There is never enough time, unless you’re serving it. —Malcolm Forbes (1919-1990)
Has this ever happened to you? You agree—months in advance—to write an article for The Hospitalist, thinking you will have plenty of time to research and write it. You hurriedly enter the item on your calendar and turn back to all your current commitments. Later, as the date approaches, you realize that you’re running out of time to do justice to the article to which you had committed.
Psychologists have explored the common human problem of overbooking and have found many contributing dynamics. A 2005 study in the Journal of Experimental Psychology suggested one explanation: Most of us, when accepting invitations weeks or months in advance, tend to view the future as more open and less busy than the present. “The nature of time fools us and we ‘forget’ about how things fill our days,” comment study authors Gal Zauberman and John Lynch.1
How do hospitalists weigh competing demands on their time? For answers to this question, naturally we asked several already-busy hospitalists to discuss the issue. They shared some lessons learned and a few strategies for managing their most precious commodity.
“Many things take longer than they’re supposed to,” points out S. Trent Rosenbloom, MD, MPH, a former hospitalist and currently assistant professor in the departments of Biomedical Informatics, Internal Medicine and Pediatrics, and the School of Nursing at Vanderbilt University Medical Center in Nashville, Tenn.
His situation on the morning of our interview necessitated a reschedule due to a longer-than-anticipated smog check the afternoon before. “I told myself, next year, I’ll take care of this before the deadline,” he says. “But I always end up doing this at the last minute because everything else gets in the way.”
“This interview is another example: overcommitting once more,” writes Michael J. Hovan, MD, when he agrees via e-mail to a telephone interview about the problem of overscheduling. Like most hospitalists, Dr. Hovan works with a perpetually full plate. He is inpatient director for the Hospital Family Medicine Service and assistant professor at Mayo Medical School in the Division of Family and Community Medicine at the Mayo Clinic in Scottsdale/Phoenix. Like his colleagues, Dr. Hovan has had to struggle with juggling multiple roles.
“The hospital is a far different practice environment than it was just a few years ago,” he remarks. The high intensity of patient management is now coupled with increasing administrative complexities due to a more heavily regulated environment.
As a relatively new specialty, hospital medicine requires more attention in order to establish its visibility and viability. Dr. Hovan feels this pressure keenly because, as a family medicine hospitalist, he’s in a minority position. (The majority of hospitalists trained in internal medicine, according to SHM’s 2006 Annual Survey.2)
“It’s even more important for my department, in a tertiary academic center, to maintain a visible presence on particular committees,” he says. The result of all these necessary roles? “There really are no weekends or defined time off,” says Dr. Hovan. “I’d estimate that 20% of what I do is done ‘off the clock.’ I have taken the Mayo computers to Hawaii, to family ski vacations, and [to] far less exotic locales away from the hospital setting.”
“Medicine Is Stressful”
Mary A. Dallas, MD, formerly medical director of the hospitalist service and currently medical information officer for Presbyterian Healthcare Services, an integrated healthcare delivery network in Albuquerque, N.M., noticed certain trends when she was creating schedules with the hospitalist group.