Thank you for coming. So this talk is on how to save your time and sanity. And really trying to touch on clinical, not clinical, non-clinical pearls to try to maximize efficiency in your practice in different settings. So we have representation from a few different practice settings, career, and kind of life in general. I don't have any disclosures. I would love to if you want to offer me some at the end. I am, the first one, I, Makai, I am in private practice in Austin, Texas. I'm in an orthopedic group. I do mostly outpatient musculoskeletal spine kind of stuff. I also am volunteer faculty for the residencies. I have the residents usually about one day a week for two months at a time, PGY2 year and PGY3 year. And I just took on a little position mentoring a medical student every month, one half day a week. So that's pretty much it. I also am on the board of my group as well as our surgery center. And then my group is part of a bigger mega group within Texas. And I'm on the operations committee for that. So operations and process and stuff kind of get me excited. So unlike the guys in my group. So then we have Dr. Yang. He is at Vanderbilt. He's the associate residency program director. He kind of has a lot of pearls about early career also because he's in the position to mentor a lot of residents and trainees. You have Dr. Shapiro. She's more in the space of inpatient rehab. She and I were residents together. And we were probably two of the more efficient residents in our class. I think she was more of a machine in terms of rounding and getting notes done and stuff. So and she's continued that into attending hood. And then we have Prakash who is more into academics and research. And I've heard him talk. And just his accent alone is worth listening to. But he has a lot. He's accomplished so much in so few years that we want to pick his brain about his secrets in terms of what he's done to get him to where he is today. Both of the last two are also Academy Award winners today. And so I wanted to highlight that also. So efficiency and award winning. So there you go. So why are we giving this talk? So most of us, we kind of joke about being burnt out whenever we get together with friends and stuff. You know, we do feel burnt out. And it seems like it's a lot more potentially maybe after the pandemic. It was already starting even before that. And they've been doing surveys at various levels, AMA, but also within PM&R. And they're finding that about 60% of physicians surveyed are reporting at least some signs and symptoms of burnout. The AHRQ has funded two major studies looking at physician burnout. And really what they care about is its impact on patient safety and quality of care. PM&R, they published something in 2019 that showed that the rate of physiatrist burnout is about 51.6%. That's actually gone up a little bit during the pandemic. It's starting to come down just a touch with the latest survey from Doximity. And then there was a work group that was formed between the ABPM&R, AAP, and AAPM&R to try to identify interventions to help improve burnout in the physiatric population. So you can kind of see this is from the 2022 Medscape poll. I was surprised that PM&R even made it as a category because a lot of these surveys, we're not even on the surveys. But I was happy to see that, but then not so happy to see that we were towards the top. You can see we're around that 50%, 51% mark. So we've kind of crossed that threshold of more than half of us being burnt out. So burnout was actually first coined in the 1970s. And there's been a lot of different definitions in terms of what kind of signs and symptoms come up as part of burnout. They talk about exhaustion, cynicisms. If you find yourself feeling kind of bitter or angry, that may be part of burnout. Feeling kind of inefficient. You have the 12 stages on the right talking about the pressure, neglecting your own needs, dismissing or minimizing your own problems, feeling like there's never enough time for anything. And then feeling kind of impatient, feeling withdrawn, kind of shying away from social situations. There may be some behavioral changes where maybe your family or your friends or spouses might notice that, hey, you're being kind of irritable or I don't really want to approach you with stuff right now because you look a little pissed off or frustrated, stuff like that. And then just internally, a lot of depression, anxiety, inner emptiness, feeling like you're on the verge of collapsing. Causes of burnout. So they've done surveys to show that the biggest cause of burnout seems to be the administrative tasks. 60% of those surveyed attributed burnout to administrative tasks, especially things like forms, prior authorization, documentation requirements, trying to keep up with documenting your clinic notes and having to write letters of medical necessity, doing peer-to-peers, all the paperwork that comes along with it, not so much the day-to-day clinic visit. I mean, that can also cause some burnout too, but it's the burden, the administrative burden that comes with the practice of medicine and physiatry. They've also found interestingly that more women are burnt out than men, 56% of women versus 41% of men. And there's been a few different theories as to why that is. There was a Forbes article that suggested that you're working hard but still not getting paid as much. So there's still that pay gap between women and men. In internal medicine journals, they talked about how there's more burden on the woman for household work and family obligations and stuff compared to doctor dads. I mean, this is from 2014, so it's a little bit outdated. And then you add COVID and its impact on your family and your social circle, and it's kind of a perfect storm for increased burnout. There's emotional exhaustion. You know, there are studies that suggest that female doctors detach from their patients slower than men. So it takes us a lot longer when we leave the clinic setting to kind of decompress or debrief from what you just handled in clinic. And then younger career physicians. So it was interesting when they surveyed physicians at the Mass General Hospital, you would think that the longer you've been in practice, the more burned out you would be, but they've actually found that those with less than 10 years of experience in practice actually had a higher rate of burnout than those with 30 plus years. Methods of coping have been suggested. Exercise, talking to family and friends. This is all from surveys. So what do you do to help cope with burnout? Eating junk food, drinking alcohol. Those are probably not the most positive thing to do. Meditation and stress reduction. Asking for reduced work hours, or some of them actually quit their job and changed work settings. There's some fear of retaliation or medical boards finding out. Stopping 43% of physicians from reaching out to get help. So I know there's also a lot of resources out there for physicians, but there's still that fear of being found out and asking for help and how that might impact your license or your standing within a practice or a group. The preferred method for addressing burnout seems to have more to do with the administrative burden that I just talked about. So when they asked physicians, what would you want your institution to implement to address your burnout? The top choice was increased support staffing. So staffing has been an issue as we know nationally, partly because of COVID as well. I mean, we found that the less staff support we have, the more burden we have to take on to try to make up for the fact that we don't have staff to do all that work. And then getting the vacation time that they want. A lot of us don't take the full allotment of PTO and vacation time that we are entitled to. Asking for reduced volume of patients, increased physicians staffing, additional EMR support and training. And then as you go down the list comes counseling, psychological support, staff meetings, seminars. This is a big thing at hospitals where they try to do these team building exercises and free pizza and sessions and stuff. And those, as you can see, most of the physicians didn't necessarily value that as a preferred method for addressing their burnout. About 25% of those surveyed felt that there was some effective strategies that their organization offered to combat their burnout. And of those 50% credited some kind of initiative to improve workflow optimization and decreasing administrative burden somehow. This is actually, there was a Business Insider article highlighting a local clinic in Austin, the Austin Regional Clinic. They started using natural language processing tools. So that's kind of what I'll touch on briefly. There are some products that are available that uses AI actually as part of the EMR that helps to reduce the time taking notes and doing the documentation for the clinic visits. And we'll get to that in just a second. So, I had a few things that I wanted to share in terms of what's worked for me in terms of especially increasing efficiency in clinics. I like to kind of sit around and look at all the different steps and try to figure out where I can shave a few minutes here and there. Because really, if you can shave off even 30 seconds or a minute off of each patient encounter, that adds up to a lot by the end of the week. So, you know, really trying to kind of figure that piece out and the biggest part being documentation. So when I first joined my group, I used a lot of templating and typing and then I kind of switched more to dictation and then a combination of dictation with templates. And then we had, I had an in-person scribe and they were mostly pre-med students that we hired from UT and they were excellent. You know, it was great to have that connection and mentoring the caveat, the cons to that is that because these are pre-med students, they stay for six months to a year during their gap year but then they move on to better and greater things. So then you end up having to train them again. There is a learning curve. And then once you finally get them up to speed you really only get a few months out of them. During COVID, you know, we had some virtual scribes. So a lot of the scribes ended up just scribing