Strategies for Success for New Physicians in Outpatient Care

If you’re just getting started in practice, or starting over in a new job, it’s important to set yourself up for success right from the start.  This is true whether your career path is in academics or the private sector. 

Starting out on the right foot is not as difficult or mysterious as it might seem, but it can make all the difference to both your professional trajectory and your personal fulfillment.

In this article, we’ll focus on five key areas that will help you provide the best care while managing the demands of a growing practice. Developing these strategies early on can improve both patient outcomes and your own well-being.

1. Master Time Management and Efficiency

Let’s be honest. Managing a busy outpatient schedule without sacrificing the quality of care can seem daunting. Physicians often find themselves juggling patient visits, charting, and administrative duties without a definite plan. This can easily lead to inefficiencies.

If your position includes hospital work, supervising, or teaching responsibilities, these added challenges can snowball very quickly. But taking shortcuts only leads to more complications and frustration for both you and your patients.

Your strategy for success: Developing effective time management skills is crucial. Prioritizing tasks, utilizing electronic health record (EHR) templates, and implementing workflows that streamline documentation can save you valuable time.  

Task-batching and time blocking are crucial skills that will serve you well. Try to limit the amount of time you spend returning to unfinished tasks by getting them completed as soon as possible.  

Think about putting in a few hours up front to set up your chart management systems, including smart phrases and, where feasible, appropriate AI integration. Don’t be afraid to create a workflow to delegate simple tasks when it’s appropriate. When you organize your day efficiently, you will not only reduce after-hours work, but you’ll also improve patient care and satisfaction.

2. Cultivate Work-Life Balance

It’s become normal and sometimes even expected that your working day will bleed into your personal time. In the current environment, this often morphs from a slow drip to a frank hemorrhage.  This lack of control not only impacts you and your family, but ultimately can have a negative impact on your patient care.

Maintaining clear boundaries between your professional world and your personal life is essential to avoid burnout. The importance of your own well-being cannot be overstated. When you’re burned out, you’re more likely to make mistakes that impact your patients’ lives

Your strategy for success: Consider setting aside specific times for charting and answering messages, so you can limit after-hours communication. This is a technique known as task batching. By grouping a chunk of similar tasks together, you’ll achieve greater focus and get more done.

Don’t overlook your own well-being.  Scheduling time for self-care activities such as exercise or relaxation can help you recharge and maintain a sustainable work-life balance.

If there is a hobby or activity that you’ve been yearning to try, simply get started. Don’t expect perfection or even competency. Just do it for the joy of trying something new.

3. Build Strong Patient Communication and Relationships

Building strong relationships with your patients is key to delivering effective care. When patients trust you, you will deliver your care more efficiently, and you’re likely to see fewer after-hours messages and questions.

Your patients want to feel seen, heard, and cared for. However, developing this rapport can be challenging when time is limited, and managing patient expectations or difficult conversations can often feel overwhelming, especially for new physicians.

Your strategy for success: First, keep your charts current. When you go into the office visit armed with accurate and up-to-date information, your patients will feel more confident that they are in good hands.

Setting expectations early is important when managing difficult situations, especially when dealing with complex diagnoses or treatment plans. But having the data at hand and a plan in place is not always enough.

Of equal importance, your communication style matters. Listening actively, showing empathy, and offering clear explanations can improve the experience for your patient and inspire greater confidence in your care.

4. Sharpen Your Clinical Decision-Making Skills

As a physician, making sound clinical decisions quickly and confidently is part of the job. Dealing with the more complex cases can be challenging, especially when you’re still building your clinical experience.

In training, you’re continuously learning, but it’s important to remember that you’re never done. To be a doctor is to be a perpetual student. For optimal patient care as well as your own professional fulfillment, it’s critical to stay up to date.

Your strategy for success:  Staying current with evidence-based guidelines and refining your decision-making process will help you feel more confident when faced with uncertainty. Using decision support tools, collaborating with colleagues, having an excellent referral network, and continually educating yourself on new developments will ensure that you make informed decisions efficiently and wisely.

In addition to maintaining your CME requirements, consider subscribing to a service like JournalWatch, which sends out regular emails summarizing important research from multiple medical journals. Stay curious and engaged.

5. Cultivate Emotional Resilience and Stress Management

Outpatient care can be emotionally demanding, and it’s common for physicians to experience stress or compassion fatigue. To be clear, the role of healthcare systems cannot be overstated. If your situation seems toxic, it might be reasonable to look for other opportunities that are a better fit.  But often there are constructive and sustainable ways to improve the status quo.

