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38 Negotiation andCollaboration Skills
449
Financial Resources The need for nancial resources is a
never-ending struggle for a Program Director. There is no
doubt that graduate medical education can be expensive, and
if you want to continue to improve your program, often it is
critical to grow, expand, or change, and this often costs
money. Depending on the situation, you may nd yourself
going to negotiate with a Department Chair, a Hospital Chief
Financial Ofcer (CFO), a DIO, or some other leader who
controls the nancing that you desire. While every scenario
is different, there are some commonalities of the process that
can be helpful for the Program Director to prepare for the
negotiation. Remember that in most cases, nancial resources
are limited, so asking for money for your program means
that some other department, program, or cost center will
have less funds for its use. Therefore, it is important for the
Program Director to be able to explain to the person to whom
you are requesting funds what the value of your proposition
really is. How will these additional funds benet the patients,
the learners, the faculty, or the organization? Is this the best
use of these limited funds? What are the consequences of not
having this additional funding? By being prepared to answer
these types of questions, you can make a better case to support your request. Even better is to be able to suggest where
these additional funds could come from, so that you can further justify your position.
Staff Positions Having the appropriate number of people to
do the work required for a residency program is often a challenge that Program Directors may face. Depending on your
organization and their experience with graduate medical
education, there may not be a clear understanding of the
needs of your program to successfully train family physicians. Even in academic centers with a lot of GME experience, family medicine is unique and some leaders may not
fully understand the nuances specic to family medicine that
are different from other specialties. It is the responsibility of
the Program Director to help identify and articulate those
unique differences so that the Program Director can advocate
for the human resources needed for the program. Whether
the need is for additional Faculty, administrative support
staff, clinical support, or even additional resident spots, the
Program Director will need to be armed with information to
support the request. It will be necessary to reference ACGME
requirements, best practices as identied by the ABFM,
American Academy of Family Practice (AAFP), Association
of Family Medicine Residency Directors (AFMRD), and
other respected associations, as well as specic needs unique
to your institution. Again, rather than simply requesting
more resources in the form of additional staff, the Program
Director should be prepared to give specic details as to how
those additional staff are needed and what the consequences
might be without having them. For example, a Program
Director might use minimum faculty-to-resident ratios in a
clinic or dedicated Program Coordinator time required by
the ACGME.Provide statistics such as the number of applicants reviewed and the number of interviews scheduled for
new candidates to justify the faculty and staff support needed
for interview season each year. The AAFP Residency
Program Solutions publishes Criteria for Excellence that
provides recommendations for a program who wishes to
excel beyond the minimum requirements to produce a highquality program, and this data can be useful for a Program
Director to provide to an administrator the ideal human
resources a program may need to be successful based on best
practices.
Clinical Partners As a Family Medicine Residency
Program, you will work with a number of clinical partners.
The nature of family medicine training requires that our residents spend time in many different settings with many different specialties. As such, it is necessary for us to develop
partnerships with physicians, clinics, hospitals, and potentially other community health partners in order to meet the
requirements that we have. Some of these may be easy to
establish, but others may be more challenging. There may be
circumstances when a simple “ask” is not enough, and you
will have to negotiate with the clinical partner to secure
learning opportunities for your residents. In those cases, you
may nd yourself using the negotiation skills that we have
discussed. Oftentimes, the biggest pushback you may receive
from clinical partners is “What’s in it for us?” Unfortunately,
funding is rarely available to offer nancial benets to the
physicians or clinical partners that we are asking to provide
learning opportunities for our residents, so we have to be creative and help the potential partner to see other ways this
partnership can be benecial to them. First and foremost,
you would hope that physicians feel some sort of commitment and obligation to help teach the next generation of physicians, as they received that benet from their predecessors
at some point when they were in training themselves.
However, not all physicians feel that responsibility, and so
you might have to be armed with other potential benets they
can expect to receive as teachers. Some programs that are
sponsored by academic institutions can offer continuing
medical education credits (CME) to precepting physicians.
Sometimes there are other perks available to volunteer faculty as well, including access to resources of the academic
institution for research and clinical information, conference
and development opportunities, and networking availability.