from home. That didn't work as well because they're trying to listen in. They're trying to see what you're doing. It's not the same as them being in the room with you and you, you know, them being able to ask you questions live. And then more recently for the last three months or so have been piloting a AI scribe platform. There's a lot of different companies out there and it probably, if you're going to look into something like that, it'll have to be something that interfaces with your EMR. So, you know, Epic I think is maybe Dragon Nuance product, Microsoft, I think. I have Athena. So we're working with a company called iScribe. There's a lot of different ones out there. There's some that are cloud-based that's not affiliated with any of the EMRs but then those you end up getting a Word document or something that you cut and paste into your note. The most useful part of the AI, it seems like at this time what it's capable of doing is mostly the HPI section. They're starting to get into more of the putting in orders and stuff but it still needs a lot of oversight from you. And then, you know, what I've come up with over the years are a lot of smart texts. And what was nice is I can do smart texts within my EMR. I have had EMRs that didn't have that option of using smart text but there are freewares that you can put on your laptop or computers that actually allow you to make your own smart texts. So for example, I use Phrase Express Free and that one allows me to kind of have a dot phrase that then brings in or whatever cue that you want to use that'll bring in certain verbiage. So if there's something that you keep typing over and over or saying over and over in your note, I can put that in there. I have also asked my billing person to send me the utilization policy. So a lot of insurance companies, including Medicare, has guidelines in terms of when they allow certain things. Like for example, if I'm gonna order an MRI, I know that if they have, let's say, Aetna that uses Evacor for prior auth for MRI, they require certain things that we have to hit, like six weeks of physical therapy within the last six months with a before and after visit, you know, all that kind of stuff. So I actually have that as a smart text. So when I go to order an MRI, I click on that or I can insert it as part of the smart text and that'll come in. And obviously I make sure that that has been done and it's in the HPI section, but saying it specifically, saying Evacor imaging guidelines reviewed, patient meets criteria, specifically they have had blah, blah, blah, that seems to help decrease the number of denials and peer requests that I get. So I have started using that. And then patient counseling. So if there are certain things that you always tell the patients, or, you know, for example, I have patients who ask me about supplements. So I've given supplement talks. So I have, you know, a few things that I always tell the patients, I put in the end of the note. So when they get the patient care summary, it's in there. I used to have handouts, but I've noticed that you can hand out pieces of paper, but a lot of patients lose it. And nowadays they access their records through the portal anyway. So if you put it in the patient care summary, the assessment and plan section, they'll actually get it and they can access it whenever they want. So I have that. I also have order sets with diagnoses. So a lot of times, you know, certain things have certain diagnosis codes that will get it covered. So matching that up already from the get-go also allows me to save time because I know that for this diagnosis, I can order this lab work or whatever, and that'll usually get it covered. So I have all of that set up within a system. And it's come up over the, you know, every year there's always small changes that I have to make. And I always tell the billing people that if they start finding denials, to let me know if there's a trend so I can change the little templated verbiage or things that I have to check off before I order some of those things. I also have templated letters for medical necessity. I have not tried using chat GPT for some of these things, but I know that others have and have had pretty good success. The only thing with those chat GPT type letters is that you have to make sure that those references actually exist. So you kind of need to, as you know, if you attended any of the plenary sessions, you know, you kind of do have to provide some oversight at this point that it's not really coupled with accuracy. It's really more a very eloquent way of phrasing certain things. And it might help you get out of trouble if you're really angry and you wrote something out of your emotions and then you give it to chat GPT and they make it a lot more eloquent. It's also a nice way to text your in-laws if you're angry about something. It'll help approach thorny topics. So that's a side note in terms of efficiency in your life. I also have patient handouts. So I like to kind of define, you know, what my practice is. At this point, I'm 15 years in practice. So I know that there are certain patients are not the best fit for me and I'm not the best fit for them. And so being able to define what your boundaries are and what your parameters are in a really neutral way as part of just your intake paperwork helps. So mine says, okay, you know, I have a mid-level in my practice. This is her role, but you'll have, you know, I meet with all new patients. I come up with a care plan. You have access to me this way, you know, all this stuff. I have phone numbers on there. I have everything on there. I also say what I won't do. So, you know, I'm not, for example, in the state of Texas, you have to be registered as a pain management clinic with the Texas Medical Board to do chronic opioid treatment. So I'll put in there, that's not what I do. I do prescribe it for short-term acute pain, but I don't do it for chronic. So, you know, I have patients who show up, they get that paperwork, they read it, and then they leave because they realize that I'm not gonna really provide the care that they want. And that's actually a good, you know, efficient way because I'm not wasting their time and they're not wasting my time. So I have that as a handout that I give them. My MA is actually pretty well organized. She has a binder of all the different handouts and, you know, things like dermatome pictures and spine models and stuff. She keeps it all in a binder, so it's all readily accessible. And then, you know, really the big thing is making sure that you and everyone that you work with are working at the highest level of their pay grade or training. So, you know, you as a physician, you shouldn't be the one rooming patients or doing something that someone that doesn't have a medical degree could do because it's, you know, it seems like a nice thing to do, right, that you're helping your staff out. And I do help, you know, in certain situations, but really you wanna work at the top of your license and your training, and that has nothing to do with whether you think that you're superior to them or not. It's really just the most efficient use of your time. And at the end of the day, what you do is what brings in the money into the group or institution or wherever you work. So really kind of looking at the busy work that doesn't have to be done by a physician or automating stuff that you're doing manually, those kinds of things all help. And then I'm a mom and a wife, so I also have kind of tried to figure out how to increase efficiency in life. So we have a family calendar. There's different apps there that you can use, share calendars and stuff with alerts. My husband will say, you know, you didn't put an alert on, and then that's why he slept through it or whatever. If I have school-age children, I try to look for opportunities to carpool with other parents if I can, share the load as much as possible, outsource as much as possible. I used to feel guilty about outsourcing, like I can clean my own house, but really, do I want to spend two hours cleaning my own house when I could pay someone to do it if I have the means to do so? So really trying to figure out, okay, I have this much time. Time is also precious. It's a resource. So what can I be doing with my time that's actually enjoyable, like spending time with my family or doing something with my kids versus doing something that, you know, cleaning the house or doing the dishes or laundry, that kind of stuff. I've also, now, after yesterday's talk, I'm not sure I should be using Alexa, but I have those little echoes in the kids' rooms, and I have Alexa yell at my children, and that seems to also help because I have it on reminders, so I tell them to wake up. It's time for you to come downstairs. You know, remember your violin today or whatever it is, and it keeps me from yelling. I'm sure they're listening in, but, you know, I use it that way. My kids are boring, so it doesn't really matter right now. And then I try to plan the week. So I look ahead. I try to anticipate conflicts. You could do some meal planning. I've also resorted to takeouts, but I, you know, try to make it a little bit healthier takeout, and I have things on rotation. I keep things pretty simple. So, you know, during the pandemic, we all started wearing scrubs every day, and I was like, you know what? This is easy. I don't have to think about what I'm gonna wear in the morning, so I just wear scrubs every day, and it's much nicer when my kids have a uniform. My older one doesn't, but you can, you know, it's just kind of nice to really not have a lot of choices about things like that because that time spent thinking about what am I gonna choose today also adds up over the week. And then I have text macros on my phone. So I have text macros for my EMR, I have text macros for my phone. So when I start typing can you, it says can you please help carry some groceries out of the garage or whatever and send it to my husband. So I have stuff like that in my life. And then really burnout prevention. So I know when I kind of get to that about 75, 80% mark of like I'm about to hit that burnout territory where I feel like I can't go on and I feel just exhausted and I feel like I'm on the verge