Welcome to the Clinician Researcher podcast, where academic clinicians learn the skills
to build their own research program, whether or not they have a mentor.
As clinicians, we spend a decade or more as trainees learning to take care of patients.
When we finally start our careers, we want to build research programs, but then we find
that our years of clinical training did not adequately prepare us to lead our research
program.
Through no fault of our own, we struggle to find mentors, and when we can't, we quit.
However, clinicians hold the keys to the greatest research breakthroughs.
For this reason, the Clinician Researcher podcast exists to give academic clinicians
the tools to build their own research program, whether or not they have a mentor.
Now introducing your host, Toyosi Onwuemene.
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, I am talking about what is needed to protect your time, what is needed to protect
your time.
And I recognize that so many of us are fighting for protected time.
We're asking for it, we're begging for it, we're saying, please protect my time.
And many of us are not getting the protected time we need.
Sometimes people are saying, well, okay, why don't you go get the grant funding and then
we'll protect your time because now you'll have money to do it.
But we don't even know the first step to protect our time, to get the grant funding that protects
our time.
So it seems straightforward, just get the grant funding and then your time is protected.
But in reality, it's really hard because without the protected time, how can you get your grant
funded?
So it's a very difficult thing.
But I wanted to share about how I've thought about it over the course of my faculty career.
And I will say that it's still evolving.
And so what I tell you today may be different from how I feel about it three months from
now.
And I think what that speaks to is the fact that it just really is about you being creative
to get to the goal that you want to get to.
When I started, I thought, okay, I just need the grant money and then I'll be protected.
And it's more than that.
Because I found out that, well, if your time is not protected, you may never get to the
grant money.
But getting the grant money is not a definite sign that your time will be protected.
And the commitment to protect your time comes before there's really even any money seen.
And that's hard to imagine.
It's hard for many people to wrap their minds around, especially when you're starting out,
but it's the reality.
So it's like, okay, if I need the experience to get the job, but I can't get the job without
the experience, how do I get the job?
Or how do I get the experience for the job without the job?
It's the same thing.
How do I get the protected time when I need the grant money for the protected time, but
I can't get the protected time without the grant?
It's circular.
Yes.
Okay.
So I just have some thoughts about it, and I'm interested to hear your thoughts as well.
So the first thing is to be very clear about your goal.
And this may be the hardest thing, because sometimes the goals are not clear.
They're fuzzy.
I wanted to do research, but I just wanted to do research.
And people would say, exactly what do you want to do?
And I'm not sure.
I could do this, and I could do this, and I could do that, but I just wanted to do research.
And so I seemed unserious to many people, because they're like, well, you want to do
research, but you're not sure exactly what you want to do.
How can we help you when we don't know, because we can't know if you don't know?
And it's the reality.
If you don't know, well, nobody else can know.
Or they can make stuff up, which is probably worse than them just not knowing, right?
Or just going along with the flow of you not knowing.
But if they make up goals for you, and then they begin to hold you accountable to goals
that you didn't make for yourself, even worse.
And in reality, as people, we are very clear in our goals.
Because it's just locked up deep in our subconscious, where it's safely under the lock and key of
protecting ourselves from judgment, or ridicule, or embarrassment, whatever it is.
We don't want to unearth all the stuff covering our true desires and our true goals.
And so we keep them hidden under embarrassment, or shame, or just the general fuzziness of
I don't want to acknowledge my true desires.
But it's really important.
And that is why it takes work to really unearth, what do you want?
Why do you want it?
Because along our training, we've been handed packages of this is what you should want.
This is how you should appear.
This is what your desire should be.
This is exactly what you should need.
And they don't always resonate with who we are at the core of our being.
But we've done it enough times such that we start to forget, but we don't really forget.
We just bury our desires under so many layers that it feels like we've forgotten.
And it takes work of peeling back those layers to figure out what do I want?
What do I want out of my career?
Because sometimes the things we want are actually very, they're not socially acceptable.
For example, to be able to come out and say, I'm a mom, and I have two children that I
really love to spend time with.
And I'd like my job to be able to give me an opportunity to spend time with them.
Nobody wants to say that, but it's a true desire.
It's mine.
It may be yours.
Why would you go to your division chief and share that?