Some academic institutions offer free computer software
(such as Microsoft Ofce) or discounts to corporate partners
for volunteer faculty. Depending on the specialty of the physician or clinical organization with which you are looking to
partner, you can remind them that the residents they are
training today may be the family physicians of the community tomorrow, and a future referral base. Also, as licensed
450
S. J. Tretter
physicians, residents are able to provide a lot of services to
the preceptor’s patients for which the preceptor may be able
to bill, resulting in practice efciencies and maximizing revenue for them. Armed with these talking points in advance
can help a Program Director be better prepared to negotiate
with potential clinical partners to help provide training
opportunities for your residents.
Collaboration
As mentioned at the beginning of the chapter, collaboration
is sometimes seen as an opposing principle to negotiation.
Rather than two parties working toward a consensus from
differing starting points, collaboration is a coming together
of two or more parties to create a common good. But as
we’ve seen, this can actually be on the continuum of negotiation, in which each party gets something that is greater than
the sum of its individual contributions. Bucknall describes
how knowledge translation involving complex adaptive
systems, such as health care systems, can be one example of
how collaboration can achieve benets for all parties involved
[10]. In the world of GME, we are often asked to collaborate
with one another, and at times it is essential that we do so in
order to meet the objectives that we have placed upon us. In
this section, we will discuss some tips as to how to best take
advantage of collaboration to experience the best it has to
offer.
Know Thyself It is important for a Program Director to
fully understand what it is that the program has to offer in
the form of a collaborative relationship. The residents, faculty, and staff, as well as their collective knowledge, skills,
and manpower, offer a huge resource that the Program
Director can leverage in a collaborative relationship. In my
experience, it is not uncommon for others to come to me
with a desire to collaborate with our residency program
because we have so much to offer. As an example, the
Hospital’s Health and Wellness Department may collaborate
with the Family Medicine Residency Program to offer preparticipation sports physicals to area high schools. The
Hospital receives a workforce of physicians with the skills
and knowledge to provide a valuable service, and the program receives an opportunity for its residents in sports medicine, a required ACGME element of the curriculum in
family medicine. In another example, a nonprot organiza-
tion may wish to apply for a grant to reduce perinatal mortality in the community, and they wish to partner with the
Family Medicine Residency Program, which has a patient
base and willing resident and faculty physicians to help
implement an educational program and resources. Again,
both parties receive benets through this type of partnership. In fact, the Common Program Requirements of the
ACGME now require interprofessional collaboration, and
Program Directors will need to seek out these partnerships
in the future to be compliant with requirements. Knowing
and understanding what your program has to offer potential
partners will help you to seek out mutually benecial partnerships for collaboration.
Know the Stakeholders As you prepare to collaborate with
others, it is also worthwhile to spend a little time and effort
to get to know the stakeholders within the collaboration. In
this way, you can identify opportunities or contributions
from them that you will nd benecial for your program. For
example, you may be approached by a Federally Qualied
Health Clinic (FQHC) in your area requesting to host resident rotations, as they have an interest in meeting residents
who might have a future interest in recruitment opportunities
at the FQHC.As you get to know more about the clinic, you
may learn that they have a high percentage of prenatal and
pediatric patients, and perhaps your residents need more of
these types of encounters to have a well-rounded clinical
experience. Conversely, you may want to explore a partnership with a local VA clinic in an effort to increase the geriatric experiences for your residents. By strategically
considering potential collaboration partners, you can better
position your program to meet its needs as you also help
meet the needs of the partner.
Collaborative Process The process to form a collaboration can vary, based on the nature of the collaboration and
the parties involved. However, there are some basic elements that can be helpful to keep in mind to ensure a successful partnership. First, the goal and objectives for the
collaboration need to be clearly stated for all parties. In
this way, everyone has a common outcome to meet. Once
the goal and objectives have been identied, it may be necessary to create a steering team to guide the collaboration.
