Episode Notes

Dr. Kevin Mailo welcomes back Dr. Sarah Smith as his guest to discuss the topic of sustainable clinical practice, what it means, and how to achieve it. In this episode, they discuss the struggles physicians face to organize their day, combat burnout, and take time off. Dr. Smith shares tactics she learned through her struggles as a physician in Australia and Canada and how she overcame them. 

Dr. Smith shares her best practices for physicians to manage their days, shift their mindsets, and set goals at a sustainable and manageable pace. You’ll hear the impact of small decisions, and little shifts can lead to big changes both in your personal and professional life. They also discuss ways physicians can feel more empowered and make proactive decisions to provide quality care and balance their own mental and physical health.  

About Dr. Sarah Smith

Dr. Sarah Smith is the Charting Coach for Physicians. She is a Rural Family Physician and Certified Life Coach through The Life Coach School. She helps physicians get their admin and paperwork done more efficiently to create time for the things they love. 

Dr. Smith has spent the last three years coaching hundreds of Physicians, over 1000 hours of coaching, in the specific area of “getting home with today's work done”.

Resources discussed in this episode:

• Slim’s Cabins - Saskatchewan

• ChartingCoach.ca

--

Physician Empowerment: website | facebook | linkedin

Sarah Smith: website | instagram | facbook | linkedin

--

Transcript

Kevin 00:01

Hi, I'm Dr. Kevin Mailo, one of the co-hosts of the Physician Empowerment Podcast. At Physician Empowerment. We're dedicated to improving the lives of Canadian physicians, personally, professionally, and financially. If you're loving what you're listening to let us know we always want to hear your feedback. Connect with us. If you want to go further, we've got outstanding programming, both in person and online. So look us up. But regardless, we hope you really enjoy this episode.

Kevin 00:36

Hi, I'm Dr. Kevin Mailo, one of the co-hosts of the Physician Empowerment Podcast. And I am very, very glad to have a returning guest, Dr. Sarah Smith joining us again. So for those of you that have been following the podcast, we had Sarah on in one of our earlier earlier episodes, talking about charting and boundary setting. And Dr. Smith is known as the founder of the Charting Coach. And, yeah, and it's an outstanding program where she helps Canadian Family Physicians truly manage their practice, and more importantly, get to a better place personally and professionally. So that we are not feeling overwhelmed, that we feel like we can manage our work and our lives and your episode, the last time was just so powerful. It really connected with a lot of people, I got a lot of positive feedback about it. And so I'm very, very glad to have you back again, Sarah, and why don't you tell us a little bit about what you do. And I'll just introduce the topic today, which is sustainable clinical practice. And I'll let you tell us what that means to you and what that should mean to the profession.

Sarah 01:49

Sounds good. Thank you so much for having me back. Yes, last time I was on, I did promise to come back and talk about sustainable clinical medicine. So I'm back. I am a family physician, rural in Alberta right now and originally from Australia. And you'll find out how I got to Canada if you have listened to the last episode. But this time, we're talking from a slightly different perspective. So I went and did the hard work to become a different doctor. So originally, I was in that pain of hours and hours after work evenings, weekends, charting, inbox paperwork as a busy family doctor, and this particular painful experience had followed me from an Australian practice to a Canadian practice. So it wasn't the country at fault.

Kevin 02:41

We’re looking at a global phenomenon.

Sarah 02:43

It wasn't the EMR. And it wasn't the government. It was a me problem.

Kevin 02:47

You're kind of an interesting test case, in that sense, Sarah, right, because I think we always view our issues as hyperlocal. But I do I myself do look at some of this data in health care across the western world. And you can see it, it's actually a global phenomena. That's there are many factors driving it. And I don't want to get into all of them. But you are the interesting test case, I don't know that anyone else has moved across the world, only to discover the problems…

