Managing the Clinical C R E E P…

This issue is inspired by a follower who sent me a DM on twitter with a request for this topic!

So here we go – academic medicine is the triumvirate – clinical, teaching, and research. We call the folks who excel at all three, “triple threats.” I don’t need any more words to say what we all know: the expectation is that we translate these institutional missions into our own personal career missions.

So let’s talk about the clinical, specifically with respect to how to manage the overflow of clinical responsibilities. As junior faculty there is immense pressure to be a team player, fill clinical roles, and bring excitement and energy to the clinical enterprise. And – I venture to say – all of us want to contribute in just that way.

So how do we balance that desire with the very real toll that clinical overwhelm can take on the other two areas, most especially, research?

Here are my thoughts. And as usual, it starts with you. See what you come up with at the end of this exercise. Don’t bother trying this unless you are ready to be 100% honest with yourself with the answers. No “shoulds” allowed. Period.

Ok, here we go:

1. How much clinical time do you actually want to do? Really? Not because you ‘should’ to keep up your skills (hello surgeons), not because you worry about what others will say (hello everyone), not because of whatever other thing just popped into your head. Look at your week, Monday through Sunday, and ask yourself how many days (or ½ days) do you want to be in the clinic, in the OR, rounding inpatient, etc. No matter where you are know, you need to know your ideal goal.

2. How much time are you spending on clinical care outside of what you are officially slated to do? For example – If you are slated to do 1 clinic a week, are you spending another half-day signing notes?  If you are scheduled to do 1 OR a week, do you always end up with another add-on day? Add up all of your clinical time now, and organize it into assigned time and overflow time.

3. What is the difference between your answer to #1 and #2?  2 hours? 2 days? Identify just how much more time you are spending than you want. Then, identify what exactly you are doing during that extra time. Get clear on this and specific because otherwise you can’t do step 4. (*If this is all assigned time – skip to my note below.*)

4. The first step to beating back clinical overwhelm is to identify the true source of the time creep. Now is the time to remind you of the rules – Be. Honest.

Some common sources of clinical time creep amongst junior faculty:

• Taking on institutional culture: Example – An assumption is that you are readily available for clinical questions 24/7 unless you are in your own health emergency.
• Wasting time in perfectionism: Example – Triple checking everything for fear of ever making a mistake.
• Indulging in inefficiency: Example – Choosing to check emails in between patients instead of charting, leaving more work left undone at the end of the day.
• People pleasing to avoid discomfort: Example – Saying yes to covering on a research/writing day when you really mean No.

(This list is not exhaustive. Take what fits and add others that are in play for you.)

For each one of these causes, the locus of power resides with you.

The question is – are you willing to be different?

You may not be able to have the same approach to clinical work as colleagues who do not share the other goals that you do. This is not about changing your high standards for providing quality care – this is about approaching it differently.

With. Boundaries.

As Women of Color, we can be hyper aware of needing to be excellent in all realms, including clinical. But step back and decide what is your definition of clinical excellence? Safe and high quality care for your patients?

Consider the idea that this is attainable on your terms.

5. You have already identified your ideal amount of clinical time. If you could design your ideal workflow (note signing, following up on results, etc), what would it look like?

6. Take one element of your current cause of clinical overload and consider one first step to change.
Examples:
I will prioritize notes being signed over notes being ‘perfect.’
I will not add on cases to my academic day for the next 6 weeks.
I will check labs 3 times a week, at 2pm, and follow up immediately. 

These are examples. Think about your own situation and write one that fits with you.

Then be ready to be uncomfortable, while you adjust to the idea that there is more than one way to provide the high quality care. And that you may be misunderstood by someone else…and you will live.

Take one step, and watch the world not end.

*Note: If your clinical overload is due to the fact that you are assigned more clinical time than what you are supposed to be doing in your contract – that is another matter. That falls under the category of power dynamics with authority, and the action needed is well planned and well executed personal advocacy with receipts. If this concept is foreign to you….get a coach! (ya’ll knew I was going to say that 🙂 )

It always seems like it’s about every other thing, but, I promise, it actually always starts with you.

I believe in you, because your dreams are worth it.

Much love,
Kemi