In smaller projects, the “team” may simply be a couple of
individuals from each of the collaborative partners, but the
concept remains similar. Using the goal and objective of
the collaboration, the team will determine how they intend
38 Negotiation andCollaboration Skills
451
to meet them using the resources that each party brings to
the partnership. This may include brainstorming or perhaps even require some element of negotiation between
the parties. As part of this process, it is important to also
determine what outcomes are anticipated as measures of
success with the collaboration. The team should identify
how and when these outcomes will be measured, by whom,
and to whom will they be reported. It is important to have
this level of accountability up front so that there are no
surprises or misunderstandings that might occur later in
the process at the detriment of the partnership. Assuming
that the outcomes are successfully met and reported, the
team can consider the collaboration to be a success. At this
point, depending on the nature of the collaboration, it
might be an opportunity to then determine if a new and
greater goal and objective is needed to further advance the
partnership. If not, then perhaps knowing the time frame or
long-term goal of the partnership would be important to
determine.
Let’s look at an example of how this type of collaborative process might work for a GME program. We will use
the example mentioned previously, where a Hospital’s
Health and Wellness Department wishes to collaborate
with a Family Medicine Residency Program to provide
pre- participation sports physicals in area high schools.
First, the goal and objectives need to be identied. For
example, the goal of this collaboration may be to provide a
sports physical clinic at each of the area high schools each
spring for the student-athletes to complete their required
preparticipation physicals. The objectives might include
arranging a health care team comprised of resident physicians, faculty physicians, athletic trainers, physical and
occupational therapists, nurses, and registrars to attend a
sports physical clinic on a designated day and time after
school at each of the local high schools to complete the
exams, forms, and submit them to the Athletic Director’s
ofce. Once the goal and objectives have been identied, a
team comprised of representatives from the various hospital departments, the residency program, and the high
schools may meet to work out the details of how to organize and execute this initiative. An outcome measure of the
initiative might be the percentage of student-athletes of a
particular high school that has a completed pre-participation sports physical on le prior to the start of the sports
season. This outcome measure helps determine the success
of the initiative, but the residency program also has
received additional benets including sports medicine
experiences for its residents, documented community service, and positive goodwill for the program in the
community.
Larger initiatives or collaborations with a higher degree
of complexity may require more project planning and management to be successful. Although project management is
outside of the scope of this chapter, I wanted to include a
resource that might be helpful to Program Directors who nd
themselves requiring that degree of collaboration. Memorial
Hospital and Health Care Center in Jasper, Indiana, is a 2018
Malcolm Baldrige National Quality Award Recipient, and as
part of its journey to excellence has developed a robust
90-day team structure that has been used successfully for
many collaborative projects. The 90-day team structure was
based on a tool developed by another Baldrige Recipient
(2014), Hill Country Memorial Hospital in Fredericksburg,
Texas, and expanded by Memorial Hospital and Health Care
Center. The 90-day team structure provides a systematic
method of collaboration among team members with a clear
direction, accountability, and measurable outcomes.
Table38.4 outlines this structure and how it can be used in a
collaboration [11]. For more detailed information regarding
the use of this tool, the reader can contact the author.
Summary
Negotiation and collaboration skills are essential skills for
any Family Medicine Residency Program Director. Day-today work will require them, as will larger initiatives in order
to be successful. The work of graduate medical education
training requires so many varied resources that must be coordinated in ways that form a complex structure, and the cooperation of all the stakeholders is critical to be successful.
Although every circumstance and situation may be unique,
there are commonalities that can be found within the negotiation and collaboration processes. By understanding how
and when to negotiate and collaborate, a Program Director
will be better prepared to manage the complexities required,
leading to a high-quality, functional Family Medicine
Residency Program.
452
S. J. Tretter
1.1 Organize to improve (Select the team, dene team roles)
1.2 Dene the team charter
1.3 Schedule weekly meetings
1.4 Develop the preliminary project plan and timeline
90-day team checklist
Plan 1.0 Dene purpose and form team
Table 38.4 Checklist for 90-day team, taken from Memorial Hospital and Health Care Center, Jasper, Indiana
1.5 Develop team ground rules
1.6 Conduct an overview of 90-day plan process during the 1st team meeting
1.7 Review/rene team charter
2.0 Understand current process/states
2.1 Determine current performance/Complete system data capture and analysis to identify project baseline and potential impacts.
2.2 Develop SIPOC (Supplier, Input, Process, Output, Customer)
2.3 Flowchart current (as-in) process (as appropriate)
2.4 Identify the key measures you will be monitoring
2.5 Determine baseline performance of all key measures
2.6 Validate data collection process to ensure good data is being collected
2.7 Create charts to visually display collected data
2.8 Set goals for your project
3.0 Understand causes of process variation
3.1 Rene charter problem statement
3.2 Brainstorm potential causes of variation
Pretend there are no limits on resources, stafng time, etc. How would you address problems/opportunities?