Burnout continues to impact nearly half of all physicians. Those in outpatient care are disproportionately affected. Burnout and compassion fatigue are not your fault, but if you find yourself falling into a funk, it’s important to seek help.

More and more healthcare systems are offering coaching and other resources. When possible, take full advantage of those opportunities, or find your own. To ensure long-term success, it’s essential to build resilience and develop ways to manage the pressures of the profession. 

Your strategy for success: Incorporating stress-reducing strategies into your daily routine—such as good nutrition, mindfulness meditation, and regular physical activity—can help you manage the emotional demands of the job.

Building a support system of colleagues, friends, and family can also provide an outlet for discussing challenges and staying emotionally balanced.

Take advantage of coaching and other services that might be offered through your institution or professional groups. Or seek out a coach that specializes in physician burnout and related issues. If you are experiencing depression or other mental health challenges, contact a mental health professional. You deserve to feel well, happy, and invigorated.

Conclusion

Starting and maintaining your career in outpatient care comes with its own set of challenges, but by focusing on these five key strategies, you can build a strong foundation for success.

Mastering time management, improving patient communication, and developing emotional resilience will not only enhance your professional satisfaction but also improve the quality of care you provide.

By investing in your personal growth and well-being, you can thrive as a physician while maintaining a balanced and rewarding lifestyle.

If you’ve enjoyed this article and would like to stay in the loop for more insights on creating a sustainable, fulfilling, and happy life as a physician, sign up for my newsletter or reach out on my website. I’d love to hear from you.

If you’d like to learn more about my coaching practice, you can schedule a complimentary introductory meeting by clicking the link below.

Three Things Physicians Should Know About Meditation

An earlier version of this article appeared on the KevinMD website in November, 2o23.

Meditation is a hot topic with deep roots, but sometimes it feels like it’s being pushed as a modern-day version of snake oil for what ails the spirit.

The practice is often touted as an antidote to burnout, when in truth most of us know that a meditation app won’t solve the systemic issues that plague healthcare today. It’s no wonder that some physicians might be skeptical.

That’s why it’s exciting that academic researchers have been taking this ancient practice seriously. And they are discovering that meditation can have powerful and measurable benefits for your mental well-being, your memory, and even your physical health.

A quick search on PubMed.gov retrieves thousands of reports and peer-reviewed studies on meditation, the majority of which were published in the past 10 years. Getting a handle on the health benefits of meditation could take you down a fascinating, twisty-turny rabbit hole worthy of Alice in Wonderland.

There are many forms of meditation, but this article will focus on mindfulness meditation. This is sometimes known as Vipassana or insight meditation, although Vipassana is a more specific form of meditation that comes from the Buddhist tradition.

Mindfulness meditation is a form of meditation that focuses on being present in the current moment, slowing down your thoughts, and observing without judgement. These features make mindfulness meditation especially valuable for physicians.

Here are three things that you should know about mindfulness meditation.

Meditation may enhance your skills as a physician.

There is a broad range of research looking at the impact of meditation on neuroanatomy and neurophysiology. For physicians, the ability to focus on the details, remain present for our patients, and maintain equanimity when faced with stressful situations are especially important.

Meditation can help by

• Improving the ability of the brain to pay attention to a task

• Enhancing body awareness

• Helping you to regulate your emotions

• Increasing capacity for memory

• Boosting your sleep quality

• Improving your cardiovascular health

It may be best to meditate in the morning.

Although meditation may improve your sleep quality, there is good evidence that in the short term, mindfulness meditation can actually increase brain arousal. Why does this happen? The theory is that since meditation may help to focus the mind, this can result in heightened awareness and attention. That’s why it may be better for most people to meditate at the beginning of the day.

On the other hand, you may find that less focused forms of meditation can help you drift off to sleep. Apps like Calm and Headspace are good places to find these types of practices.

 A five-minute daily meditation can have lasting benefits

Morning might be the best time to meditate, but few of us are willing to wake up 30 minutes early just to sit quietly in a comfortable position. The good news is that a study of stressed-out mental health professionals found that a mere 5 minutes of mindfulness meditation can have important benefits.

How to get started with meditation

Getting started with meditation is easy. Counter to what you might have heard, you don’t have to escape to an ashram or travel to a tropical island to learn how to do it. I’ve written a quick-start guide to meditation for physicians that you can access here.

As a certified Mindfulness Coach, I share meditations online, along with many other excellent meditation teachers, but there are even simpler options. The Waking Up app is a fantastic resource, and includes a 30 day starter course. Insight Timer is another good choice.

