Welcome to the Clinician Researcher podcast.
I'm your host, Toyosi Onwuemene
and it is an absolute pleasure to be talking with you today.
Thank you so much for tuning in.
Today's episode is about not pursuing the productivity bonus.
Yes, do not pursue a productivity bonus.
Do not pursue the clinical productivity bonus.
Ha ha ha ha.
I can already see this is going to be a controversial topic.
But I want to say, if you're listening to me,
you're a clinician researcher trying
to advance your research program.
And I want to tell you already, spoiler alert,
that the clinical productivity bonus is taking you
away from your goal.
I know it's bringing you money.
I know it's probably going to help you pay for that nice
vacation, but it's taking you away from your goal.
And I want to just talk to you about how
to think about the clinical productivity bonus.
Now, this particular episode came to me
from a couple of weeks ago where we were talking
about our productivity bonus.
And I have to tell you, it used to be really simple
and straightforward.
You exceed the number of RVUs.
You get it.
And now it's a little bit more complicated.
It's like if you are in research, this is what you get.
You get less in the clinical space.
And then if you do this, and then there's
the reward for good citizenship.
And it's 30% for the, it was so complicated.
I remember thinking, like, if I spent time trying
to figure out the math to maximize my productivity bonus
100%, that's time not well spent as far as contributing
to my research program.
So I want to share some of my thoughts with you.
And I would be excited to learn about your thoughts as well.
Please share them with me.
I'm on LinkedIn.
Send me a direct message.
OK.
Number one is that physicians are
susceptible, extraordinarily susceptible,
to working hard at hard things.
Ha ha ha.
Now I'm preaching to the choir here, but you know what I mean.
If someone says, oh, no, you may not be able to make it,
you're like, oh, yeah?
You think I can't make it?
OK, we'll see about that.
Then you hustle.
You do all this hard work.
You make it.
And you're like, yes, I did it.
But was it worth it?
Should you have spent any time doing it?
That is a thing that's a pitfall for physicians.
And many physicians fall into the trap
of working hard for the sake of working hard.
This patient's blood pressure is not where it needs to be.
I'm going to do everything I can.
And you know what?
They're not even taking their blood pressure medication.
They don't even care about blood pressure.
And you're working so hard.
So here's the thing.
You are susceptible, if you're a physician,
to working hard at things that are hard.
And if someone tells you that this
is what you need to do to jump through the hoops
to get this productivity bonus, guess your susceptibility.
Yeah, you're going to be working really hard.
You're going to be working really hard
to make the productivity bonus.
And that is a problem.
That is a problem.
Because when you're working on all the metrics
to be able to get the productivity bonus,
guess what you're not doing?
You're not moving your research project forward.
Why does that matter?
It matters because as clinicians,
research training is not part of your clinical training.
Yeah, you may have gotten a little bit of research training
here or there.
But when you think about people who are doing research
full time, PhD scientists, you barely
have enough research training.
And so you have a lot of skills to build.
There are skills you don't even know you don't have yet.
And so do you have time to chase clinical productivity
when you really need to be building your research skills?
I think the answer might be no.
But you might be saying to me, but Toyosi, I need the money.
And I'm not laughing because I'm mocking you.
I'm laughing because, yes, that's
a challenge with academic medical centers,
is that you know what?
They don't really give you money to remunerate
your clinical productivity, even when you're not
trying to meet the targets.
But being in an academic research environment
is not necessarily the place you came to get rich.
And you have to be clear about what you came for,
what you're going to get.
Now, am I saying that you shouldn't make money?
Please do.
But think about, does your academic job
have to be the source of all of your income?
And how else can you think strategically
about making money such that you're not
investing all this time doing all this clinical work that
ultimately may not really pay you for the investment
that you put in it?
All the while, your research may be suffering.
So clinicians are good at working hard at hard things.
If someone gives you a couple of hoops to jump,
your tendency is to jump the hoops.
But I want you to ask yourself, what is my goal here?
Why am I here?
And are these hoops I should be jumping at all?
So number one is, please, recognize your susceptibility
to working hard at things just because they're hard.
All right, and avoid that.
Recognize your weaknesses so you can protect your weaknesses.
All right, that's number one.
Number two is that productivity bonuses are there
for a reason.
They are there to incentivize you.
This is the thing.
If you think about tax law or tax code,
it's all about incentivization.
It's not to reward you for your good work.
It's to make you do more of that work.
I will tell you that one of the things that was so eye-opening
to me was when I finally sat down with my business manager.
This was as a result of some project I was doing.
And I said, tell me about the productivity bonus.
How do you account for that if people exceed their productivity
bonuses?
You know what I learned?
I learned that it's budgeted.
And so there's a ceiling to the productivity bonus.
You can work your heart out, exceed all the targets,
and there's a limit to how much you can earn.
Ooh.
So productivity bonuses are not really there to reward you
as much as they are to incentivize you to more work.
And I think you need incentive to work.
I don't know if clinical incentives are what you need.
I think you need incentives to be
able to advance your research, incentives
to be able to move your publications forward,
incentives to submit those manuscripts.
And guess what clinical productivity bonuses are not
incentivizing you to do?
They are not incentivizing you to your research.
And if your early career, even if you're a mid-career,
you've got a lot of work to do to move your research
to where it needs to be.