What is the craziest possible way to x the problem?
Is there any new technology that could be used?
Think of another industry. How would they think about solving the problem?
ensure improvement
3.3 Use tools to determine cause-and-effect relationships (Fishbone, 5Whys)
3.4 Determine root causes of problems/primary contributing causes. Validate root cause to ensure that team has identied the correct issues to
3.5 Prioritize solutions using impact/effort matrix
4.0 Dene future desired state
4.1 Clarify customer requirements
4.2 Dene high-level future state/process
4.3 Conduct a gap analysis between the current and future states
5.0 Select the improvement
5.1 Brainstorm a list of possible alternatives
5.2 Research and identify best practices (in and out of healthcare)
5.3 Look to innovate
Look back at the root cause. Do your ideas directly impact it? If not, come up with more ideas.
5.4 Evaluate and prioritize alternatives
5.5 What alternative is most aligned with our mission, vision, and core values?
5.6 Select the improvement
6.0 Plan the improvement
6.1 Identify and address any constraints
6.2 Determine resource requirements (dollars, people, materials)
6.3 Identify new measures of success
6.4 Develop an action plan for implementation
38 Negotiation andCollaboration Skills
453
7.1 Get stakeholder input on planned improvement
Do 7.0 Implement the improvement
7.2 Modify improvement plan based upon customer/stakeholder input
7.3 Develop modied materials/forms/processes
7.4 Conduct training as needed
7.5 Implement pilot (as needed) or implement improvement
7.6 Capture measures
7.7 Review all proposed recommendations with departmental leadership and executive champions
8.1 Evaluate results of measures against goals/baseline
8.2 Modify process as needed based upon results
8.3 Determine if ready to move to standardization or back to another pilot
8.4 Rene implementation action plan
Check 8.0 Check the results of pilot/implementation
9.1 Formalize documentation of new process/communication plan/standard work/dashboards/handoff plan
9.2 Finalize new ow chart and SIPOC
9.3 Develop an education plan (initial and ongoing training)
9.4 Implement training
9.5 Determine if other departments/areas could benet from improvements
9.6 Share best practices as appropriate
9.7 Develop ongoing monitoring plan
Act 9.0 Imbed through standardization
Evaluate 10.0 Evaluate long-term success
10.1 Dene process owner for ongoing process
10.2 Complete the process owner worksheet
10.3 Monitor performance according to plan
10.4 Continuously improve the process
10.5 Identify potential projects to be addressed by future teams with champions
10.6 Conduct exit interviews with team members
10.7 Summarize and communicate learnings
10.8 Team celebration and recognition
454
S. J. Tretter
References
1. Goldstein SI.The SI2025 report reveals opportunities for collaboration between GME and Health Care Systems. J Grad Med Educ.
2017;9(6s):58–9. https://doi.org/10.4300/1949- 8349.9.6s.58.
2. Bazerman MH, Curhan JR, Moore DA, Valley KL. Negotiation.
Annu Rev Psychol. 2000;51:279–314.
3. Shell GR.Bargaining for advantage: negotiation strategies for reasonable people. NewYork: Penguin Books; 2018.
4. Macaluso M, Houston LJ, Kinzie JM, Cowley DS, Bessey LJ,
Ladd C, Walaszek A.Negotiation skills as a program director. In:
Graduate medical education in psychiatry: from basic processes to
true innovation. Cham: Springer; 2022. p.53–69.
5. Riches N. 3 elements of an effective negotiation.
Lowry Group, 16 Mar 2021. https://lowrygroup.net/
blog/3- elements- of- an- effective- negotiation/
6. Mercier J. 5 elements of a good negotiation. Young Leaders
of the Americas Initiative, 23 Sept 2021. https://ylai.state.
gov/5- elements- of- a- good- negotiation/
7. Fisher R, Ury W, Patton B. Getting to yes. New York: Penguin;
2011.