of tears or whatever it is. I know that that's kind of starting to happen. At that point I look ahead, you know, whether it's a week or however long you're booked out for, I try to block out a half day or even a couple hours where I maybe block it and say I have an appointment or whatever. And I leave a little early, have a little time to myself. If I take a half day, sometimes I'll go to the spa or whatever, or maybe I'll grab lunch with my friends or whatever. But I try to just pick even small things, just kind of spaced out. So it doesn't necessarily have to be a big vacation because sometimes vacations can be stressful too. So I try to find little ways to try to kind of understand and take inventory of where I'm at and then try to intervene as soon as I can. And then having trustworthy friends. And now, you know, with all the virtual stuff and social media and texting and stuff, you don't have to be in the same town to be able to complain about whatever it is you want to complain about in your life. So I have friends from residency and, you know, we have group texts and we have Zoom calls and we have all this stuff to try to, you know, really decompress and vent. And there are certain things that you can't really vent to other people or lay people because they think, wow, a doctor is whining about this or, you know, I wonder if my doctor is talking about me behind my back. So it's kind of nice to have physician friends also, especially PM&R friends that you can talk to and what do you do in this situation and trade ideas, that kind of stuff. And then really finding hobbies and activities that you enjoy and then learning to set some boundaries to try to minimize the risk of burnout. And then I remember a few years ago, there was a plenary on micro-resilience by a Paralympic athlete. And she kind of talked about micro-resilience. So having little moments of time, even during your day, that kind of gives you that little pause, even for a few seconds. So at my desk, I have a little happy wall. I put pictures of my kids when they were little and cute, not now. And then thank you cards where I can read and kind of feel like, you know, feel appreciated, especially after I get yelled at by a patient or whatever, I can go and read someone that was grateful. So I have that. I have, you know, little pockets of time that I use. You know, this is personal, but I intermittently fast. So I don't eat lunch. So I have a lunch hour that I can use to catch up on work, but I also could, if I wanted to go out to my car, listen to music or, you know, do something where I have a little bit of pocket of time between my morning and afternoon clinic. You can do things like, you know, little essential oils. You know, I'm not drinking it or anything, but you can, you know, do little things like that that kind of gives you a little pause just for a few seconds, even if it's between patients, just to kind of ground yourself, get out of that situation, especially if you just had a difficult patient encounter and then letting go of that guilt. You know, so a lot of us carry that guilt. You want to be there all the time, and we're not going to be able to do that. You know, it's that whole, you know, analogy of the airplane and oxygen and all this stuff. You have to put your mask on first and then other people. Similar to that, you really want to make sure that you're taken care of. You know, I mean, I do still tend to put my needs, you know, on the back burner a lot, but, you know, you want to try to find ways to take care of yourself if you can. And then turning off phone notifications on airplane mode or having some downtime, you know, those screen time limits, you know, not only for your kids. You can do it to yourself, too. And that kind of cues you in when you've been spending too many hours, you know, listening to, you know, looking at Facebook or whatever it is that you're doing that occupies your time that takes you out of reality. And then muting your energy vampire. So we all have all of those people who only text you when they want something. I've gotten like four of them during this conference where, you know, some mother that I don't really know that wants to ask me about their daughter's ankle. And it's like, well, I'm at a conference, you know. So being able to say no or setting boundaries and saying, you know what, I have a policy. I don't treat patients, treat people that have my phone number because I won't be able to be impartial. So I would, but I'm not just saying no. I'm going to send you to my partner. I can arrange for one of my partners to see you so they don't feel like you're just saying no. You're actually giving them a solution, but you're still setting your own boundaries in terms of what you feel comfortable with. And I think that's it for me. All right. All right, my name's Aaron. I'm the non-award-winning panelist here, but I did, my now 11-year-old gave me a trophy two years ago. It said, congrats on adulting. So I have done it. So take that with a grain of salt. So I realized like when we give talks like this, it really is, you know, we talk about jobs. It's about the environment you want to look at or things like that. And when I talk about this, I feel like I got to give a little context of who I am because this is how I do it. It's not how you should do it. I think I'm efficient, but I could be really wrong about it. And, you know, I was looking at or hearing the plenary and I was a little sad because I'm at that bottom valley of happiness. And I'm like, it's going to get better. And I'm like, oh my gosh, I'm going to keep going down. So, and I'm happy. So I think if I can just give back, you know, my job here is to talk about how I would talk about trainees, med students, and residents of how, you know, if I could go back in time, what would I tell myself at that time? So before I do that, just a little background, you know, I have three girls, you know, and my beautiful wife, I have outpatient-based practice in academics and the associate program director. I like to do other things. I like to be part of, you know, national committees. I do some little work in the dean's office and faculty development. So another big passion of mine is mentoring early career physicians, not just in physiatry, but all across the medical center. And so, and also other things, I mean, you know, I always tell my trainees, you know, it's just as important for me to do all these things outside of work, just as opposed to me doing things in work. So there's a lot of different things that help keep me balanced. So I love to do this. I try to do this with a lot of my talks. I ask my 11-year-old to make a slide. And so it's gonna get better and better, but she is 11. So I asked my daughter what she thought efficiency meant. And so she said, and this is her, I did not edit this. So, you know, the period's in the wrong area, so it's okay. So efficiency is getting things done. She put her age there. Efficiency is being smart. Efficiency is a word I don't know well. I'm only in the fifth grade. Efficient, and I highlight this because I think this is a really good point. Efficiency is getting stuff done smart, not speedy quick. Because I think one of the things my chair has a difficult time talking about to our department is if he mentions the word efficiency, immediately people clam up. Because it sounds like you want me to work harder and bring more money to the department. And it's gonna take away from my life outside of work. And so, and I think part of this talk is just to say that's really not what the point of this talk is. It sounds like we're trying to get stuff done quicker so we can just do more work or whatever it is. And I think there's a little bit more to that. And then of course, that's what she has put in there. So take this here from an 11-year-old. So I think she brings up a good point because efficiency does not equate to speed. If you look at it, efficiency of practice, which pertains to how we do our work, is how much work we accomplish over the time and energy put in. Or another way to think about it is the least amount of inputs to achieve the highest amount of output. So how can we do our work well and not have to feel like we're putting so much into it, but get what we need to get done, accomplished well. So why does it matter to me personally? You know, there's, again, different personalities. You can look at this email inbox on the phone and you know that person who either has zero in their email or 13,000, you know. I saw an email box once. It was 101,000. I was just blown away. I'm like, okay. I'm not gonna say which one I am, but you might have a guess. But everyone has a different personality. So that's why I think it's hard to talk about this, you know, and just apply it to everyone. If my life hack is gonna be different than your life hack. But I really do believe that, you know, we do need to be balanced, right? Because for me, it's, I'm less stressed. I feel like I'm more humanistic to patients. I have more time to focus on them and less, you know, concern about my wellbeing. You know, on the outpatient docs on average spend twice as much more time on clerical work than actual direct patient care, which is pretty sad. So when you talk about hacks, half of it's talking about how to document quicker or how to do less clicks. And that's the reality of it. But I think that's a sad reality for a lot of future doctors if they think that's what they're gonna go into. And so how can we address that? And I think more efficient we are, maybe we can handle some of those outside clinical needs better and spend more time with direct patient care. And then lastly, you know, this, I talked to someone who's on the tail end of the career. And, you know, they came to me and said, you know, I'm almost done, but I feel like I'm busier than I ever was. And we can often fill our time with whatever it is. And we think, you know, we're gonna sail off into the sunset and now work one day a week, but I feel like life just will keep throwing stuff at you. So you do need to set those boundaries. I thought this was a great slide. This is from the Stanford Wellness Model. And they're talking about professional fulfillment. And it's these three reciprocal