Changing your clinic workflow and improving your efficiency takes initiative and effort beyond that which you need to care for your patients.  When I finished fellowship and began my attending career, I was exhausted - to some degree physically, but moreover emotionally and mentally.  The stress of my quest to become more and more surgically proficient while acting as the point person for all clinical concerns in my department as a trainee led me to a state of burnout. For my first years as an attending, I cared only about completing my daily schedule and getting home to enjoy other parts of life.  Additional work to improve my clinic, expand my practice, and accomplish goals beyond my assigned patient load felt burdensome and not worth returning to my trainee level of effort that helped me get into a competitive residency, become chief resident, and land my dream fellowship.

Motivation can come from many places.  For me, it was a combination of several things that sparked my journey to improve the efficiency of my practice.  In part, I did feel more rested on an attending schedule compared to that of a trainee, even if it took several years.  I also gained more self-confidence after practicing as attending for several years - this helped me feel more comfortable bringing proposed changes to our large academic department, and being more upfront about what support I needed to be successful.  The birth of our first child increased my motivation to get home on time with my notes complete.  Overall, each of these steps increased my awareness of the need to be more efficient in clinical practice.  The momentum of each step created new inspiration and made what I had imagined as a burden feel like a new exciting project.  The first step, however is identifying your motivation.  What will make it worth it to you to spend time changing your processes?  What will help you invest your time now to save your time every day moving forward?

Here are my top reasons for improving your practice efficiency:

1. Time is your most scarce resource.

No matter what we do, time that has passed is gone and cannot be returned.  While this is key feature that is inherent to most other reasons on this list, it deserves it’s own mention.  When we remember that time is a purely non-renewable resource, it inspires how we value every activity in our life and how we choose prioritize the moments we have.

2. Time is your patient’s most scarce resource.

Reason number one is a universal truth that applies to all of us.  Your patients do not want to spend time sitting in a waiting room any more than you want to get out of clinic an hour late or sit in traffic on the way home.  Patients are grateful for efficient care - and even more irritated when inefficiency leads to long waiting times.  A timely visit leads to positive feelings from patients, more pleasant interactions during the visit, and reviews that help build a reputation and word of mouth referrals.  When we’re mindful of everyone’s time, everyone wins.

3. There is more to life than our career.

All of us have people who depend on us outside of our patients and coworkers - families at home, friends we like to spend time with, communities we belong to and enrich.  Thankfully, the majority of these loved ones understand the career we have chosen and the sacrifices that come with it.  However, I am sure I am not the only one to have countless memories of apologizing for missing events, showing up late to dinner, or coming home late only to sit and finish writing notes instead of being present with my family.  Maximizing our time, and our attention in that time to those we care about is priceless and can drastically affect our emotional state.

4. Efficiency limits burnout.

Think of all the stressors we encounter in a clinic day.  A visit runs long and you see the list of patients checked in and waiting beyond their appointment time.  A part of the patient’s workup is missing or entered incorrectly by support staff and needs to be redone before you can finish the patient’s encounter.  Phone calls pile up from patient questions that will need to wait until you can finish your appointments, but will prevent you from leaving on time.  As a physician, the responsibility defaults to each of us for the majority of these tasks.  Inefficiencies therefore take their toll on our emotional and mental health as the path of least resistance to a problem’s resolution is through the doctor.  The investment to improve your systems to stay on time and delegate tasks appropriately protects us against the pileup that leads many of us to exhaustion.

5. Improving productivity aids our reimbursement.

In a world of tighter and tighter insurance regulations, Medicare reimbursement cuts, and increasing operation costs, patient care does not create the revenue that it used to.  While not the primary reason for most of us, seeing our patients more efficiently allows us to expand our practice, improving our revenue and our own financial situation.

6.  Our patient population is growing faster than our number of providers.

From an altruistic standpoint, efficiency in patient care is a population health necessity.  In my area, many patients are waiting 9-10 months for new subspecialty appointments.  A major healthcare network in our state has zero primary care providers who are taking new patients.  As the baby boomer generation continues to age, our population will continue to outpace our workforce.  Improving our efficiency is one of many vital steps to being able to care for our growing population.

7.  Greater efficiency leaves time for projects adjacent to our medical practice.

Time spent after caring for patients can be devoted to research, innovation, and education  - parts of our job that motivated many of us to pursue a career in medicine, but can often take a backseat to the ever-increasing demands of patient care.  These ventures help us improve the quality and quantity of our workforce, and lead to advancements in healthcare that otherwise would not come to be.

8.  We can pursue business ventures outside of medicine.

Over time, more and more physicians have come to work as employees in large hospital systems and medical practices.  While those who run their own practice remain entrepreneurs, the rest of us function as W-2 employees whose income is tied purely to their daily work schedule.  Financial freedom depends on creating sources of passive income, whether they are from owning your own business, buying real estate, or taking on investment ventures beyond your traditional retirement account.  Efficiency in our clinical practice leaves us not only time in which to educate ourselves on these topics, but also the energy to pursue opportunities that may release us from a dependence on our salary prior to retirement age.

9.  We have interests outside of medicine.

The question of what do you like to do outside of work stressed me out for many years during training.  “I used to play guitar” I would often reply.  Many of us gave up hobbies along the way of our medical journey.  At the time, these sacrifices feel appropriate to succeed and become the best physicians we can be.  It is easy, however, to lose many of the things that make up our personality.  Having a few more hours a week to explore these hobbies enriches our lives in meaningful ways.

10. Improving our practice energizes and motivates us.

Call it positive feedback, inertia, momentum, or any other label - when we take steps to improve our daily workflow, it energizes us and builds confidence.  Seeing the success a small step like training a medical assistant to filter and answer simple questions that do not need your input makes us wonder what else we can do to improve our efficiency.  In my experience, this motivation carries into other facets of life as well.  

It’s easy to fall into passivity after years of grueling training.  Taking an active step towards improved efficiency and time management can revolutionize your approach to your work and your life overall - to start, all you need to do is focus on your reason why.