Saving Physician Careers, One Micro Change at a Time

BY DIANE W. SHANNON, MD, MPH, PCC, MMS MEMBER AND VICE CHAIR OF THE WOMEN PHYSICIANS SECTION GOVERNING COUNCIL, PROFESSIONAL COACH, AUTHOR, SPEAKER

I’m naturally introverted, and I avoided public speaking for most of my life. But in February of this year, I stepped onto the TEDx stage at Northeastern University and gave a 16-and-a-half-minute talk without notes or prompts.

Why?

I stepped up because I felt called to share what the physicians I’ve worked with have taught me about how to save physicians’ careers.

Many of the physicians who seek my help feel beaten down, exhausted, stuck, and powerless. Often, they feel their leaders don’t understand or don’t care about their daily stresses. They are overwhelmed and frustrated, and see no foothold for change. They are contemplating leaving their job or leaving medicine.

And yet, with protected space, support, and accountability, they mobilize the energy to turn things around. They break down big challenges. They try tiny change within their realm of power. Together, we watch, like researchers, to see what works. They find that some changes help, some don’t, and some need tweaking. It’s an iterative process. Over time, most are able to transform their work experience into one that is satisfying and sustainable. Some decide to move to different organizations. Very few leave medicine entirely. 

Watching them find a process that worked ,specifically, the intentional use of micro changes approached as small experiments, was the impetus for me to move beyond my fear and deliver the talk in February. The experience was both terrifying and incredibly fulfilling. 

In the talk, I describe the experience of three physicians, but time didn’t allow for many more examples of the micro changes I’ve watched physicians use. Sharing this (partial) list might spark some ideas for physicians who are currently frustrated, burned out, or dissatisfied with their work experience. 

• Related to practice efficiency

• Reducing interruptions (sign on office door, DND on phone)

• Using the Pomodoro technique to improve efficiency (timed single task focus)

• Batching tasks (e.g., inbox management, charting, and lab review) to avoid multitasking or task-switching

• Precharting

• Increasing the percentage of visit notes finished before seeing the next patient 

• Limit-setting and expectation-setting with patients

• Trying to touch messages, labs, etc., just once

• Related to mindset or ineffective thinking patterns

• Reining in people-pleasing with patients, peers, or family members

• Rooting out perfectionism when it shows up as taking too long on notes, getting lost in the weeds of results, or conflicts at home (e.g., loading the dishwasher)

• Addressing imposter feelings, which can lead to lack of advancement, compensatory overwork, and professional dissatisfaction

• Quieting an exacting or harsh inner critic

• Addressing excessive self-sacrifice, feeling the patient always first with no thought to one’s own needs

• Note that each of these thinking patterns is useful to a degree, sometimes even necessary in training and practice. However, overuse can lead to overwork, exhaustion, irritability, and insufficient time for recharge, self-care, and quality time spent outside of work. 

These lists show where physicians might apply micro changes, but how should they approach trying them?
Try the following three steps:

1. Make a list. Write down the frustrations and inefficiencies you experience at work. Consider whether an ineffective thinking pattern might be at play as well. 

2. Circle the ones you can influence. Focus on the issues where you have some power to make a change, even if it’s tiny.

3. Pick one to test. Try one micro change experiment. If it doesn’t work as you hoped, that’s information, not failure. Tweak it or try something else.

Research over the past decade has shown that the bulk of the drivers of physician burnout are system problems that require system solutions. These solutions might include a more flexible schedule, EHR shortcuts and improvements, the availability of consistent, well-trained support staff, or the removal of workarounds that cause delays or use time or energy without adding value. What can individual physicians do about these?
They can learn to make requests for these improvements more effectively. Here are some tips to do that:

1. Consider the goals or needs of the decision makers you’ll be approaching. What keeps them up at night? What are they trying to achieve? How is their performance being measured? The budget? Patient access? Staff turnover?

2. Approach them with a solution to your problem that aligns with their goals or needs. Relationship-building and data gathering can help here.

3. Avoid presenting problems without solutions. Make it easier for them to say yes.

 To be prepared for the TEDx talk, I invested a fair amount of time in writing, editing, and practicing, but the result was well worth it. Investing the time to try some micro change experiments to address frustrations and inefficiencies can have a similarly positive payoff for physicians. You don’t have to transform your career overnight. Start with one small experiment. You may be surprised by how one micro change can become the first step toward a more sustainable and fulfilling career in medicine.

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