domains. And some of them we can control. Some of them is the environment we work in. So one of them is the culture of wellness. That's really the institution. Do they value wellness? Do they value time off? How's your department handling some of this? So this is a little bit beyond our control. Another one is personal resilience, which, you know, how do we handle adversity? How do we handle things that are thrown at us? A lot of resilience can come from things we find outside of work, family, exercise, hobbies, that can help us build our resilience. And then lastly is the efficiency of practice, which I talked about. How efficient are we in our practice with how much input are we getting and what's our output? So those are all reciprocal domains. So if I think about counseling a med student or resident or even early career, here's just some things that maybe I would mention to them. So the first is, if you're in training, you think, oh, once I become an attending, I'll figure it out. But I'll tell you, I still have people I graduated with who come home at 7, 8 p.m. still. It hasn't really changed. And so I think it really starts in residency and you have attendings around you. So you should have people that you want to emulate possibly and see how they do it. And the other big thing is, you know, again, I think of some of my classmates, you know, some of them got better because they had to get better. But I think it comes at a sacrifice of a lot of different things. Other things, you know, I think a lot of it is, again, documentation. I hate to say it, but you want to know what are the important components of writing a note. You know, sometimes we have people who write very long HPIs. And I ask them, do you read that HPI before your next return visit? And like, no, I don't read. I just go to the assessment and plan. So knowing what parts of that is absolutely necessary for you to give good care when you come back. What are you looking at? What do you need for the proper documentation to code or bill for your services? You know, for me, the other point was, I used to type all my notes for about first four years of practice. And people would comment about how quick I could type. And I was like, yes, I'm just going to keep doing this and type, type, type. And then, you know, I think part of it is just old habits die hard. And I'm like, I don't want to learn how to dictate. It's just really hard for me. That's just, that was my personal story. And now I just can't go back. And I felt like it just took that hump to just learn how to dictate. And I was definitely a latecomer to it. But again, I just felt like it's really helped me just move along through life. And again, for trainees, I mean, I'm seeing more and more residents already starting to utilize a lot of this. And then, this just reminded me, how many use Epic as their EMR? So a lot of us. Have you guys heard of Epic signaling data? Has anyone ever seen that? Can you raise your hand if you ever heard of it? So this is very interesting. I heard about this. But basically, you know, Epic can track everything, just like we think our apps track everything. Epic can track so much information. And when you look at this signaling data, it will track how much time you spend in your in-basket, how long it takes you to write a message back to a patient, how long you're, from the moment you open a chart to the moment you close. It tracks, there's so much data in that. And so, you know, for me, I took a look at it because someone told me that existed. And I was blown away. I'm like, oh my gosh. And here's where I'm logging in into Epic, what times I'm sending messages. And you know, you could see, you know, you know, you could be on some different trends of people being in your department and going on at 11 p.m. finishing notes. So all that data's being tracked. But I think it's an eye-opener. If you have Epic, there should be Epic signaling data that shows you. And I think it just helps framework, you know, what can I be more efficient in? Do I, am I spending way too much time in my notes at this time? So just interesting information that's out there. And then lastly, I think, you know, especially when you're starting off early, your support staff needs to know your needs and the boundaries. Because one of the big things I think, Chris Stander mentioned in giving value is like the difference between working in groups and working in teams. In teams, people have defined roles. And he used the analogy of point guard versus a center. They have their, they are all on the same team, but they have different roles. And I think where we can become inefficient is doing tasks like I mentioned outside of what we're meant to do. Because we're helpful, we wanna be team players. But I think the team will work better when we all have set those boundaries and we know what this person's supposed to do, we know what I'm supposed to do. So these are just a few things that I do. Again, this would not apply to everybody, but I tend to prep my notes. I know lots of people who don't prep their notes and that's okay. I tend to do that when I have downtime. And so, you know, I don't take any notes home, I prep and you'd be surprised. There are a lot of things that you can prep ahead and if they don't show up, the note goes away in Epic. But it just helps me personally. So I know after an encounter, I can close that as soon as I can. I dictate. Another big thing I've been asking my trainees to do, because we're so used to do this in residency, is taking notes in the room with the patient. And we come out and there's like notes everywhere. And part of it is then you're taking the notes and then you're having to now put that into dictation form into the notes. And I think it's just the way our brain is trained to do that for so long. But for me, you know, one of the big things I just learned over time is just allows, when you're not doing that, you're focusing on the patient a lot more, you're looking them eye to eye. And if your notes are already ready, you come out and you dictate it right away. Because I couldn't do what I do if then if I took notes and did it later, if I didn't take notes and I did it like two hours later, I'd forget everything, to be honest. I'm like, what was that patient? You know, so I think for me, it's helped to just be present in the moment there and then just dictate it right away. And so try not to take any notes home right after that. And then obviously having a schedule is really important. And then lastly, just trying to minimize distractions. We get distracted with so many things. And I think part of that is just how our brain is trained. We may just go off on tangents. And I remember, you know, I worked with an attending and nurse would come in the chat and then we'd just be off on this area for 25 minutes and then come back to the note. And I'm like, what just happened? So, you know, I think just setting those boundaries early, especially as a young trainee to, so your staff knows like, hey, if you're dictating, you know, just try not to distract me if it's important, just let me get this done and then go on to the next one. And so, again, that's personality dependent. You know, I know we all like to interact with other people, but I think my staff knows like, hey, if I'm working on something, you know, if it's an urgent ask me, but if not, then just come back after I'm done dictating. So that is it. Thank you. Thank you. Good afternoon. I'm Lauren Shapiro and I primarily do inpatient rehab, but have some clinics as well. Currently in academic practice, but I've also worked in private practice in the past and I actually learned many of my tips for efficiency there. So I'll be discussing tips for efficiency in the inpatient setting. I don't have any relevant financial disclosures. I think the challenge for those of us who do inpatient rehab is pretty clear. The inpatient work is never really done because our patients need around the clock care. Families also tend to come in late in the day when they're off of work, which is usually when we should be going home and increasingly many of us are facing pressure to admit to our facilities 24 seven. And there are, for many of us, if not all of us, there are other demands on our time, peer to peers, prior authorizations, and many, if not most, are also doing outpatient care and or consults. There are a lot of drivers of burnout in inpatient rehab physicians. I was fortunate to be a co-author on the study here and some of these drivers include regulatory demands, which was the number one driver of burnout, late admissions, understaffing, and on-call responsibilities. So it's important that we adopt the right mindset. Being efficient allows you to save time and focus for what matters most. Always working long hours is really going to limit your long-term ability to help others in your career. And very small changes can make a really big difference, particularly when you look at eliminating redundant work, which I promise won't negatively impact the quality of care that you provide and it will probably really improve it. So one example I often think about is restructuring how I was covering our inpatient unit while on call. So prior to 2020, we had two small inpatient rehab units on our medical campus. And at most, our census would be about 48. And I would also take each patient's heart, lungs, and abdomen. I wrote these lovely individualized notes for each patient. And you know, when I was on call, I was working 12-day stretches without a day off. And I will tell you, my days were very long and I had very little sleep. And on my day 12, I looked like a zombie. I had no patience for anybody. And it was really, I wasn't providing great care either. then in 2020, we moved into a larger facility and suddenly when I was on call, I was responsible for 72 beds and we were pretty full and many of them had COVID and I'm like donning and doffing PPE and dealing with all sorts of things. So it was no longer possible or sustainable really for me to do what I was doing previously. So now I just briefly check in on each patient. I spend more time with the patients who actually need it. I'm taking brief breaks between our units and I found that actually speeds me