Sarah 03:17

Followed me. Know, no, this was impossible, right? I thought this was the way right, sign up for family medicine, sign up for inboxes, sign up for never having a life, sign up for giving away my weekends. Like this is just what I expected. I asked every mentor along the way. How do I do this? And their answer was come in on Sunday, like that was the unanimous answer to my question that I'd had since residency. So the answers were not out there. And it was simply the listening to a general life coach at the time about, I can do impossible things, I can have a different experience in medicine right now with nothing changing. And I just thought that was completely ridiculous. And she had no idea what I was facing as a family doctor. So off, I went into the world to find the coach who could help me figure out this impossible puzzle because I was done with giving away my life to medicine. And I didn't want to leave medicine because I had no other skill set. I literally had no other way to support my family as the single-income earner in our family. Right. So for me, the skill set was medicine. I had to figure this out. So I went out into the world. At that time, the only physicians who were coaching, were helping me leave medicine and I wasn't ready because I had no other thing to do to earn money. Now, It's a lot of things like what you do to help me figure out how else I could have kind of approached that at the time. But in this moment in time, I'm like I'm gonna have to figure this out where I am right now, with the staff that I have the EMR that I have the patient panel that I have the way I'm being paid. And now what? So went back to the original general life coach and said, Okay, I'm in, I'm ready to do impossible things, you said it's possible, let's go. And it took me a full 18 months of changing everything about how I showed up within exactly the same clinic, EMR patient load, and going home, with everything done. Bucket loads of time, right bucket loads of time, sit on the couch at the end of the day, feeling accomplished, but also guilt free. Like, done. I’m done. And that was such a incredible experience. So proud of myself, and I had all this time and I'm like, I have to share this. So I originally started with the family doctors, yeah.

Kevin 05:55

Without question. And, you know, I'll just share my own reflections. So this year, I retrained in family practice, like I had originally, you know, done family medicine residency, and then done emerged and worked, you know, nearly 10 years in the ER, as a community emergency physician, but I decided I wanted to expand my skill set, and just have more potentially more flexibility down the road. But I was overwhelmed by how much a family doctor has to manage. And, frankly, if I, if I can be blind, until I go through your program, Sir, I don't know that I'm gonna feel super confident, taking on a panel myself. Again, just being very, very honest. Because until you learn that workflow, until you learn those boundary setting strategies, it's, you know, it's quite, it's daunting, honestly, it's daunting, and there is so much in that, that we just didn't get, we got, of course, a rigorous academic training in medicine, you know, the disease, diagnosis and management, and, you know, all of those core clinical skills, but nothing in practice management, nothing really in charting. So, so talk to us about what sustainable clinical practice truly means. Tell us. Define it

Sarah 07:15

Yeah. So just before I step in there, one of my very early mentors said, don't take on a practice owner, position until you've done five years of the medicine just to get used to the medicine because the decision-making around patient care, looking after a panel of patients, takes you about five years of getting used to the whole, just medicine and fast decision making required before you even think about taking on the whole hire and fire half. Like when we think about the business of medicine, those hats, you're right. Nobody's taught us that unless you had a mentor showing you in that apprentice style, how to do the business of medicine. And I was lucky growing up in the Australian system, I was one resident in one practice. So, I had the whole cohort of mentors to show me and they were very transparent, they would show me the earnings, how much it costs to hire and fire, but they didn't expect me to do any of those pieces. And, in addition, I was asked to see patients on my own panel, and I would earn 55% of the fee for service for those patients. So that was in my favor to learn how to do medicine as if I was graduate already. Right. So it's given me that it had a baseline so I could always, you know, fall under the number of people who need to be seen and still have a certainty about what I would be earning. But yeah, what does sustainable clinical medicine mean? So, in the world, there are lots of carrots and sticks to make physicians stay because it's very expensive to replace a physician. So, if you look at some of the US big organizations that estimate about a million dollars to replace a physician, so for physician says: “I'm done, had enough, burned out, you've done it, I'm out.” It's about a million dollars to turn over a new physician. That's it. That's pretty incredible. So of course they want retention. But when the physicians turning up and saying, it's too much, you're asking too much, I can't. I can't even go on vacation. Because I could check my inbox or iPad or whatever. It had to come from the physician. So me the physician in my clinic, and I watched this little video from the primary care network. It was about Evolution 2.0 And they were going to bring us team players to help us. I’m like great, sounds amazing. And in this little promotional video, they had this tiny little sentence that said, physicians get today's work done today. And I'm like wow. I’m in! I looked at through all of their resources, zero backup for that statement, so annoyed at that whole thing. So I'm like, okay, back to me figuring out on my own, here we go. So, um, sustainable clinical medicine means you have, wherever you are right now, physician, no matter what sort of physician you are, you have some things about your practice that you cannot change. For instance, your EMR, your location, how many staff you have the role that those staff play potentially, your hours of work, the number of patients, you have to see whether that's you choosing that number of patients, or an RVU, with those US physicians who are required to do a certain number of productivity encounters per week. And there's bonuses potentially attached to that, or because of the fee structure and your other expenses in life. So there are concrete things about your day that you can't necessarily change or can't change easily, right? So hiring a new person could be an amazing idea. But your organization will say no, for whatever reason, maybe they're unionized, maybe, you know, that's just you're just a salaried physician who has zero control over who's hired and fired. So there's concrete parts of your day. But a sustainable practice means, now that we know your concrete parts of your day. Now, what? What are you able to do differently about what you're doing in your day that can create a clinical day that is confined to what you're given? So whether you’re ER, hospitalist psychiatrist, family doctor, what is it that you are being asked to do? And then how can we start to do it in a way that you can contain it to what you're given? And we're not looking for an answer immediately and an immediate change for tomorrow? Don't burden yourself with that. We're looking at what do you want to create? What does successful, sustainable look like for you? And then what are the steps we take to get there? What are the things we need to change about your practice? To get you closer and closer until you either get there or get at least closer to the mark? Sustainable means?