And so do you have time to pursue the incentives
or the productivity bonus?
I don't know.
Only you can answer that question.
But I don't want you to pursue an incentive that
doesn't incentivize the outcome that you want.
Yes, we all want financial goodness.
And there's a bigger, bigger thing
beyond just the finances.
And are you incentivizing to get those outcomes?
Are you incentivizing yourself to get the outcomes
that you actually want?
OK.
Number three, instead of pursuing the clinical productivity
bonus, what if you prioritize your research?
And this is important because when I talk to faculty,
and to be honest, in my own experience,
too, we're struggling to keep the time for our research.
We're struggling to protect that time for our research.
Even when we have protected time,
we're working hard to continue to protect that time
in a way that's meaningful.
And so instead of focusing on the productivity bonus,
what if you really focused on building your research?
What if you really focused on advancing your research?
Now, I may hear some of you say, well,
but the productivity bonus also includes research.
Yeah, but if you're doing what you're supposed to be doing,
you don't have to pursue the productivity bonus.
You're already going to make it by virtue of just doing
what you're supposed to do.
The incentive is to incentivize you to do the thing you're
supposed to be doing.
And so if the incentive says, if you write two manuscripts,
you get a bonus, is two manuscripts your only goal
for the entire year?
I hope not.
I hope you have a goal of submitting more than just two
manuscripts.
Do you see why the bonus, the productivity bonus,
may not actually serve you?
Because it may actually set a lower target for you
than you need to have.
So don't pursue the bonus.
Focus instead on your own goals, the goals
you set for yourself from the beginning.
So what should you do?
Create a strategic plan.
OK, here's the thing.
All the things that are not accounted for in a plan,
they're not going to get done.
However, the things that people are going to bug you about,
did you write that note?
Did you close that chart?
Did you call the prior authorization?
Those will all get done at the expense of your research.
And so if you want your research to succeed,
you set the stage for what's going to be done
by creating a strategic plan.
Look ahead to the next couple of months
and decide, this is what I want to accomplish.
This is what no one's going to come and knock on my door
and say, are you doing this?
Yeah, they're going to come and knock on your door
and say, wait, you're late to clinic.
But they're not going to knock on your door and say,
did you submit the manuscript?
So that's what you want to have on your strategic plan,
all the things that help you advance.
Number five, and I'm back from the beginning,
because these are the things I want you to focus on.
But number five is you should do a weekly planning meeting.
On Friday or on Sunday, don't wait till Monday.
Look ahead to the week.
Map out the schedule of meetings and all the things
that you're supposed to be at,
but definitely create space for your research
and your writing.
Make sure you're moving work forward.
Make sure you're moving manuscripts forward.
Make sure you're writing those grants.
Make a weekly plan so that you can budget
in the time you need to advance your goals.
That's number five.
Number six is write consistently every day.
And by every day, I don't mean like seven days a week.
I tend to write four days a week.
Sometimes I'll do five days.
But make sure you're writing.
And that's what's the thing about writing.
Writing is a keystone habit.
Writing is a habit that helps you accomplish other habits.
So the more you write, the more you work on manuscripts
that get you to publication,
the more you're looking for things
to put into those manuscripts
so that you can submit them for publication.
The more you're doing the research
that gets you to the writing,
that gets you to the manuscript
that allows you to submit for publications.
So writing, daily consistent writing is a keystone habit
that gets you to the research results that you want.
Make sure that you're prioritizing your daily writing.
And finally, you wanna minimize the creep of clinical work.
This is why the productivity bonus is not for you.
Because if you're already struggling
to find the time you need to do the research,
why are you pursuing the productivity bonus
that takes you further away from research
to do more clinical care?
Don't do that.
Instead, minimize the creep of clinical work
to let other people incentivize you to a minimum standard.
You incentivize yourself and do the work you need
to build the kind of research program
that you absolutely want to see that you can be proud of.
So I'm gonna summarize those seven things that I said.
Number one, remember that you're a physician
and by virtue of your makeup,
you are susceptible to working hard at hard things.
If someone creates a convoluted bonus structure,
you're gonna be working hard at it
just because it's what you do.
Be careful of that
and protect yourself from that weakness,
which we all have, by the way.
Please don't fall for it.
Number two, productivity bonuses are meant to incentivize you.
They are not there as a neutral reward
for your good efforts.
They're there to make you work harder
and you don't wanna work hard at things
that you don't want to produce results in,
especially relative to things
you actually wanna produce results in.
Number three, instead of pursuing a bonus,
prioritize your research and writing goals.
Number four, create a strategic plan.
Number five, do a weekly planning meeting.
Number six, write consistently, at least five days a week
or if you're gonna do what I do,
though sometimes I'll write five days.
And number seven, minimize the creep of clinical work.
I hope this episode has been helpful to you.
If you know of a colleague
who just got a productivity bonus
who really should have been doing more work
in their research, send this to them,
but not as a means of judgment,
just to remind them that they are easily distractible
by things like incentive plans and help them out
so that they can focus on the things
that they really want to move forward.
All right, it's been a pleasure talking with you today.
I thank you so much for this opportunity
to be in your ears and I look forward
to talking with you again next time
on the Clinician Researcher Podcast.
Have a great day.