Well, you know, I haven't like protected time because I really want to be able to spend
more time with my children.
But instead, it seems more kosher to say I'd like protected time because I need to be able
to move my research forward, and this is what it takes.
That does sound more reasonable to say.
But in reality, what is the desire that drives you?
It's one thing to make up a different desire that seems more palatable to the person you're
speaking to.
It's another thing to have no idea what really drives you, because what you want matters.
Yes, it is my goal to be able to spend time with the children I love, and that's okay.
And it is my goal to excel in research and to lead a wonderful program of research that
serves an umbrella as an umbrella for so many people.
Both things are true.
And I also want to be able to see patients, right?
All things are true.
But what's the highest priority?
And how do you optimize for the thing that's the highest priority?
And that really comes by clarifying your goals.
Because if your highest priority is I just really want to be able to hang out with the
kids I birthed.
Maybe research is one strategy to have flexibility that allows you to do that, but maybe it's
not the only strategy.
And so when you can clarify exactly what you want, then you can start to think a little
bit more broadly about what all the options are to help you achieve that goal.
But the first step is being very clear about what is the goal?
What do you really want?
And it could change.
Every season of life is different.
Sometimes you don't need flexibility.
You're like, no, the children are not home.
Or I don't have children.
Or I have other people who work to take care of them around the clock.
I don't need that flexibility.
And that's okay.
What do you need?
What is your goal?
What do you want?
I want my research program to give me intellectual stimulation and allow me to grow.
Or I want my research program to be a place where I can support underrepresented faculty.
Whatever your goal, once you are very clear about it, then you can take the steps to actualize
it.
So I know we're talking about protected time and understanding your goal is important because
it helps you be strategic about how you protect your time.
And it gives you something to look forward to.
Right?
There's joy set before you.
This is the thing I'm going to get.
Oh, this is all the work I have to do to get there.
But that's the thing I'm going to get.
And oh, wow, there's a long journey there.
But that's the thing I'm going to get.
And it allows you to keep your eyes on the prize so that even when challenges come, and
invariably they do, and they try to derail you because someone says maybe your goal is
not so important, you're very clear.
Like, that's my end goal.
That's what I'm gunning for.
And you stay focused.
Okay.
Number two is to assess your basic clinical requirements.
What do I mean by that?
What do you need to do?
The minimum you need to do.
I know, I know, I know.
I just want to take a step back and say, you like to give your best, your maximum kind
of person, not a minimum.
So this is not me asking you to lower standards.
It's just me asking you to do a thought experiment.
Just think about it.
You don't have to commit to it.
It doesn't have to be true for you.
Just think about it.
No judgment.
Just thoughts.
What if you thought about what is the minimum viable clinical work you need to do to be
able to succeed?
For example, maybe you're 80% clinical.
What is the minimum amount of RVUs, right?
Usually a lot of institutions put that numeric value on this is how much it takes to generate
one relative value unit and you need 5,400 relative value units, right?
You want to be very clear about that.
Why do you want to be clear about it?
Because you want to understand what's the ceiling.
I mean, there may be no ceiling, but what's the ceiling?
And I'll speak a little bit more about the ceiling.
But what's the floor?
What's the minimum you do and you're still successful in that way?
And the reason you want to define it is because you want to be strategic.
It's kind of like having money in the bank.
How do I deposit a million dollars in dollar bills?
I mean, to this, I don't know, maybe you're doing a money exchange.
Just work with me here.
I'm not sure I pulled out this example, but you want to know how many $5 bills versus
$1 bills versus $20 bills, $100 bills am I going to pull together?
But you don't know how you're going to pull together the full amount for this ransom unless
you're aware of how many denominations you have that are $5 bills or $10 bills.
So that's the exact same thing.
It's like, how do you strategize the time that you have unless you understand what kind
of denominations of time you have available?
So let's say you are doing, for example, a procedural based service and you just do,
you know, a half a morning of procedure.
And that half a morning of procedures generates 300 RVUs.
I know, a little bit of an exaggeration probably, but just work with me here.
Half a morning of procedures, 300 RVUs.
Half a morning of clinic, maybe 15.
You want to know because as you start to think strategically about your time, you want to
know what produces what.
What's the basic?