Kevin 12:20

I’ll just share one reflection, and like already, what's, you know, what I'm hearing is the power of reflection and goal setting, right? Because we all say, well, I just want to be less busy. I just want to be less burned out. I just want to be but what does that mean, in clear, concrete terms? And that's a unique question we're all going to be answering for ourselves.

Sarah 12:42

That's right. So if you look at my example, I wanted to be home at five o'clock. Right? reliably, I was getting a text almost every day from husband saying when are you home? I wanted to just be able to be home at five. Right? But that's easy. All you have to do is hop in the car at ten to five you might have to,,

Kevin 13:01

So you're not from Toronto

Sarah 13:05

I didn't actually mean that I would be done. Yeah. Wait a minute. Okay, so I want to be home at five with everything done is a completely different sentence and a completely different goal-set than I want to be home at five. Right?

Kevin 13:24

Exactly. Exactly. But that's powerful. Right. It's about having that clarity. You know, yeah, I mean, when we coach physicians in this, not quite the charting and practice management space, but we talked, we talked about the power of like, clear goal setting in terms of actually write it down. Like if you have an ideal practice of what you want, write it down. Okay, continue.

Sarah 13:52

Alright, so I wanted to be home a five, and what had everything done. So now we have to step back from the busyness of the day, this is the big step back. And we have to really think about what's inside the day. And I like to use the phrase “we’re mathematicians, we're not magicians”, okay. So there's going to be X number of phone calls, X number of inbox / Portal messages, number of results that come in and we’ll have ebbs and flows. So as I come back from an emergency, if there's going to be a lot more in my inbox, or I might be covering a colleague, but for the most part, what is in the day, like how many patients, how many charts, how many interruptions am I getting? What is the expectation, like what is the rest of today's work? So we have to consider that when we're thinking about what do I need to have get done? Because I'm not just going to magic 200 results in 10 minutes. Not going to happen? Yeah. So that's part of the consideration of now that I know what my goal is. And now I have to think about what's involved in my clinical day. And then I have to think about why would I want to make a change? Because the way I turn up and do something is so easy and familiar, I've been doing it for years this way. Any change is putting another burden on you. So you have to have a reason why you’d want to do that.

Kevin 15:15

So how do you go about beginning to implement some of this?

Sarah 15:19

Yeah. Even before we start making changes, and there’s foundational steps, which we kind of covered last time, they're getting your chatting done as you go, and the finding that protected time to get the inbox done. So you're not doing work twice. But it's the noticing what you're saying to yourself about your day, makes a huge difference. So you can get tired before you even walk out the door in the morning. So when you wake up, and your brain says “Here we go again. I hate clinic. Nothing ever goes right? Oh, no, I have to see Mr. So and so today. Ugh, this is so hard. I'm so tired.” We are defeating ourselves. We're not the inner cheerleader. We don't have to be all lovey, lovey. But we can also be adding suffering. So you have 13 patients today, for instance, and if you say, that's such a lot, that is already hard to overcome, because if you can say 13 patients, this is my day, let's go. Gives us a different fierceness about ourselves. That helps us in the moment, it's that part of I'm choosing it because I'm staying. So if I choose to come into work tomorrow, and there's 13 patients. That's what we're gonna do. We're gonna do 13 patients, we can do 13 patients. And that, that little bit of reasoning to ourselves.

