Working Less Can Make You More Productive

Gregory A. Hood, MD

Disclosures

August 01, 2017

In This Article

Escaping From the Time Trap

People began keeping track of time around 2000 BC. Given what has happened since, and the expectations for productivity that have come to be expected per unit of time, one may wonder whether the whole effort to keep track of time was a bad move.

Lack of time is acutely felt in the healthcare industry today. Both patients and providers cite the greatest satisfaction coming from the perception of time spent with each other. Both lament the relentless erosion of this time over the past 25 years.

Bureaucrats and administrators have, shall we say, a different perspective as to what "productive" time is. Given the efficiencies of scheduling, electronic systems, and the volume of patient care demanded, we have reached a zenith of what is possible to pack into each working hour. Is there another way to improve productivity instead of simply adding more hours?

As an example of how things have changed, one study of internists done in the late 1970s found that "the general internist averaged 50 hospital encounters and 51.4 office visits per week. He or she spent 5.6 hours per work day in patient care activities, which included 2.4 hours per day doing office examinations and 2.0 hours in the hospital. The average length of an outpatient encounter was 18.4 minutes."[1]

Given the wholesale advances in patient age, health complexity, breadth of treatment options, subspecialization, documentation requirements, and additional changes, a pace such as that seems luxurious compared with today's common averages of 30-35 patients or more per day, plus all the attendant medicolegal and documentation requirements. It becomes clear that adding more time to work cannot ever meet these demands.

Physicians, particularly those who supervise other providers, or who perform additional management functions, are already living professional lives that embody the assertion by Douglas Adams, author of The Hitchhiker's Guide to the Galaxy, that "time is an illusion. Lunchtime doubly so."[2] Beyond lunchtime alone, physicians are starting work earlier, working later, and sacrificing opportunities for health and enjoyment in their own lives.

In 1979, Adams also wrote, in words that might sound familiar to today's overtaxed physician, that "he felt that his whole life was some kind of dream and he sometimes wondered whose it was and whether they were enjoying it."[2] But perhaps there might be a clue and an opportunity to improve productivity in the realm of dreaming and wondering.

Madeleine Dore, an Australian writer, recently wrote a piece on this topic for the BBC.[3] If one accepts the premise that more time is not available, then one must, by default, look to the energy expended per unit of time and evaluate how it may be best spent, Dore argued. The answer isn't to cram more work into the time we have but rather to evaluate how to use one's energy most efficiently. We are a culture that abhors "attention deficit" and emphasizes the deplorability of "moments of unfocus." However, Dore asks, might there be a way to harness these moments and actually get more done in less time?

Today's healthcare workforce struggles to get everything done, despite squeezing in as much work as possible during the day. Tasks that used to take minutes stretch into hours. The workforce finds itself suffering anxiety; poor sleep; fatigue; and such physical manifestations as headaches, pain, and impaired sexual performance as consequences of overwork. It would be wise to face the root issues.

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