up because before the resident and I were taking different bathroom breaks and we were like losing steam and now between each floor, we take a bathroom break, we drink some caffeine and we get going again. I only write level one notes on the vast majority of our patients. You can see my level one template, which I have as an auto text here. Feel free to steal it. I do write more if I'm doing more medical management, but you know, if I'm just adding collates, I can just add that onto the bottom of my note. Now I have far more energy and focus when emergencies arise and they often do and I'm typically far better rested the following week. So my day 12 goes much more smoothly. So I talk a lot about eliminating redundancies and I just have a word of caution before you go about doing this. Make sure you know the CMS requirements for inpatient rehab really well because we can make some of these easier or faster, but we simply can't eliminate things like the four-day plan of care. Other team members can and should help complete parts of them, but they are ultimately our responsibility. But you know, I really encourage everyone to think about does your IRF or hospital system have policies that are completely unnecessary? I would also say trust but verify when you have consultants coming into your facility and they're telling you to do things that don't sound quite right. Several years ago, our inpatient rehab unit brought in consultants who told us that the notes that our residents were writing that we were attesting to with addendums did not count towards the three face-to-face notes per week. So they were kind of telling us we had to write separate notes from our residents three times a week. That was completely false. So when you hear something that doesn't sound right, contact your MAC, your Medicare audit contractor, or email CMS directly. Their email is here for your questions regarding IRF coverage because we were wasting a tremendous amount of time and it was completely, completely unnecessary. Another thing is think about those common forms that you're filling out all the time. Your disability parking placards, your special transportation services. Pre-print these. They're PDFs online. Put your address, your medical license number on there and just sign them. It's going to save you so much time. I'm a little old school in that I still like a good stamp. You know, many of us who do inpatient rehab will know we get a lot of faxes from CVS and Walgreens for patients we've discharged like three years ago after their stroke and they're still asking us to renew their Norvasc and their Lantis. You know, rather than writing this out every single time, I bought an eight dollar stamp, prescribed in hospital, needs to see PCP to determine if the drug remains appropriate. I can't tell you how much time that stamp has saved me. You know, as many of the prior speakers have said, you know, we write a lot of letters, particularly appeal letters, also letters of medical necessity. I write a lot of fit to fly letters. My patients tend to be from other places. School work absences, just save these on your desktop or build them into your EMR. Don't rewrite these from scratch. There are some AI tools, as others have mentioned, that can provide some writing assistance. Doxibony now has one that's kind of built in that has some nice templates that can serve as a template, but you will still certainly need to edit these. Optimize your EMR. Create custom IRF specific order sets. Don't use the same ones the hospitalists are using. Consider developing different order sets for common diagnoses you see. Look for opportunities to improve upon them to save time. So we look at ours at least once a year. We do make changes that, you know, shave a minute or two off of order entry. Work with your IT department to import that which can be imported into your notes. In this day and age, there is absolutely no reason why any of us should be manually entering things like vitals, labs, meds, or even functional status. I have found over the years I've sometimes had to bring screenshots from other inpatient rehab facilities to show our IT department what our EMR is capable of, but the good news is physiatrists are nice people and they're always willing to share. So just get on PhysForum and ask people for templates. They will give them to you. In general, I find it very helpful to build a progress note template for subsequent visits and inpatient that basically hits a 99232 level, and then I can add and subtract as is appropriate. Here are some of my favorite smart phrases in Autotext. I'll just leave that here, but certainly on the day of team conference, a little Autotext that I could put into my note that I discussed in team conference this morning, see my separate interdisciplinary note for details. I also have smart phrases in Autotext for when I build based on time. As an efficient doctor, I will tell you I seldomly do because I'm usually faster and hit a higher level, you know, more quickly than I would get a higher level of billing and coding, but when I do bill based on time, I have my template kind of built in that prompts me to document everything I need. I have a number of attestation statements that I share all the time with people in my department, but these are things that you should not be writing every day. I have a separate attestation for my discharge summary to prompt me to put the total time I've spent because I had a tendency to leave that off my documentation, and that's really important, particularly if you're going to bill in 99239. Occasionally, I'll remember to bill for initiating home healthcare, and when I do, I have a nice little template for that so I can build that g-code. We also order a lot of custom wheelchairs from the inpatient setting. I have a nice little template for our face-to-face notes built into our EMR as well. I think it's really helpful to minimize the need for others to page you, so I'm very proactive. I like to make sure I know about overnight events, and I stop by the nursing station before I round, so they don't stop me in the middle of the hall and be like, oh, did you look at so-and-so's rash and have to make another trip? I also routinely check in with my social worker or case manager right after rounds as well to reduce the need for, you know, texting back and forth. I have clinic in the afternoons. I reliably reach out to either my resident or non-physician practitioner, depending on who I'm working with, the moment my clinic is over. I encourage them to let me know of any major issues on the floor as they arise, but I know if I'm very, very diligent about calling them when clinic is over, they'll interrupt me a whole lot less for things like a little dysuria or constipation. Keep your team conferences really focused. It's important to set expectations for team members to arrive on time and to be prepared. A lot of our therapists are very young, and they need some coaching, that they have to accept that there are simply some things that are not within our realms of control, and that we need to focus on the things that we can change as a team and on what the true barriers are to discharge. Now, in order to keep team conference focused, it's important that we make sure they know that we're available to discuss their other concerns at other times. Family meetings are sometimes the efficient thing to do, particularly if there are a lot of family members involved, if they tend to come in at night or on weekends with like a long list of questions, and when the family needs a lot of repetition. Sometimes we actually have downtime. It's very, very rare. It's a great use of that time to prepare for busier times ahead. I like to devote some time to improving my efficiency. I make a lot of smart phrases and autotext when I have some free time. Complete some CME, we all have to get that done. And then, you know, we all have side projects. You know, in academic medicine, we're often doing research, we're preparing talks. I like to divide my big projects into little pieces so I can use those little bits of downtime. I just make to-do lists and I tackle little pieces at a time, and I do some block scheduling to help me do that. You also have to recognize that even the most efficient doctors are going to sometimes encounter settings or times in which we simply can't be as efficient. So I do clinic in two locations. One is a super efficient setting for me. The other is really slow and painful. So what do I do? Well, I'm working with the staff to kind of make it more like the other clinic, but I streamline what I can. I accept that things there are simply going to take more time, so I'm less frustrated when that happens. July, as an inpatient doctor in an academic setting, tends not to be my most efficient month, because I have new residents I need to train how to kind of navigate our healthcare system. So I plan for it. I accommodate it. I outsource what I can that month. I avoid taking on extra projects during that time, and sometimes, as much as I hate to do this, I have to accept B-plus work that month. And I take breaks before and after. So I know July is going to be bad. I make sure I take like a four-day weekend in June before the new residents start, and then I plan to take some time off in August as well, which segues to taking time off. I think sometimes with inpatient rehab, we are a little bit nervous about taking time off, because that usually means a colleague has twice the workload. But it's really important we all take time to recharge our batteries. Be very mindful of your covering colleagues' time. Like, I always make sure I sign things out, because it takes me a fraction of the time it would take them to do chart reviews. And I always alert my full team so that they know that I'll be away. There's no reason for them to waste time, you know, figuring out who's covering me. Just send them an email, look for where you go. But it's also really important that we try to disengage from work during our time off. I saw this study from last year by Marshall et al., which was a survey of women physicians who found that more than 90% of us are engaging in work-related behaviors while on vacation, with more than 90% answering work emails, which