What makes some people more productive?

Time management in Dentistry continues to be a massive stumbling block to success especially when “speed” and “effectiveness” are confused, one leaves you knackered at the end of the day and not earning properly, the other brings rewards that you can appreciate.

We all have the same amount of minutes in an hour, hours in a day, days in a week etc. But some people clearly get more done than others. Often there is resentment from the “doing less” camp who say that the achievers cut more corners, don’t do things properly and so on but I find this is mostly sour grapes.

My experience of being in dental practices, operating theatres and offices is that the people who get most done are the ones who plan their days, roll their sleeves up and get on with it, start their day on time, who “eat the frog” as early in the day as possible and build in flexibility for when “stuff” happens.

Pozen and Downey found that the most productive people were good at:

  • overcoming procrastination
  • getting to the final product 
  • focussing on daily accomplishments &
  • delegating clearly and effectively

On the other hand those who scored lower:

  • did not plan their days in advance
  • were easily distracted by the avoidable 
  • did not have great routines &
  • (frequently) blamed others for their lack of productivity

If you want to have a good day you have to decide what a good day is and work backwards. Sadly too many people still let the tail wag the dog.

Burnout – Physicians

From The Lancet 13 July 2019.

Hui Wang, a 32-year-old Chinese ophthalmologist, experienced sudden cardiac death on June 30, after working with fever for 6 days in Beijing. Hui was the father of a 1-year-old girl, and married to a doctor, who donated Hui’s corneas to two patients after his death…

According to a viewpoint published in the Chinese Medical Journal, reports on sudden deaths among Chinese physicians sharply escalated from 2008 to 2015, and most of the deaths, resulting from heavy work load, were male surgeons and anaesthesiologists in tertiary hospitals in large cities…

Physician burnout, defined as a work-related syndrome involving emotional exhaustion, depersonalisation, and a sense of reduced personal accomplishment, is not only a serious concern in China but also has reached global epidemic levels. Evidence shows that burnout affects more than half of practising physicians in the USA and is rising…

Physician burnout, defined as a work-related syndrome involving emotional exhaustion, depersonalisation, and a sense of reduced personal accomplishment, is not only a serious concern in China but also has reached global epidemic levels…

Evidence shows that burnout affects more than half of practising physicians in the USA and is rising. The 2018 Survey of America’s Physicians Practice Patterns and Perspectives reported that 78% of physicians had burnout, an increase of 4% since 2016. Furthermore, 80% of doctors in a British Medical Association 2019 survey were at high or very high risk of burnout, with junior doctors most at risk, followed by general practitioner partners. Increasingly, physician burnout has been recognised as a public health crisis in many high-income countries because it not only affects physicians’ personal lives and work satisfaction but also creates severe pressure on the whole health-care system—particularly threatening patients’ care and safety.

The 11th Revision of ICD (ICD-11) in May, 2019, provided a more detailed definition of burnout, characterising it as a syndrome of three dimensions—feelings of energy depletion or exhaustion, increased mental distance from one’s job or feelings of cynicism or negativism about one’s job, and reduced professional efficacy…

Addressing physician burnout on an individual level will not be enough, and meaningful steps to address the crisis and its fundamental causes must be taken at systemic and institutional levels with concerted efforts from all relevant stakeholders. Tackling physician burnout requires placing the problem within different contexts of workplace culture, specialties, and gender. Physician wellbeing has long been under-recognised in LMICs, and physicians’ sudden death and suicide due to overwork—the consequences of extreme burnout—have not been uncommon in many Asian countries. With rapid development of medical sciences, it is time to use medical advances to benefit the health and wellbeing of all people, including physicians themselves…

Clinical freedom in a time of austerity.

First published online in Dentistry Blog on 8th April 2019. Full article.

Clinical freedom is becoming an aspiration rather than reality.

I regularly have to straddle a line between what principals need and what associates want, whilst attempting to keep both sides happy.

Often this involves money and the phrase ‘clinical freedom’.

Amongst the things they never teach you at dental school is that you must cover your costs before you can take anything out for yourself.

Increasing overheads makes this hard.

For instance, a 13% increase in CQC fees to ‘better align the cost of regulation’ must be borne by business owners.

As far as NHS practices are concerned, the minimal rise in fees during a decade of austerity have been swamped by rising costs.

Where contracts are fixed and consume a week’s full-time work to achieve them, there is little or no room for increasing productivity.

Associates, who have the dubiously privileged position of being self-employed, must take their share of the repeated squeezes on practice owners.

Either earn more (difficult with a fixed contract) or cost less.

Because previous generations earned a bigger slice than you, unfortunately does not mean that there is any divine right.

In any profession it is time and expertise for which people pay.

The third party fee setter (the NHS) took a set of fees from a decade and a half ago and continues to run with them.

This ignores the flexibility and evolution that existed in the dental contracts for nearly six decades, which helped practices stay agile in order to remain profitable.

Sometimes these money pressures are manifested in a reduction in quality of working conditions; for instance equipment might not be maintained, materials and laboratories are chosen on cost and choice is limited and staff might be ‘bargain basement’.

As the first casualty of war is truth, so clinical freedom can become an aspiration rather than a reality.

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