Kevin 16:52

Well, I think you know, another part to this is that notion of acceptance of the things that we cannot control, you alluded to this earlier, right, is one source of burnout. And we know this across different, you know, different professions and fields in occupations is the fact that people feel burnt out when they feel powerless, right? People who work in large organizations that don't care about their feedback, feel disconnected from them, they feel burnt out, they feel irrelevant, right? And there are those aspects to being in even private practice, like you said, the EMR is potentially fixed, right? Or your workspace, you know, where you practice is fixed until the lease is up or until you sell, right? I mean, all of these things are fixed. But the things that are not, we should be seeking to exercise control. But that also includes the patients that we have, right, and acceptance that inevitably there are going to be those difficult cases that we have to navigate through. And in knowing that everyone deals with this, this is part of the job. Yeah, but you know, only people that are professional, like Netflix watchers get to really choose what they do all day. But for the rest of us, there's this notion of, there's going to be a certain struggle. But accepting that can be a very powerful source of wellbeing for us. Because then we say, Okay, where does my energy go? It goes into these things that I can control.

Sarah 18:21

Yeah. Now, there's the difference between ideal and what we've got. So ideally, for instance, a new patient, you might like to spend two hours with them to get to know who they are, and deal with today's issues, right, ideally, and you've been given X number of minutes to see them.

Kevin 18:40

Yea, not counted in hours counted in minutes.

Sarah 18:44

And excellent is the best you can do with the resources you're given. So when we come up against this and say, I can't do a good job, because I don't have two hours with this patient that really adds that suffering, right? You really feel shitty about you being a doctor, when you're saying, I can't do good medicine in 30 minutes, and then saying, Okay, I have 30 minutes or an hour, whatever your new patient is, how can I best spend the time? What is the objective of today's visit that would give my patient what they are most requiring? That's a huge question, not at them question. Remember, you're the boss in the room. This is another part of the work we do is we save the physician is the executive decision maker in the room. So when you're in the room and you're hearing the questions or requests in the room, you're really navigating what is of most importance here, whether that be because the patient is requesting that because I'm noticing that this is very important for us to achieve today. And then the dissonance of and I've got 30 minutes and now I have to make some decisions and negotiation and have all this tied up in a little neat bow with my documentation done in the minutes given, right? This is not going to look like an ideal medical history taking that you were taught in medical school. It’s not going to look like a comprehensive physical exam, like you were taught in medical school. And the documentation is not going to look like something a professor would write. Right? And all of that is the puzzle of medicine. This is the part where physicians start questioning themselves and saying, Is this okay? And only you can answer? Does this you, know, did it cover the most important things for the patient? Did they get enough information to give me pertinent important information about this encounter? Can I kind of back up my decision-making with pertinent positive negatives? And is it good enough in my documentation for the next person or myself to follow what was going on next time I look at this chart? What else do I need in here? Or insurance and billing? Done? So we don't get two hours. We don't get to squish two hours into 30 minutes. We're not magicians. It’s this now what? About my entire day. I have 30 minutes, now what?

Kevin 21:17

Yes. Yes. So, keep going. Tell us about like workflow during the day. Talk to us about, you know, boundary setting, you know…

Sarah 21:31

So some physicians will get a knock on the door, every single patient encounter. Okay? So it's the noticing is just being curious about what happens in my day. So you're in a room doing your highest level work with a patient, you're listening to their story, your physical exam, your illness, script, medical reasoning, decision making is all happening in the room, you're focused on them. And hopefully, we've dumped everything else out because we've completed our work because we work behind us. Knock, knock, knock. You open the door. Mr. Jones is 10 minutes late, will you still see him? Now, your brain says, what's happening this afternoon? Is it my day for kid pick-up? What time does daycare close? How far behind am I running? What's Mr. Jones got going on for him? I don't have a choice anyway. Because my, you know, my employer says I must patients, like literally, I've the amusement of there was no question, I had to see them anyway, because of the rules of what I engage with in my workplace. So it was a yes or no, and we close the door. We turn around and we're like, Where was I? that is very expensive. Oh, goodness, it’s contributing to your decision fatigue, it’s contributing to interruption of your highest level work? This is a very sacred space, it could look like a pop up, a knock on the door, an alarm going off? Whatever, you may have calls you have to take. And even then I would say do you have somebody who can intersect to say this is one that has to be taken and I will take it to the door and knock on her door and interrupt her? Versus that's, you know, this call and that call that didn't really need to be taken. And the one I was actually waiting for that came through? Right? So just protecting ourselves. What was the rule this morning at eight o'clock? You knew if you could run late this afternoon? And who did you need to tell as you tell that person, hey, I have kid pick up today? It's a no for anyone late this afternoon. You have my blessing to go rebook them. That will stop X number of interruptions this afternoon, this is handled for you.