I am certainly guilty of, because I cannot have an inbox like the one you showed. More than 50% are participating in work-related meetings, and I think Zoom has made that far worse. And over 40% are actually engaging in clinical responsibilities. So if you're going to take a vacation, please make sure that you are at least getting some restoration from that time away. So my takeaway points. Efficiency preserves your time and focus for that which matters most. And there are a lot of ways to improve your efficiency in the inpatient setting that don't negatively impact the quality of care you provide. And at the very least, we should all be using technology as much as possible to help us get our mundane regulatory tasks and documentation done quickly. Thank you very much. All right, thank you so much. Dr. Mukai confirmed what my wife always tells me. I'm only standing here because I've got an accent, so I understand that. So it's the only reason I've got so far in my career, so I appreciate that. So my name is Prakash Joban. It's a very nice introduction that Dr. Mukai has put here for me. But essentially, I'm a clinician scientist at the Shirley Ryan Ability Lab, so I do a mixture of research and clinical care. And today, I'm really going to be talking about academic efficiency. And my real disclosure is to say I have no financial—I wish I had some financial disclosures. I do not. I'm a clinician scientist, so I'm not always the best paid in my department. And I don't have all the academic efficiency answers. There aren't studies that I can cite to say this is how you can be the most efficient, unfortunately. But what I dream of is being this gentleman about 40 or 50 years from now. And I'm looking through that glass, and I'm thinking about my career. And I'm thinking, what is it that I'm known as? What is it that I will be defined as as I'm now leaving my career and thinking about this time in retirement? And is it as a clinician? Is it as a scientist, educator? Have I made tons of money? Am I an innovator, leader, entrepreneur? Am I an advocate? Or am I a family person? Am I a family guy? And so when I think about that, when I started in academics, I wanted to be this person, which is all my academic credentials. I feel like it's the first thing people ask you in America when you go to a party. They ask you, which college did you go to? What medical school are you at? And I love to just be able to be there and take pride in where I'm at. But the older I get, maybe I'm just getting softer, is that this is what I want to be defined as. And I think Aaron, I've spoke to him personally before, and one thing he always says is he wants to be efficient so he can get home sooner to his family. And that's his priority. And I think when I started academics, I was very, very focused on the left side here. But as the more I get on, the focus for me is on the right side and being with the craziness of which is my home and these people. But the first thing that I would say from an academic perspective and efficiency is knowing what's important and what your metrics are. Whenever I talk to residents about academic growth, I think it's important for them to understand what the academic ladder looks like. What is it, the metrics that you need to get to, to then go up that academic ladder? Do you start off as an instructor or assistant professor? What sort of things do you need in your documentation when you go up for academic promotion? And start those things early and make sure that you're not waiting until you're going up for academic promotion. Then you start putting all those things, you try and look back at what conference you presented, etc. I tell all my residents to make sure that they document all those things they did in medical school, even residency, and that those things are, they keep updating it on a say a quarterly basis of all the things that they've done because that will make your life easier as you go up for academic promotion. But knowing how each one of these steps of the ladder and what you need to do is really important. So I'm on the more clinician scientist, clinician researcher track at Northwestern, but I also wear an educational hat as well. And so that educational piece for me is not the one that I am valued on or evaluated on, I say, as much as I am on how many research grants I bring in and how many patients I see to an extent more from the fiscal part. But that's the part that I have to focus on is being a clinician and the research. So education shouldn't be something I'm focused on as much. And so when I first started as attending, I had this tendency to say, yes, yes, yes, yes, yes, I'll teach anything, I'll do these things. But now as I've got on, I've realized that was pretty inefficient because it was taking time away from these other two areas which I am evaluated on. The other thing is in knowing your metrics, there's also times, well, I think one thing is having upfront conversations with your director, with your chair, et cetera. It's like, how am I evaluated academically? Because that to me, you can match what you should be working on in an efficient way to match what their goals and expectations are. But there are times where your goals and expectations and interesting things or opportunities come up that you're really interested in, but your department may not value. And those are maybe could be seen as you're being inefficient, you're being distracted, you shouldn't be doing that. But I have taken a couple of risks like that and it's paid off. One of them was actually this adaptive golf opportunity that came up. And I've done some research in residency, specifically on golf and the health benefits of golf. And most people when I started talking to them about golf, they would laugh, like, why would you do research on golf? It's just for older people who just have a lot of free time. But what I found was actually, I did a study looking at people with knee arthritis and the benefits of golf. And then we got approached by the USGA to me, basically help with adaptive golf and really trying to be an assessor for adaptive golf. And initially my boss was like, that is a complete waste of time. That shouldn't be in work hours, you're going to have to do that extra. And so I did, I started working with them on an extra and then eventually we built a program. And at this point now we're having patients actually who are golfers who start getting, coming to our practice and it's grown our practice. I'm not involved in that part so much, but I will say that now it is very valued and they give me time to actually go and do that. So there are going to be times in your career where you will have to take risks and decide if it's a calculated risk because you love doing that and you're passionate about it. But the important part is what is the vision for your career? When I talk to residents, I often talk about their, and in our residency, there's so many opportunities, so much research going on, so many posters, presentations that they could give, et cetera. And sometimes they're residents that just do everything. And what I tell them is that it's much better to have a vision for your career. Think about your career as being somewhat of a pyramid and that guy looking through the glass is the top of that pyramid. All the things that you are going to do are little blocks that let you climb to the top of that pyramid, if that makes sense. So you'll be very, very focused hopefully at the end of your career, but all of these things should lead up to that end of your career. So doing projects in a specific area that fulfill that vision that you have for your career is really, really important. And also tell them that when they write their personal statement for fellowship, having some sort of strategy of how you're going to get to that final endpoint, and then being able to tell an interviewer that you are actually doing this to reach that final goal in your career can be very, very attractive for a fellowship director. So speaking of that vision, I started doing this when I was in residency. And it's something that's always helped me to maintain my efficiency in this idea of academics where you feel bad saying no to things. This is some way of me making sure that I'm doing things that lead to that vision. So I think about my academic research goals on a yearly basis, the clinical skills, procedural goals, the leadership, administrative goals, advocacy goals I have, the educational goals, the life goals and location. And this is part of a conversation I have with my wife of, are we happy here? Is this where we want to be? And we have always, my wife knows I have like a five to 10 year plan at home. And these academic goals in my role, the thing that has the most value for my department is getting research grants. But many of these other things are also very academic and important as well. And these could be some examples of things that you think about. And the reason I'm saying this is that you can then choose the things that fulfill that vision that you have at the end, at the bottom of this screen. But just some ideas to think about how to actually, so for example, educational goals for me have turned into being involved in the resident research curriculum. Rather than me giving lectures about osteoarthritis and educating on that necessarily, developing the resident research curriculum is seen as valuable for my chair. And so that's what I focus more on. So then I sort of want to go into five pearls of five tips and tricks that I sort of come to that have helped me in improving my academic efficiency. The first part is clarifying what matters to you. I try and intentionally set time for the highest priority items early on in the day. That's because that's the time where I'm most awake and most alert. I'm less distracted and I want to get started and for me that's starting the day say very early because my kids are asleep and I can just start working on stuff really really quickly. I find those first few hours of the day are the most important for me. I delegate items I think that's a common thread between all of our talks today and so I delegate items. I have research staff when I started in the same way that we try and do