As with many things, meditation isn’t for everyone. For some, it can even create mental distress. If you find that meditation provokes anxiety or agitation, it may be best to avoid it. And if you’re under the care of a mental health professional, check in with them first before beginning a meditation practice.

If you’ve enjoyed this article and would like to stay in the loop for more insights on creating a sustainable, fulfilling, and happy life as a physician, sign up for my newsletter or reach out on my website. I’d love to hear from you.

If you’d like to learn more about my coaching practice, you can schedule a complimentary introductory meeting by clicking the link below.

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References:

Britton WB et al. Awakening is not a metaphor: the effects of Buddhist meditation practices on basic wakefulness. Ann N Y Acad Sci. 2014 Jan;1307:64-81.

Fox KC et al. Is meditation associated with altered brain structure? A systematic review and meta-analysis of morphometric neuroimaging in meditation practitioners. Neurosci Biobehav Rev. 2014 Jun;43:48-73.

Hölzel BK et al. Mindfulness practice leads to increases in regional brain gray matter density. Psychiatry Res. 2011 Jan 30;191(1):36-43.

Kozasa, EH et al. Meditation training increases brain efficiency in an attention task. NeuroImage, 2012 Jan; 59: 745-749,

Krittanawong C et al. Meditation and Cardiovascular Health in the US. Am J Cardiol. 2020 Sep 15;131:23-26.

Lam AG et al. Effects of Five-Minute Mindfulness Meditation on Mental Health Care Professionals. J Psychol Clin Psychiatry 2015 March; 2(3): 00076.

Levine, G. N., Lange, R. A., Bairey‐Merz, C. N., Davidson, R. J., Jamerson, K., Mehta, P. K., Michos, E. D., Norris, K., Ray, I. B., Saban, K. L., Shah, T., Stein, R., & Smith, S. C. (2017). Meditation and cardiovascular risk reduction. Journal of the American Heart Association, 6(10). https://doi.org/10.1161/jaha.117.002218

Pérez-Peña M et al. Mindfulness-Based Interventions and Body Awareness. Brain Sci. 2022 Feb 18;12(2):285.

Rusch HL et al. The effect of mindfulness meditation on sleep quality: a systematic review and meta-analysis of randomized controlled trials. Ann N Y Acad Sci. 2019 Jun;1445(1):5-16.

Taylor, G. B., Vasquez, T. S., Kastrinos, A., Fisher, C. L., Puig, A., & Bylund, C. L. (2022). The Adverse Effects of Meditation-Interventions and Mind–Body Practices: a Systematic Review. Mindfulness, 13(8), 1839–1856. https://doi.org/10.1007/s12671-022-01915-6

Youngs MA, Lee SE, Mireku MO, Sharma D, Kramer RSS. Mindfulness Meditation Improves Visual Short-Term Memory. Psychol Rep. 2021 Aug;124(4):1673-1686. doi: 10.1177/0033294120926670. Epub 2020 May 25. PMID: 32448056; PMCID: PMC8242403.

Wu R et al. Brief Mindfulness Meditation Improves Emotion Processing. Front Neurosci. 2019 Oct 10;13:1074.

Maximize Your Time: Essential Toolkit for Physician Time Management

Being a physician often means that you are expected to be a wizard with time, creating minutes and hours out of thin air. It’s not your imagination. A recent study found that in order for a primary care physician to provide guideline-recommended care and communication, they would have to work nearly 27 hours every single day.

With burnout impacting more than half of US physicians, some healthcare systems and many medical associations are beginning to take note. The problem is multifactorial, but administrative burdens are an important issue for many physicians. System-wide commitments to streamline tasks and automate simple processes are beginning to take hold. But true reform is likely to be several years away.

Meanwhile, when every second of your day seems to belong to someone else, managing your personal time isn’t just an option, it’s a necessity. But despite the ever-growing demands of the profession, the skills of time management are rarely taught in our training years.

As a cardiologist in a busy practice for many years, I developed a keen interest in productivity, educating myself by studying some of the masters in the field. The skills I learned allowed me to practice more efficiently. And equally important, I found meaningful ways to nurture my interests outside of medicine, and to create more time and energy for my friends and family.

As a physician coach, I enjoy sharing these simple techniques and insights with my clients. For some, they can be transformative. By optimizing your personal time, you may find that the more rigid pressures of work feel like less of a burden.

You can pick and choose what works best for you, but the important thing is to commit to making at least one change. When you invest a little time and energy to get started, you may be surprised by how much you get back.