Kevin 23:37

Well, just treating things not like one-offs, because I think that tends to be how we look at it. I mean, you know, you're always putting out fires in clinic-based practice, but you realize that there can actually be a pattern to this. Right, where you can exercise a lot of control in those interruptions, because you have clinic staff and Wing’s talked about this extensively, as well as the importance of delegation, right? Because if you have rules or guidance, well now, and now we don't need to worry, but it even improves the working conditions for your staff. Right? So if you have somebody that's late, and you cannot and you know, you can't accommodate somebody who is 30 minutes late, then it's easy for your clinic staff to say, I'm so sorry. No, they don't have to run down the hall. They don't have to send you a message. They don't have to jumble like it, actually, you think it's improving just for you, but it's also improving for your clinic staff. Right? It reduces their burnout because now we have some guidance, right. And that's just one small example.

Sarah 24:43

Yeah. Let's say you have to see late patients and you still have kid pick up right now how do we engage in that next visit with that person who was late, who used up their entire appointment getting here? How are we showing up to run that consultation differently? If you have choice, you don't have to spend that X number of minutes you were given in its entirety. You have autonomy, about what is the focus for today, we're going to be super fast. Okay, that language with patients just learning new language with patients so important, even opening sentences, How are you? Versus what are we doing today will cost you three to five less minutes in an encounter. Anything else? At the end? catch yourself doing that, versus It was great seeing you today.

Kevin 25:39

Wow. Wow. But you're right. Back to your earlier point about? We have these ingrained habits, right? And there's so much automatic wiring.

Sarah 26:00

Yeah.

Kevin 26:01

But if we're, if we're mindful of it, and we're intentional, we can slowly make change. Where the sign off is different. The opener is different. And it dramatically improves your workflow. I love that. Wow.

Sarah 26:15

I get them to write it on their hand for the first week you're practicing it. It was good to see you today.

Kevin 26:22

Exactly. Not tell me the next five things that are worrying you.

Sarah 26:27

That’s right, yes. Knowing that bringing a list into the room is expected. We talked a little bit about that last time. Right and not going and thinking you have to handle the whole list. Right? You're still the boss in the room. You still get to say this one and this one. Oh, I've just got a quick question about my 20 years worth of headaches. You know, that's not a quick question. You know, that's at least a five-minute deep dive to make sure. So you get to do things that are safe for you, such as triage the problem, but then I would love to spend the time understanding and working on this puzzle of your headaches, let's rebook that. So we have a good space to do that.

Kevin 27:11

Exactly. Exactly.

Sarah 27:15

It is part of the learning, the nuancing of us as the executive decision-makers in the room.

Kevin 27:23

And even for myself, you know, just reflecting on my own, you know, training time in family practice, you realize that every complaint, or presenting issue generates X number of minutes or hours of paperwork to follow.

Sarah 27:40

Potentially, yeah.

Kevin 27:41

And so, you know, you think it's that 20-minute encounter, but it's an hour of paperwork, referrals, results to order, or tests to order the results to review, communications to be made and follow up. So you have to be mindful of this, like fanning or this you know ripple effect on your workflow, when you would just agreed to see multiple complaints. And, you know, to go back to your point, how good a medicine are you doing, when you're doing that? And this is a lot of this is unique to family practice, in the sense that, you know, as a specialist, you can, you're kind of there to focus on a narrow problem, although some, you know, a specialist to be fair, like do deal with a lot of the psychosocial or, you know, complex interacting issues. But I think certainly family medicine is defined by a lot of this holistic care.

Sarah 28:31

But even in our specialty areas, when a surgeon is seeing your patient, and the surgeon is in the room singer new patient that you sent with, you know, a good letter, and we're not going to say we're doing a donkey letter at the, within this process, I think it's important that we say, here's a question I want answered, is this patient suitable for surgery? And the patient arrives and the surgeon has no CT or ultrasound report, or no history of their previous surgeries. And that surgeon has that happen five times a day, and they go looking for the CT. That there is a system problem. That there is a oh, now what? I noticed that I have to go looking for CT scans with every new patient and I wonder why? And we go back down to the corridor, we say, hey, Mary, when we get new patient encounters, what do we tell patients to bring with them? What do we ask to be found for this encounter? Well nothing. Oh, I wonder why. Or now what? I wonder, could we think about before this patient arrives, this checklist, tick, tick, tick. And then I can do my job in a much more efficient way and have an answer for this patient within this first encounter. It's these stepping back and saying what is really happening in my day that's costing me frustrating me. I whine about it all the time. That can be a good way to find these things.