everything that other other practitioners should be doing we try and do for them as we're a team player. I was doing things that myself and one person mentor that I first started he gave me one of the worst advice that I've ever received which is like don't ever hire anyone in your lab because that hiring someone is really expensive. So I was doing all the assays I was recruiting people etc and then I he subsequently left and then I hired someone I was like why didn't I do this for the first year I shouldn't be doing all this stuff. So that was key for me as well. Decline opportunities that are not aligned with your goals. So again thinking about that vision for your career you know politely decline and and don't see that you know I often have residents ask me I've been asked to do this or that but is that does that fulfill your vision or goal it might be good for your ego but your ego you won't be thinking about that when you're up till two o'clock in the mornings because you said yes to that project that you wanted to do that you said that you said yes to three or four months ago. There's this idea of also satisficing I don't have anyone this is a this is probably if someone's type A this is really difficult for them to do and this has been I am a little bit type A this is difficult for me to do. This is the idea that you are going to do you're not sacrificing and you're not you're but you are to an end it's a little bit you are it's satisficing is basically you're going to not going to do something to an optimal extent you're going to do it to a satisfactory extent and so sometimes for example I would say notes when I first started as attending I used to do the most pristine notes I was like why am I doing this pristine notes I could just do a satisficing notes it's satisfactory it fulfills I'm gonna get paid for this note and I'm not gonna get sued for this patient because I've said everything but I think satisficing is something that is doesn't come naturally to physicians but it's important to think about and if you're having difficulties prioritizing what's important to you reach out to mentors they're the ones that are going to be really honest with you and tell you yeah that's complete nonsense why are you doing that. Now in terms of what matters I also found this very helpful as well this action priority matrix which is idea of some things are low impact low effort some things are high impact low effort high impact high effort and low impact high effort and I found this if you start putting some of those academic things that you need to do in each of these buckets it might be a really good way to sort of manage your time as well and obviously the high impact high effort that's the stuff that you should prioritize the most and I do that certainly with major research grants or projects that I do. The other one that this one I found it was more tailored to physicians so this is one that was actually something which was very very nice it was like the top the the the x-axis is do you love it or would feel passionate about it whereas the y-axis is it required or essential to your career and I actually found this really really nice and it's like yes no yes no and so like the bottom right is delegate or drop this if possible do at the minimum level if possible non-urgent administrative tasks so that you know we all have all of those but I find some of this sort of breaking down a lot of the things that I have to do on a daily basis this I found very very useful. Number two is tracking your day tracking your tasks I think I would absolutely fall apart if I didn't use my Outlook calendar and I've had residents that have ghosted me for meetings because and they're like I'm like don't you use Outlook for your calendar like no and I'm like just just use Outlook and I I would totally have done the same thing so it's really really important to follow that notebook or journal is fine and organizing our projects so in in the green area that that picture is actually I put all of our research projects on a Google spreadsheet and it's the residents job we have tons of projects in the musculoskeletal vision so about 25 to 30 projects and the residents updates our their projects when and tell us where it is so we have a meeting once a month where they all update their projects and then it's their job to actually update their projects on the Google spreadsheet so we can keep track of where that project is there are other apps that have also I found really useful there's Trello which is another app that's really useful this is one where you you have multiple individuals involved in a project and they each update that project and so say they've written an introduction to paper it goes into Trello and then that's checked off it's a very nice sort of checklist type app that I found very useful and then Evernote is something I don't know if any of you have used before it's a really good way to keep track of meetings we all have meeting fatigue but this is a way for you to actually keep track of meetings etc and and keep notes in different areas as well from those meetings the other thing the step three is being focused be present I that we call this in in many different types of a deep work this is where you're really really having to focus this may be in research you know writing a grant writing a paper you can't do that late at night when you've just come home from clinic so I really find that really really useful is trying to do that deep work particularly in the morning there's this Pomodoro method that you'll see described in the literature online and I have a slide next that I'll talk about talk about that but I do not try I don't never try and do deep work you know between meetings like on the fly and I try and strategize zoom meetings because that's become the pervasive thing for research in particular and education so I try and strategy zoom meetings at the tail end of the morning or later in the afternoon when I'm beats and I'm fine taking a meeting I always end every single zoom meeting with the action items because we've all been in meetings where you're like I don't even know what we're gonna do next this meeting was useless but I try and I try and summarize the meeting that I have with someone so we're both on the same page before we go forward so the Pomodoro technique has shown some helpful efficiency so this is idea that you work in 25 minute bursts so you 25 minutes your phone is off you're not going to answer your phone in that time or look at your email and then what you do if you think about something it's understandable that your brain might get distracted you think about something then you're going to write that down but you're not going to act on it then you take a five minute break and you basically do it in so you do 25 25 minute bursts with five five minute breaks it becomes 150 minutes of work and and then you take a 30 minute break at the end of that I found this really useful for writing papers or other things and when or writing research grants but it could be you know for writing your notes etc I don't know but I think there this could be a very useful thing in other areas where you need to do deep work time savers so Aaron talked about I think we've all shown pictures of this email this horrific email I didn't have I mean it's getting larger now it's like 3,250 when I look at this this is this is my kids watching ET by the way in the end so they're there but but so but this is horrific I when I get palpitations looking at that sort of thing and I think I have also been guilty of that in the past I think most of the time it's when I've signed up for like gap outlet emails or I don't know my wife signs up for anthropology a lot so so so that is so time savers for your email is also another really important thing to think about so I use dot phrases in my email not just for my notes there are text expanders as well for emails passwords as well which are really important Outlook can actually organize your inbox so in our hospital I'm an outpatient doc I get the residents sign out for inpatients and we have 240 patients in hospital I get that email every single day and and I also get the update on how many inpatients are in the hospital right now and I get that email every single day and for some reason they don't they can't unsend it to me I have to get it but that now it's this is totally bad but it just goes into a inbox called site a separate inbox that I made called sign out so I never look at that one one day it feels great I just delete 40 emails that one day but that's a great way to sort of save time because even that idea of just clicking delete of that email takes me time but now I never have to look at that again email filters and batching unsubscribing unsubscribing might be hard on your Google email where you've signed up for some company etc but but I do that very very quickly if I get an email from a company I don't know to my work email I immediately unsubscribe I don't know how they probably still get get a hold of me but I do that the other thing is when you're a resident or a medical student in particular they rule the faculty will tell you they get really long emails from medical students and I when I was a medical student I used to do that and then I get a one-line response back from the faculty member and I would be like oh my god they hate me they really hate me I was I spent hours on that email and they responded in one line but but actually you know it's it's efficiency again I think and I tell the resident I got it when I see them I'm like or the medical student got away and when we finally chat I'm like I got the email don't worry I don't take it personally I respond in one line I just I swear we're gonna set up a call that's fine thanks for the information so I think once you explain it to someone and they're on the other side they will understand that you don't need to be you know really long and subscribe to those emails this is the same I have IRB templates so any resident does a project with me I just send them a template that I have before of a similar project that saves them and me a lot of time and similarly for manuscripts have been pretty productive with manuscripts because I have sort of templates