8. Steele M.The 7 elements of the Harvard negotiation method. The
Training Box, 25 May 2021. https://www.thetrainingbox.eu.com/
the- 7- elements- of- the- harvard- negotiation- method/
9. Weiss A-PC.Negotiation: how to be effective. J Hand Surg Am.
2017;42(1):53–6.
10. Bucknall T, Hitch D.Connections, communication and collaboration in healthcare’s complex adaptive systems comment on “using
complexity and network concepts to inform Healthcare Knowledge
Translation”. Int J Health Policy Manag. 2017;7(6):556–9. https://
doi.org/10.15171/ijhpm.2017.138.
11. Memorial Hospital and Health Care Center. 90 day team checklist.
Jasper, 15 Aug 2016.
Time Management forFamily Medicine
Program Directors
ErikaRingdahl
39
Key Points
• Effective time management requires appropriate delegation of tasks, proactively controlling your schedule, and
focused efciency.
• Delegate tasks other than those that require your expertise
or bring you joy.
• To control your schedule, plan as far ahead as possible.
Anticipate the time needed to complete tasks and protect
that time in advance.
• Increase efciency by decreasing interruptions and grouping similar activities.
Time Management forFamily Medicine
Program Directors
The origins of time management date back to the early 1900s
when Frederick Winslow Taylor promoted individual efciency in his doctrine, “The Principles of Scientic
Management” [1]. Prioritizing tasks and differentiating
between the important and the urgent became more mainstream with Stephen Covey’s popular “Seven Habits of
Highly Effective People” [2], published in 1989. Effective
time management is critical for Program Director success
since feeling overwhelmed by administrative tasks and subsequent burnout contribute to a high attrition rate. The short
average Program Director tenure [3] means that most program directors are in their rst 5years of the position. The
early years in the position can be associated with a steep
learning curve and many inefciencies, which further promotes the cycle of feeling overwhelmed and burned out.
Program Directors can improve their time management by
anticipating task cycles, controlling time allocation, respectful and responsible delegating, and increasing their personal
E. Ringdahl (*)
Department of Family and Community Medicine, University of
Missouri, Columbia, MO, USA
e-mail: ringdahle@health.missouri.edu
efciency. It is equally important to employ these strategies
in all domains: residency work, clinical work, and domestic
work. Improved time management in one domain creates
time and energy in other domains, which can be allocated to
the events identied as most important.
Anticipating Task Cycles
Residency
Residency events happen each year in a predictable cyclic
manner. Recognizing and anticipating the cyclic nature of
these events allows one to plan further in advance, remediate
mistakes from the previous year, and build upon the previous
year’s product rather than starting from scratch each year. It
can be helpful to create a timeline of residency events, always
working with an eye on activities that occur in the next
3months. Each anticipated event should have a scheduling
template and associated documents that promote, implement, and evaluate the event. These documents can then be
updated and rened each year.
The start of the academic year in July brings with it
onboarding and orientation of new residents. Welcome letters, orientation calendars, program manuals, curricula, and
presentations should be updated each spring in anticipation
of the onboarding process. Each August, most programs
attend the AAFP National Conference (which will change its
name to FUTURE in 2025) to participate in the residency
exhibitions. At the end of the conference, leftover promotional materials and giveaways can be counted and stockpiled. Updates to the promotional materials and ordering
additional products need to be completed at least 3months in
advance of the following year’s conference at the end of
September, ERAS applications can be downloaded, reviewed,
and invitations to interview sent. Most residency programs
will conduct interviews from October through January.
Consider holding a Recruitment Retreat early each summer
© The Author(s), under exclusive license to Springer Nature Switzerland AG 2025
R. Kellerman, G. Irwin (eds.), Graduate Medical Education in Family Medicine, Excellence in Medical Education 2,
https://doi.org/10.1007/978-3-031-70741-4_39
455
456
E. Ringdahl
to review processes, update evaluation rubrics, plot the interview day itineraries, and work out logistics and interviewer
schedules. Doing this several months in advance allows for
interviewers’ clinics to be rescheduled or canceled as needed
for interviews. Match Week occurs each March. As soon as
interviews conclude, anticipate the need for correspondence
with and welcome gifts for incoming residents. Planning
should begin at this time for any departmental celebrations.