Kevin 29:54

It's listening to that inner voice. You know, it's done in psychotherapy. Where is it coming? From dig deep, right? It can be highly informing. When you go, gosh, that annoys me and annoys me every day. And every time that happens, we let me stop. And can I fix this?

Sarah 30:13

Can I just have a conversation with someone? And who would I have to have a conversation with? And then I'll watch and monitor how that conversation went? Did I get it right? Do I need to edit it a little bit to get the results that I was looking for? Like, we have this ability. These are tradable skills, as part of our leadership role. We are all leaders as the executive decision maker, you are already a leader, even if you don't have a hat that says that.

Kevin 30:36

I like that, that is so powerful, and so empowering, as well. Because we forget, we feel like we're just, you know, pulled a million different directions responding to somebody else's request, whether it's the consultant, the patient support, or admin staff, colleagues in the clinic, like we're feel like we're always pulled.

Sarah 30:57

Yes. Oh, always, I had that experience multiple times. But we just want you to record it, if they're a smoker or not. And I would just be devastated. I'm like, You don't understand what I have to do in my day, I have so much to do already. I don't want to do that, too. I just don't have the time, mindspace, my bandwidth to do anything else. Stop it. Stop asking me to do things.

Kevin 31:16

Well, and again, it is, you are the most important resource in your practice. We teach that over and over again at Physician Empowerment. You are the rate-limiting step. For Success. Everything else is peripheral. Everything else is peripheral. It goes back to your comment about what does what does an interruption at the door for five seconds really mean? It means that you have disrupted the most important part of that patient's care at that time. Right. And you know, you've interrupted your own workflow.

Sarah 31:51

Yeah. Even the way we talk to our patients matters. So when we talk to dermatologists who are trying to improve the flow, they want to see high volume, that is what they choose to do. But the patient's appointment is at 3:40. Right? So when a patient's appointment is at 3:40, but there was absolutely no way the physician was going to be entering the room at 3:40. Because the patient is registered, goes upstairs, hops in the waiting room, goes into a room sees the MA, who does this. And then the doctor comes in, and then the nurse comes in to do education. But we've not explained any of that to our patient. If we step back and say, Okay, well, how do we help the patient understand, this is a team process, the physician is the three-minute part in the middle. But at 3:40, you're going to be meeting Mary, who's an excellent MA, and she's going to be taking the story. And then the physician will come in and go this, this and this needs to be taken off. And the rest of them are this and so it's this particular thing, doing their highest level work. Nurse Jane comes behind. Here's your nurse, this is Jane, she helps explain this better than I do. And she spends the time helping them understand where to put this. How to take off that. How to manage this wound after we take it off. And that is their experience rather than it's my job as the doctor to be in that room at 3:40. Like no, the way you set your clinic up was amazing. You just didn't give that gift to your patients to help them understand.

Kevin 33:25

Delegate right?

Sarah 33:26

Yeah, using our team wisely.

Kevin 33:27

Use your team. I mean it we see it in surgery. I mean, the surgeon doesn't set up the O.R.

Sarah 33:34

You wouldn’t want them to.

Kevin 33:36

You wouldn't want them to right. I mean, it's everybody does it. But you know, for us, I think it's family doctors we get we feel, but it is okay to step away. Right. And, and yeah, your office staff when they're trained well, and they're supported in the day. The work can be more rewarding for them as well. For sure.

Sarah 34:00

There we found Family Medicine in Canada, we know we have a crisis right now. So we have somewhat about 18% of new family grads, saying that they want to take a panel of patients. Right? We have a lot of Canadians without a family doctor. And the education of family practice residents often happens within family medicine context where the family doctors are saying there's too much I need a break. I can't. So when we, when we're looking at these systems, structures, patient medical homes, whatever they look like, it's the stepping back and looking at it broadly, to help understand how do we interact with it as family physicians. This is just one again, another example within medicine. So academic practice. The family doctors have their own panel, they'll see patients on a 15-minute schedule, they work these hours and they have this break in the middle than another set of hours or they're seeing patients with residence at the same time, or this overseeing a resident or two or three or four, who are working and then not taking on patients that day. And then we look at how are they paid? How many staff do they have? How many rooms do they use? And we're starting to help them understand what is possible within this day? How can you show up in a way that's going to help you be successful? When you're ticking off those charts with your residents? That's now a new work list for your week, or your day that you're creating. When will you do this work? Because I'm sure you don't want to be doing it Friday night or Saturday morning.

Kevin 35:42

Exactly.