for the residents that they can use as well chat GPT was mentioned I don't use this for manuscripts that would probably be bad but I do use it for things like when I my research lab I needed to do the page for the research lab so I just asked asked chat GPT to write that for me and it was better than what I could have written about my lab itself I also tell residents that or tell people that I don't like to do back-and-forth text messages I know it's old school but like let's just call it be done we've get it done but sometimes you'll get this tirade of text messages whatever it is and I just don't have the bandwidth to text that much so I just tell them just call me we'll get it done and then and then that would be great and then I delegate tasks again to others if possible and then timing of the day you check email so the tendency is you you check your email in the morning and then if you check it once more at night you're like oh my god I got like 150 emails I'm sure we've all had that sinking feeling I just check well I try and check it one more time in the afternoon but I try not to check it throughout the day okay so once in the morning once in the afternoon once in the evening the other part is then mentor mentee and this is just a quick thing I don't I've heard about in academic world people doing contracts with mentees that would be great I could not do that I would probably there probably some breaching of the contract at some point because I don't get back to them enough but one thing is to say that residents in particular can really contribute to your efficiency as well if you have a really good resident and they're really doing projects well for you I found that really really useful mentoring is one of my favorite parts to do and so that's something else to to do with that we've had medical students and residents who've really helped other members of my lab understand science understand the medical part of the science they're doing so that's really helpful and I always tell them about meeting deadlines and keys tasks and come with solutions to me realize I'm really busy and I don't have time always to deal with the problems finally I wanted to say celebrate the successes we've talked about that but whether it's your mentor mentee has a success or your team has a success your family has a success you know celebrate those moments it fosters this team ethos and that I think has been really helpful for me in my research lab in particular to sort of really try and you know be energetic about the work that they do because they feel that it's valued work academically smart smarter not harder that's these sort of the take-home message track projects using a task amount it task manager keep meeting short and concise with a clear goal have action items to get to delegate delegate delegate things you don't need to be doing and then finally avoid those academic in pitfalls impacting efficiency this is natural as an early career person to say yes to everything but and so that can be difficult and then saying no to everything sometimes can also be really hard faking interest or feigning interest in something is also sometimes can be an pervasive in academics and be careful of that I'm not asking for help believing you're the only one confused lost tired stressed etc you know it confide in your colleagues losing perspective is also another thing and never neglect your personal life or forget your hobbies and that's it thank you thank you for coming we have this is kind of the last I think course of the day so we can stick around for a few minutes I know we went a little bit longer than we wanted to but if you have any questions or comments about whatever we touched upon today or something we didn't touch on we're here to answer questions or if you just want to make a comment we welcome all that too so thank you it was very nice very good talk I have a question about online reviews do you guys read them do you read yours you read colleagues what do you do about them do you respond to them well I'm in private practice so online reviews do play a role we have contracted with the service that kind of sends out surveys at the end of a visit to ask them about their satisfaction and if they give a five-star review we direct them to Google Yelp or whatever you know health grades that kind of stuff if they give a negative review that goes to like a patient matter like a what do you call it advocate to follow up with the patient to to see if we can resolve the issue so so we try to kind of stack the odds in our favor to do that but obviously once once in a while we will get a negative review technically you know when we've gotten advice from the medical board and our medical liability insurance we're not supposed to even comment to say that they are a patient because of HIPAA and so a lot of times what we'll do is we'll say you know we strive to give the best care possible to all of our patients please call our patient advocate with you know specific concerns we would love to to you know make it right or address your concerns it shows other people reading those reviews that we care but we're not necessarily going into the rabbit hole of arguing with them about who's right and who's wrong that kind of stuff yeah I will say in academics we tend not to have that nice support private practices do because just big academic center is not enough resources to go around but I do see that a lot of academic centers will also tend to take control of the internal reviews as opposed to just being you know random website people can get on to somebody comes in you're like oh my god you're the best doctor ever you just may be so much better blah blah you hand them a little postcard or have your staff send them a postcard saying here's some you know links of Google or Yelp pages if you don't mind you know posting a review that we love it thanks guys that was amazing so today's world there are all these expectations of sort of quick immediate responses you know I do inpatient and outpatient right an inpatient there's somebody who's sending an epic chat but there's an in basket but there's an email right and and and everybody's expecting a now answer obviously that's going to impact efficiency so what tips do you guys have for us at how to I don't know educate people away from it or manage your time on your own what do you guys do we very much have asked that our inpatients bring any concerns directly to the nurses we've had some that have like tried to call the office from their their room you know it happens more often than then you would think or try to use our portal and when that occurs I just take the opportunity to educate the patient like I want to respond more quickly to your concerns I personally I only check my inbox within our EMR once daily so if you want a more immediate response and most of our inpatients require more immediate response please go to our nurses and then of course the nurses can can help triage most of my patients know that I'm reliable about getting back to them but that I'm only in there once a day I've had a few patients I mostly do traumatic brain injury and stroke so not all of them really think through the messages they're sending me in the portal I've taken those opportunities to like educate and and you know I have one guy who likes to write me sentence fragments and then send me six different messages in the portal and I had to be very honest and have a sit down with him in the office it's like I really care about your symptoms I want to help you but I'm afraid I'm gonna miss something the way you're sending me these messages so maybe send me fewer messages but put your thoughts together first so that then I know how I can best help you and I find most of the time that goes pretty well not a hundred percent but that's the way to take care of it it probably depends on who's sending you the messages so if it's coming internally from your staff versus patients right so if it's staff I can be a little more direct so for example you know my nurse practitioner wasn't very tech savvy so she would text me and say check your email I'm like okay so texts are I'm in clinic but this needs to be handled right now someone's dying I'm about to send someone to the ER that kind of stuff email is please check this note later but blah blah blah if it's something in between use Athena tech so I try to really try to kind of define it for them same thing with the staff for patient portals oh I can I can do either a text macro that says you know that guy's in clinic right now but she will get back to you by the end of the day so you kind of put a little deadline and you kind of say that if it's an urgent matter please call my triage nurse at this number so you can kind of automate it that way or you can have your staff do that for you it's probably good to have a layer if you can of somebody kind of triaging whatever you know messages that you're getting so that if it's something that can just be handled like a prescription reflow request that gets handled you know maybe before you even have to you know handle it or do anything Any tips for outpatient clinics that are multidisciplinary on how to keep people in their lane and make it efficient? Something like amputee clinic that has multiple folks in it. I can say I used to do a multidisciplinary clinic. It has been a few years, but I worked with a physical therapist and then a rotating group of clinicians from outside vendors. I think just setting the expectation early with your team members. I used to meet with the PT who coordinated that clinic, usually the day before, so I kind of knew what to expect. I find those kind of settings can be extraordinarily efficient because having that expertise, particularly of the prosthetist or orthotist, they can tell me what needs to be in my notes to help smooth out the approval process. So I think that those types of settings can be really efficient. You just have to kind of get used to your team and let them know what your expectations are. We'll be around for a few more minutes. If you have any individual questions, just don't really want to go up to the microphone. We're here. Thank you for coming. Thank you.

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