And then what produces what?
And actually evaluating the relative value of each contribution is number three.
So number two is assessing what are the requirements?
What's my basic?
Like what's basic and what is like the maximum?
And there's always a maximum.
You're like, oh, no, no, no, you just keep getting bonuses or there's a maximum.
If you're not at an academic medical center for the most part, there is usually a ceiling
or hit where the bonus doesn't get bigger no matter how much more harder you work.
You should find out before you work too hard.
And again, it varies.
Maybe your institution has no cash, but I'd be surprised if it does, if it doesn't.
For me, I found out that our bonus was budgeted at the beginning of the year.
It didn't matter how much you excelled beyond that level because when the budget was done,
the budget was done.
And kudos to you for working so hard, but the budget is done.
And there's not much more money coming out of your extra 30 hours of work, right?
You want to know these things.
How do you know by asking questions?
You say, hey, hypothetically speaking, if I was going to max out the bonus this year,
what is the ceiling?
You want to know because maybe you were thinking you put in an extra 35 hours and you realize
that, wait a minute, you're two hours away from max.
Don't do the extra 30.
And if you go back and listen to the most recent podcast episode I did about not pursuing
the productivity bonus, you'll recognize that that's it.
It's just how, what is the ceiling?
What is the floor?
So that you're not overworking, but also so you know when you've made it.
So you're not like, oh, I'm feeling guilty because seven more people have reached out
wanting to be seen.
I don't want to double book my clinic.
If you know that you've already reached the minimum, then you might not feel as pressured
to double book or triple book in a way that doesn't serve you.
So that's what I'm talking about.
Almost the basic and then evaluate the relative value of each contribution.
And that's what I was saying earlier, where if a half a morning of let's say colonoscopy
gives you, you know, maybe even 50 RVUs compared to a half morning of clinic, 15 RVUs.
And you're done with the morning's worth of colonoscopy visits and you do the notes, which
are mostly templated, add the pictures.
Gosh, your morning is over before 2 p.m.
As opposed to your clinic, which may or may not run over.
And you also have to follow up the lab results and you need to call back patients and you
need to do prior authorizations.
And I'm not judging clinics now.
This is not my goal.
I'm just trying to contrast.
Your half a morning of procedures with a half a morning of clinic.
You recognize that both are not graded equal.
One generates more for you in less time.
So then now you can begin to structure each contribution.
But not before we go to number four, which is to calculate the energy value of each contribution.
Now, what do I mean?
Well, on the one hand, on number three, what we're doing is calculating the relative value
of each contribution.
OK, half a morning of colonoscopy colonoscopies scopes.
Half a day of scopes gets me X versus half a day of clinic versus half a day of running
the hospital.
Calculate all of that to say what gives me the most bang for my buck.
But then you also want to calculate the energy contribution.
How much energy do I feel I've expended after a half a morning of scopes versus a half a
morning of clinic versus a half a morning of running the hospital?
How energized am I feeling at the end?
Now maybe you're a proceduralist and you just love to scope.
You just love it.
You're like poop doesn't bother me.
I just love to scope.
And at the end of a half morning, you're like, give me more to scope.
I need some more colons.
This is great.
Wow, the energy expenditure matches up with the relative value.
Patch made in heaven.
Or maybe your thing is clinic and you're like, you know what?
I just love talking to people and it's so awesome, so energizing.
At the end of the clinic day, I'm like, bring more people.
This is great.
You know that even though it has fewer relative value units, it really energizes you.
That's important because then you're able to weigh the two.
You're able to weigh, okay, how much RVUs, how much relative value units does this give
me, this activity give me, how much energy does it take, how much time does it consume?
You may make different decisions based on how much energy you get from doing something.
But if you can overlap short period of time to achieve the same RVU or the same relative
value target and you're energized at the end, that's a win-win-win.
And those are the kinds of clinical activities you should stack up in your favor.
Now, you may be like, wait a minute, I don't get to choose.
These things are just handed to me.
And I would just say, you always get to choose.
And that brings me to the next one, finding allies to support your goals.
If you're ever going to succeed in getting protected time in research, you don't get
it because someone just looks at you and says, oh, I feel bad for you.
I would love to do this for you.
You get it because you recruit allies to your side.