Sarah 35:43

And this resident might not even get the feedback then because they're not getting that at all if that you might be editing their notes. So it's this really interesting piece of how would I do it if I was going to be stepping into that role? Like, if you weren't working in this situation, you're just having a look at it from the outside saying, Okay, if I went and signed up for that, even if you're already there, just if I was to go and sign up for that. But and I wanted my evenings and weekends. What do you think I'd start doing differently about my day, in order to survive that environment? What would I have to say to my residents? How would I do my teaching? How would I see my patients? What would I be able to physically achieve in a consultation with a patient? Yeah. Yeah, big step back. This big eagle eye of our clinical days.

Kevin 36:41

Yeah. How do doctors manage? Give us some insights? This is just a question because I think so many of us are not static, right? We think about maternity leave, we think about paternity leave, we think about maybe, oh, God, wouldn't it be wonderful if we could take sabbaticals like truly as community-based physicians take sabbaticals? Like a month, three month, not a month, that doesn't count three months, a year? Something truly incredible, right? Like there's this ebb and flow, right, like, many of us are forced to work at this very steady concrete pace, you know, in practice, but is there ways to sort of say, okay, well, you don't want there was something going on, you know, in my personal life, and I'd like to work less, right, or a loved one needs me, I need to work more, or, you know, what I'm loving what my kids are doing in their activities. I don't want to miss things. Right? You know, or I want to be there in volunteering, kindergarten, or whatever have you right, like, so how do we adjust to that? Because this is a major issue with younger generations who were like, no, no, I'm not signing up for a 60-hour workweek for 40 years, no interruptions two weeks of vacation a year not happening, right? Because this is one of the reasons why younger generations of doctors are not interested in it because there's this lack of flexibility.

Sarah 38:09

Yeah, well, they feel like they're trapped. I even hear constantly. I haven't had a true day off for 12 year, or well, 10 years.

Kevin 38:13

I hear that from physicians so often.

Sarah 38:14

You hear that from physicians, okay. This is possible, you guys it is possible. And it's it's really important to protect you because you will, like all the humans, need rest and water and a break and holiday to make you a nicer human. Good for your physiology. You have physiology even when you're a doctor. Okay? You still need rest and water and food. Okay downtime.

Kevin 38:41

Sad that we have to veg that, but we do.

Sarah 38:44

You do, you have physiology, your afternoon, your brain is tired, even when you're looking after your brain during the day and not allowing interruptions and those sneaky peeks at the worklist in between patients and all the things that you're doing to add decisions to your day, even when you tidy all of that up. You're still human afternoons, brain sluggish, normal. Okay. So now we need to know that about you and figure out how do we look after you in the afternoon, that type of thing really important. So let's talk about holidays. So in part of my career, I got modeled this very well. So my first general practice, and one of my colleagues went on a month holiday to go fishing. He would not be on internet and this was way before we had access to EMR. Outside of the clinic right, before internet. We had an electronic EMR, but there was paper charts, but it was before you could just you know be 24/7 accessible. He went away from it. I saw his people for him. What was fascinating, I actually learned something from that experience. His patients would come in and about eight minutes in they'd stand up to leave. I was a brand new resident, year one or two. And I'd be like sit down I'm not done. My decision-making is not anywhere near I haven't got enough information yet. And I realized patients are trainable. Ha! Who knew? Even if you've had the same patient panel for 10 years, you can still train them.

Kevin 40:09

Wow.

Sarah 40:10

Because I've done it multiple times. Don't tell them. So they'd come in, sit down about eight minutes later, they'd be starting to get up to leave. I feel like what's going on? So, but he was completely off, inboxes handled, patients handled, gone for the month. Came back much better human. We can tell when he needed a holiday. You need a holiday, you do. So I love to find a destination that has zero internet access. We have this amazing little place in northern Saskatchewan it’s called Slim's Cabins. They have cabins on the river. We go fishing, big pike, very little internet access. Okay, I give away my patients and my inboxes to my colleague. Okay, they have full autonomy. But there's rules, we talk about it. And we all have different rules. I could say if I wanted to, I want to read the consultation letters when I get back anything about them that you think is important, but leave them for me to read when I get back. Or, hey, I have these appointments set apart. So if you're seeing something and you need them seen by me on my return, put them in there just tell reception, put them in her calendar, where she's assigned these time for these patients to be coming back to talk to her. So they're not necessarily burdened by taking on and trying to manage these things that aren't very urgent while I'm away. So I like to have a full month off. It's amazing. And it's possible.

Kevin 41:48

Wow.