Residency retreats, schedule development for rotations and
didactics, and administration of the In-Training Examination
typically occur at the same time each year and should also be
anticipated. Finally, the year ends with the graduation of
third-year residents, which often involves exit interviews,
awards, social activities, and ceremonies. Again, by always
thinking 3 to 6months in advance, you can reserve rooms,
arrange coverage, manipulate schedules, and prepare materials less stressfully. At the end of each regularly occurring
event, it is helpful to immediately review what worked well
and what processes need to be updated. These reections can
be led away until the following year, when once again you
are anticipating the recurrence of these events.
Planning for these recurring events also allows for time to
be reserved, if needed for adequate preparation. For example, literally hundreds of residency applications are downloaded from ERAS at the end of September for review.
Program Directors are pressured to review these applications
quickly so that invitations may be sent, and interviews scheduled in a timely fashion. Each March, Program Directors nd
out if they lled their program in the Match. If they do not,
then they enter the SOAP process, which involves additional
application review and interviews. Squeezing these known
crescendos in workload into an existing busy schedule lends
itself to fatigue and lesser quality work. Program Directors
should cancel all meetings and clinical responsibilities for
the week of ERAS downloads and for Match Week, and then
add them back if the time is not needed or they do ll in the
Match. Anticipating the bolus of work allows meetings or
clinics to be canceled in advance and time protected on the
calendar to complete these overwhelming tasks without disruption in focus. Anticipating the event and protecting time
in advance allows for better work in a shorter amount of
time.
Home Life
Many of the major events in our home life also are cyclic in
nature. Anticipating family birthdays, anniversaries, family
reunions, or holidays that you celebrate can even out the
work bolus associated with these events. These traditions
place additional expectations on top of the usual work
demands and anticipating them like any other cyclic event
can help you feel more in control and protect adequate time
for their preparation. Consider purchasing birthday cards for
all the members of your extended family once a year. Always
have a few sympathy cards and gender-neutral baby gifts on
hand. Those who send holiday cards usually send them to the
same people each year. Utilizing the same size card each
year allows leftover envelopes to be addressed in advance
rather than during the hectic holiday season. If you exchange
gifts with others, discipline yourself to wrap them as they are
acquired. This avoids having to face a daunting unwrapped
gift pile the night before you gather with family or friends.
Another strategy to decrease holiday stress involves eliminating gift exchanges all together and agreeing to spend time
or share experiences with each other in lieu of gifts. Identify
anticipated stressors on the calendar and plan to minimize
them. If it feels stressful to cook for a large family gathering,
plan to cook recipes with which you are most familiar. Be
sure to promote preparing these familiar recipes as establishing tradition, rather than as taking an easier route.
In addition to anticipating event cycles, it can be helpful
to identify personal cycles as well. Some people have more
energy rst thing in the morning. Others are most productive
late at night. Identify when you feel the best and are typically
most productive. Protect that time to get the most challenging work done. If you have a task that is challenging, the
tendency is to put it off. Instead, try to anticipate the challenge and work on it as far ahead as possible, scheduled into
your most productive times. Working ahead gives you the
freedom to choose to work on a challenging task when you
are more in the mood to tackle it, rather than when you must
do it because of a looming deadline.
Another strategy for challenging work is to manipulate
your personal cycle and plan to do the most dreaded tasks
rst thing in the day. Then the task is not hanging over your
head all day, and you have a sense of accomplishment after
completing a difcult task. At a minimum, discipline yourself to work on your most dreaded task at least 10minutes a
day. Multiple, focused bursts of work will chip away at the
task, it will seem less intimidating, and task completion will
be less likely to be postponed. For example, growing up my
son struggled with the study of the Spanish language. He
would do all his other homework rst and leave Spanish until
the end when he was most fatigued. Finally, he agreed to do
his Spanish homework rst. His mood lightened, he had
more energy, and did a better job on the rest of his homework
because he wasn’t expending energy dreading his Spanish
lessons.
Seize Control
We tend to dread those tasks over which we have little control. Tasks that are assigned to us or that have an imposed
deadline feel more stressful. A greater sense of control can
39 Time Management forFamily Medicine Program Directors
457
be obtained by working as far ahead as possible. The deadlines then are self-imposed. Strive to work for completion 2
to 4weeks ahead of other’s deadlines.