You're not going to make it by yourself.
You're just not.
Life doesn't work like that.
Life works in community.
And academic life works in community as well.
And so if you say, I want to succeed in research, who else is rooting for you?
You're like, oh, my division chief doesn't want me to succeed.
Maybe, maybe not.
But if you don't feel so, who does?
There's always going to be someone who wants you to succeed.
How do you get them as allies to help you strategize or to help you advocate for yourself
or to advocate on your behalf?
How do you do that?
How do you find allies that support your goals?
People who've been there done that.
People who know how much time it takes to succeed in research.
Find your allies.
Or maybe it's PhD collaborators who want to work with you because you have clinical expertise
that they could use.
Who are the allies who can help you?
You're like, I've never written a grant.
They're like, well, I've written 300 grants.
You help me do this.
I'll help you do this.
And then it's like a match made at heaven.
It's like synergy.
So find allies.
People who are in your corner, people who are not afraid to reach out and help you,
find allies.
OK, number six is buy back time strategically.
What do I mean?
Well, you know, the things I laid out earlier are really in thinking about, OK, I might
not have protected time right now, but how do I maximize the value of the time that I
do have?
I mean, how do I optimize my clinical effort so that I am spending the least amount of
time doing the thing that has the highest bang for my buck so that I can squish my
clinical time down into this space where it fits well, energizes me, doesn't drain me,
and then I can go do the work that allows me now to buy myself a protected time.
So that's kind of in the background.
I haven't said it explicitly, so now I'm making it explicit.
As you start to build that momentum and you start getting fortunate and getting, well,
actually, as your preparation meets good fortune and you start buying back that time, having
done that math early allows you to recognize which ones you're going to leave behind.
For example, let's say the inpatient role, oh my goodness, it doesn't take too much time
and it gives a lot of RVUs, so awesome, but at the end of it, you are super exhausted.
You don't want to talk to anybody.
You don't want to be around anybody.
You just need three days to get out of the funk of having been in the hospital for seven
days in a row.
That may be the first on the docket when it's time to buy back time strategically.
Don't let other people make the decision for you and say, oh no, no, no, no, no, you can't
let go of the inpatient time.
I know that's a thing that sucks for you.
You can let go of your procedures and you're like, no, I've done the math.
No, nobody takes my procedures from me.
When you're buying down your time, be very strategic.
Don't let anybody just say, okay, let's take away all the other stuff and leave your clinic.
You're like, oh no, no, no, no, I've done the math.
I've done the math.
This is the time I want to buy back.
You want to be strategic about that and you can be strategic about it when you know the
relative value of each unit and how much time it takes and how much energy it consumes.
Number seven is to be fierce because the moment you get any time protected, there will come
a gaggle of geese or ducks, their cousins and their brothers and their friends all coming
to take your time back from you.
Dr. Lamina, I heard that you have nothing doing on Thursday mornings.
Would you care to come see three or four patients just to help out?
You're so kind.
You're like, yeah, I'm in my office and I have writer's block anyway.
Sure, I'll just come see one of them.
Then eight hours later, you're there wondering what happened, who stole your time.
That's where fierceness comes in where you say, no, I'm not budging.
I took this time back.
I'm not budging.
It really takes you protecting the time.
Even when no one's giving you protective time yet, even when you haven't earned it or you
haven't received it, how are you protecting the time you have now?
How are you being very strategic about the time you have today?
How are you making the most of it?
That's part of the fierceness of protecting your time.
Nobody else will do it for you.
Maybe you have a mentor who will go to bat for you, but for the most part, you're it.
How can you be fierce about protecting your time territory as you buy it back down?
All right, I talked about seven things.
Number one, be very clear about your goals.
Number two, assess what are the basic clinical requirements.
Number three, evaluate the relative value of each contribution.
Number four, calculate the energy expended for each contribution.
Number five, find allies to support your goals.
Number six, buy back your time strategically.
And number seven, be fierce about protecting your territory.
All right, it's been a pleasure talking with you today.
Thank you so much for tuning in.
Please share this episode with somebody else who needs to hear it.
It has been an absolute pleasure talking with you today, and I look forward to talking with
you again next time on the Clinician Researcher Podcast.
Thank you for listening.
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