Sarah 41:49

Even if you're in micro practice or a single practitioner. Find a buddy. You know a locum may or may not be available. Find a buddy who's also similar practice to you. Figure out how to get in the EMR confidentiality contracts. And away you go. Like, manage it.

Kevin 42:07

Help one another.

Sarah 42:09

I have a buddy. I have, we normally have buddies in our like one doctor who will go away and you're their buddy, and then you'll reciprocate for them. But it doesn't have to be. We've got quite a few physicians in our environment. And we'll pick kind of maybe like practice, or just who's not had a break or who has had a break recently who could take on this. Can we just make it an easy yes. Then there's you away on holidays with internet access. And you can still beacon network this because you don't want to have to bother your colleagues about your patients. So you do it for them. And you think you're doing a good thing. You're not. You need a break. You need an actual rest. You are replaceable. This was a lesson learned when I took a sabbatical. Remember that 18 month going around Australia. I said enough full-time family medicine, I want to go see the world I want to be a mum, I want to create some amazing memories with my kids. It's highly, highly satisfying.

Kevin 43:14

I love that. I love that. It's such a hopeful message, Sarah, when so many of us are just like you said, we're hoping for a day off, let alone a month or a year. Yeah, I think the other thing too is we don't acknowledge how stressful this job is. We deal in people's lives. We deal with serious things. We deal with a lot of sad stories, but on top of it is enormous stress in managing the practice. Right? I mean, think about think about your colleagues that, or your patients that will come to you talking about burnout, and you know, they're their workplaces when they have these rules of responsibility as executives or managers burnt out, but they don't necessarily deal with the level of stress that we have in dealing with patients lives. And so you're right, invest in yourself to be happier, healthier, and a better, better physician for it. I'm already thinking that we should get you back on and talk about, I know I gotta like a million ideas to get you back on which means when we get you back on not if we get you back on but I'm just exploring how to begin to have conversations colleague to colleague within the clinic about like, Okay, I'm making change, but how do we make change and not just fighting over the EMR? Or whether to hire another MA? But it's like, okay, what can we do to support one another? I would love to go in that direction. And hear your thoughts on it, and I know it's not just your own experience. It's you talking to hundreds of doctors.

Sarah 44:50

Yeah. Yeah. You'd asked me to explain my program it was Charting Champions is our physician program and Smarter Charting is the program I have for clinicians who are not physicians, and it's just the place like you said, you will have a season that's happening for you right now, maybe you coming back from that leave, maybe you have small children, maybe you have children who are graduating, maybe you're in the phase where you want to work like a workaholic. And then you kind of have this realization one day, I'm so exhausted, I don't want this version of me anymore. How do I get the other one, that's not a workaholic anymore? Like working hard and working? A lot is okay, you are the boss of you, if that's where you're at, and you want to work hard, do it! And when you're at that point of pivot, you can. You have pivoted, so many times already, you have already become a doctor, you weren't one before. Like you've done impossible things already, you are capable of change, and you're not trapped. And you can redesign this within the system you're working or even if you're choosing to move somewhere else. That whole pivoting learning, like through a pandemic, we added portals, we added emails, things that we never had with patients before. Yeah, we pivot all the time. We just tell ourselves, we don't know how well we can't or it's too hard. Just notice that.

Kevin 46:13

And take the time to invest in doing things differently.

Sarah 46:19

Yeah, if you want something different, go for it. Honestly, just figure out what's my lowest hanging fruit? What do I actually want? Where am I going? I don't know. It's just an obstacle course. Let's go.

Kevin 46:29

Write it on your hand. I love it. I love it. What a beautiful, beautiful and uplifting message about making things better. Right, controlling what we can control. So with that being said, we went of course we went over. But this was incredible. I loved it. Again, thank you so much for being with us today, Sarah, and we can't wait to get you back on the show again.

Sarah 46:52

Sounds good. Thank you.

Kevin 46:55

Thank you so much for listening to the Physician Empowerment Podcast. If you're ready to take those next steps in transforming your practice, finances, or personal wellbeing. Then come and join us at physempowerment.ca p-h-y-s empowerment.ca To learn more about how we can help. If today's episode resonated with you, I'd really appreciate it if you would share our podcast with a colleague or friend and head over to Apple Podcasts to give us a five-star rating and review. If you've got feedback, questions or suggestions for future episode topics, we'd love to hear from you. If you want to join us and be interviewed and share some of your story. We'd absolutely love that as well. Please send me an email at [email protected]. Thank you again for listening. Bye.