It may feel impossible to work ahead when one is feeling
overwhelmed and behind. It can be freeing to identify those
tasks for which you have little enthusiasm or have made little
progress and just abandon them. For example, I had planned
to write up a case report for over a year but never gave the
project the time or energy it needed. I nally decided I was
just not going to write it. An incredible load felt as though it
had been lifted off my shoulders and I had enthusiasm to
pursue other projects. Sometimes, letting go of old stagnant
projects frees you to focus on new tasks with renewed energy.
When looking for tasks that can be abandoned, weigh the
time the task will require compared to the benets derived
from completing that task. For example, some spend hours
creating an elaborate ling system to organize every important email they receive in case they happen to need to refer to
it in the future. Everyone must decide for themselves if the
time required to maintain this ling system is justied, given
the number of times they actually access the les.
Another strategy that helps one get to the point that they
can work ahead is to decide when “good enough” is good
enough. Try to identify which tasks do not require perfection
or your best work. Some forms requiring completion are just
not worthy of thoughtful, grammatically correct responses.
Many recipients look to see that all the spaces are lled in but
do not actually read your responses. Do not waste time striving for perfection when it is not necessary for a task to be
considered complete.
It can also be challenging to work ahead if one chooses to
wait to work on a large project until they have a large, protected block of time available. Unfortunately, those blocks
don’t come along very often in the lives of busy faculty.
Rather, a lot can be accomplished in multiple small blocks of
time, and it is also easier to maintain energy and focus for
shorter periods of time.
A lot of small blocks of time during the day may be overlooked and wasted. Some may prefer to utilize these small
blocks of time to breathe or recharge, but if your goal is to go
home earlier with more of your work completed, it makes
sense to utilize these moments for task completion.
Technology allows us to check email or lab results while
waiting in line. Keep a stack of journals in the front seat of
your car and read an abstract at every stoplight. Take work
with you to dental appointments or haircuts. Then if you
must wait for your appointment, you can minimize your frustration knowing that you have made the most of your wait
time. If you decide to use these small blocks of time to reenergize for the next project, just be sure to limit the length
of the break. While it is important to take small breaks to
recharge and refocus, a lengthy break can derail your workow. Online shopping or social media can provide a mind-
less break between tasks, but many are drawn into the activity
and do not emerge until much later than the time they had
initially allotted for the break.
Use a planning system to plot your obligations and tasks
for both residency and home life. There are many electronic
and paper planners available. Consider identifying a certain
day each week when you will plot out your work for the following week. By doing this in advance, you can schedule
time to prepare for meetings or upcoming presentations. You
can also anticipate errands you might need to run (a card for
Professional Administrators’ Day, cupcakes for your child’s
classroom party) and map out the most efcient way to run
those errands when you are in different proximities.
Deliberate planning for when you will work on various tasks
and how much time you will allow for certain tasks allows
you to retain control of your calendar. This perceived sense
of control helps mitigate feeling overwhelmed by the volume
of work or looming deadlines.
Delegate
David Allen, author of “Getting Things Done: The Art of
Stress-Free Productivity” [4] said, “You can do anything, but
you can’t do everything.” One of the most effective time
management strategies involves delegation. Some are
uncomfortable with the thought of asking others to do their
work. However, if you delegate, you create more time to do
the work that only you can do. In our clinical work, we
encourage people to “work at the top of their license”. Most
clinics employ nurses or medical assistants to whom physicians can delegate work. The nurse responds to patient messages, lls prescriptions, and completes paperwork so that
the physician can focus on practicing medicine. Similarly,
Program Directors should work at the top of their responsibilities. Important work that denes program identity, or
relationship-building with residents and medical students
should probably remain in the jurisdiction of the Program
Director. However, in every realm, one can identify chores
that do not require the full attention of the Program Director.
Delegate Residency Chores
Every residency program is required to have a Program
Coordinator. Program Directors should delegate as much as
administrative work as possible to the Program Coordinator
so that they can focus on work that can only be done by the
Program Director. For example, programs are frequently
asked to verify that a physician has graduated from the residency program. A Program Coordinator or administrative
professional can identify the dates the physician in question
was in the program, and complete the form so that the
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Program Director only has to quickly review and sign the
document. Similarly, Program Directors are often asked to
write letters of recommendation for residents applying for
fellowships or for their future practice. Rather than initiate
an original letter with each request, the Coordinator can have
a standard letter drafted that the Program Director then can
personalize with details specic to that resident.