Bullet Journal

A bullet journal is more than just an old-school planner. It's a customizable, hand-written system that combines planning, organizing, goal setting, and reflection.  Here’s why it’s beneficial:

• Customizable Layout: Tailor it to your specific needs, whether it’s daily to-dos, long-term goals, or reflective journaling. Don’t worry about making it look pretty. I use a very simple to-do checklist, and scribble notes as they pop into my head during the day.

• Mindfulness Practice: The act of writing by hand encourages memory retention and mindfulness and will help you to prioritize tasks. I like to take 10 minutes every evening to set up my plans for the next day. Even if I don’t meet all of my goals for the day, simply writing them down creates an intention and makes it more likely that they will be completed in the future.

If you want a deeper dive into bullet journaling, check out The Bullet Journal Method, written by Ryder Carroll. There’s no rush to get through it. Commit to reading just 10 minutes each evening (or morning), and over time you’re likely to create serious momentum.

Colored Pens

Never underestimate the power of colors for organization. When you use your colored pens for your Bullet Journal or to take notes while studying for boards, talks, or other commitments, you will:

• Enhance Organization: Assigning different colors to various tasks or appointments helps create quick visual categorization.

• Boost Memory Retention: Color coding  will help you to remember important ideas, tasks and deadlines.

Audiobooks

In general, multitasking is overrated. That’s because most people tend to do both things halfway. And multitasking can make you more vulnerable to distractions. But listening to a good podcast or audiobook on your commute or while exercising can be a great way to safely and efficiently feed two birds at the same time. That could be CME, a good story, or personal development.

Here’s a brief list of some of my favorite productivity audiobooks:

• Atomic Habits by James Clear focuses on the development of small, incremental habits to achieve significant life changes. The book emphasizes the compound effects of your small daily decisions and the importance of establishing systems rather than focusing solely on goals.

• Stolen Focus by Johann Hari delves into the modern crisis of attention, exploring how various factors in our environment and daily lives erode our ability to concentrate. Hari argues that the decrease in attention spans is not an individual failing, but rather a systemic issue influenced by technology, diet, sleep patterns, and societal structures. Although Hari advises systemic change, simply being aware of these forces can help you to push back.              

• Deep Work: Rules for Focused Success in a Distracted World by Cal Newport advocates for a practice of deep, focused work as opposed to the more common shallow, multitasking approach. The book offers practical advice on how to cultivate a deep work habit, minimize distractions, and maximize your cognitive capabilities. Although the ideas in the book are not always applicable to the reality of a physician’s practice, you will come away with a greater understanding of the importance of focus and the negative impact of constant distractions.

Online Yoga (or other activities)

Physical and mental well-being is integral to managing time effectively. As a registered yoga teacher, I love the option of online yoga classes. That’s because they offer:

• Flexibility: Yoga apps allow you to practice at your convenience, fitting sessions into a busy schedule. Most yoga apps give you a range of types, levels, and duration. I like DownDog, AloMoves, and YogaWorks. All three also offer options besides yoga, including strength training and meditation. And some offer live options as well.

• Stress Relief: Yoga is a great way to unwind and maintain physical and mental health. So are many other forms of physical activity. If you want to start, but exercise isn’t part of your routine, simply commit to 10 minutes twice weekly, and see where that takes you.

One caveat: if you’re new to yoga, Pilates, weight training, or any other chosen activity, consider taking a few classes or working with a private teacher first. That way you’ll have the basics, get your questions answered, and develop a practice that is safer, more effective, and more enjoyable.

 Time Tracking App 

Understanding where your time goes is the first step to better time management. My favorite easy-to-use option is Toggl. Time tracking apps can help you to:

• Identify Time Drains: When you track your time online, you may pinpoint activities that take up unnecessary time. That doesn’t mean you shouldn’t stay up to date on email or social media, but when you know where your time is going, you may find that you naturally begin to make choices that are more aligned with your priorities and values.

• Create Structured Work Intervals: I especially like the Pomodoro Technique. It goes like this: Work for 25 minutes, then take a 5-minute break. This structured and repeatable process can enhance focus and prevent burnout. You can also use time tracking to break larger projects (as well as tasks like charting) into smaller intervals. That way you’ll maintain your focus and create a more manageable and efficient process.

What time management tricks and tools have you found that keep you organized and on task? Drop me a line. I’d love to hear from you!

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If you’ve enjoyed this article and would like to stay in the loop for more insights on creating a sustainable, fulfilling, and happy life as a physician, sign up for my newsletter or reach out on my website. I’d love to hear from you.

And if you’d like to schedule a complimentary introductory meeting with me, click the link below.