work as academic physicians. While the specific tools we suggest are current as of this writing, we suggest generally adopting a mindset familiar from continuous quality improvement methods. This adaptive mindset drives us to constantly improve and refine our productivity processes, trying small changes such as learning one new EHR shortcut each week, asking and learning from colleagues, and generously sharing what you learn with others. While system-wide culture change around burnout and institutional support for physician wellness is more critical than ever (Bodenheimer and Sinsky 2014; Murthy 2022), individual physicians can still benefit from learning strategies to prioritize, track, focus on, delegate and celebrate the work that matters to us in our lives.