Most programs have one or more Chief Residents who
can also participate in residency administrative work.
Regardless of whether they plan a career in academics or in
private practice, experience with this type of administration
can be benecial and help them better prepare for their future
careers. Allowing Chief Residents real responsibility over
specic projects increases their learning and satisfaction.
Consider giving the Chief Residents the rst opportunity to
create a curriculum, draft goals and objectives, prepare lectures, and create rotation schedules or call schedules.
Program Directors should also delegate to their Assistant/
Associate Program Directors, not only to lighten their load
but to prepare for succession planning. If an Assistant/
Associate Program Director has a specic area of expertise
or interest, they could assume responsibility for most administrative work in that domain. Use weekly meetings to receive
updates from the Assistant/Associate Program Directors,
Program Coordinator, and Chief Resident regarding the projects for which they are responsible.
Delegate Domestic Chores
Be Ecient
Famous race car driver Mario Andretti is attributed with saying, “If everything seems under control you’re just not moving fast enough.” Certainly, there are tasks that deserve to be
savored, such as a good book, dinner with a friend, or a long
run. However, the value of other tasks is not increased when
they are prolonged. The key is to identify which tasks will
retain their inherent value if done quickly.
Multitasking has a negative connotation assigned, but
multitasking while doing mindless tasks makes sense. There
are activities that are not diminished because you are doing
them while simultaneously doing another task. For example,
I make phone calls while I am folding laundry or unloading
the dishwasher. In contrast, when my husband calls his
brother, he prefers to sink into a comfortable chair and do
nothing else but immerse himself in their conversation. Each
person needs to identify the activities that they believe are
immune from distraction by multitasking.
It is equally important to identify when multi-tasking may
lengthen the time needed to complete a task. Even when we
do plan to focus on a task in a certain time block, it is easy to
be seduced by quickly checking email, the patient portal, or
social media. It is hard to resist looking at your cell phone
every time you get a text or notication. These interruptions,
though brief, detract us from achieving peak efciency.
Consider deliberately delaying these interruptions and using
the act of checking email or your cell phone as a reward or
refreshing mind break once a task is completed.
If there are domestic chores that bring little joy or satisfaction, delegating those chores will create time and energy for
more meaningful work. It may feel frivolous to pay someone else to do chores that you are quite capable of doing, but
it will allow you to focus on those tasks you have identied
as most important, whether they be family activities or residency events. For example, I used to dread going to the grocery store. I would go every week, buy the exact same items,
and spend a lot of money. Then I started paying my teenage
babysitter to go to the grocery store for me once a week. The
going rate for babysitting was $15/hour. It took her an hour
to go to the store. I paid her $15 each week but saved over
$50 each week because she only bought exactly what was
on the list. When I would go, I would frequently pick up
extraneous items. By employing another to do this chore, I
avoided a dreaded activity, created time to pursue activities
I did enjoy and saved money. On the other hand, I really
enjoy doing yard work. I get to be outside, get fresh air and
exercise, and see immediate gratication. I would never
choose to pay someone else to mow my yard. The key is to
identify and then delegate those activities that do not rejuvenate you.
Residency Eciency
Most Program Directors are clinically active, and documentation competes with residency administrative tasks for their
attention. Complete clinic notes as soon after seeing the
patient as possible. The longer it has been since the patient
was seen, the more difcult it is to recall the details of the
encounter. It is almost always faster to dictate than to type
unless you can use multiple templates. Avoid watching television while doing your notes, as it is better to focus on note
completion without distraction than to prolong the task
unnecessarily.
Punctuality is critical for effective time management.
Others are also trying to manage their time so they should
never be made to wait. Consider meeting at very specic
times. When you start a meeting at 08:00a.m., folks assume
that means approximately at the top of the hour. If you specify meeting is at 7:24a.m., there is no room for interpretation. Similarly, don’t assume meetings need to be the
standard hour in duration. Schedule 20-minute meetings or
17-minute meetings.