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Welcome to the Clinician Researcher podcast, where academic clinicians learn the skills

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to build their own research program, whether or not they have a mentor.

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As clinicians, we spend a decade or more as trainees learning to take care of patients.

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When we finally start our careers, we want to build research programs, but then we find

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that our years of clinical training did not adequately prepare us to lead our research

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program.

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Through no fault of our own, we struggle to find mentors, and when we can't, we quit.

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However, clinicians hold the keys to the greatest research breakthroughs.

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For this reason, the Clinician Researcher podcast exists to give academic clinicians

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the tools to build their own research program, whether or not they have a mentor.

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Now introducing your host, Toyosi Onwuemene.

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Welcome to the Clinician Researcher podcast.

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I'm your host, Toyosi Onwuemene, and it is an absolute pleasure to be talking with you

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today.

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Thank you so much for tuning in.

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Today, I am talking about what is needed to protect your time, what is needed to protect

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your time.

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And I recognize that so many of us are fighting for protected time.

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We're asking for it, we're begging for it, we're saying, please protect my time.

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And many of us are not getting the protected time we need.

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Sometimes people are saying, well, okay, why don't you go get the grant funding and then

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we'll protect your time because now you'll have money to do it.

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But we don't even know the first step to protect our time, to get the grant funding that protects

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our time.

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So it seems straightforward, just get the grant funding and then your time is protected.

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But in reality, it's really hard because without the protected time, how can you get your grant

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funded?

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So it's a very difficult thing.

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But I wanted to share about how I've thought about it over the course of my faculty career.

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And I will say that it's still evolving.

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And so what I tell you today may be different from how I feel about it three months from

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now.

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And I think what that speaks to is the fact that it just really is about you being creative

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to get to the goal that you want to get to.

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When I started, I thought, okay, I just need the grant money and then I'll be protected.

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And it's more than that.

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Because I found out that, well, if your time is not protected, you may never get to the

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grant money.

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But getting the grant money is not a definite sign that your time will be protected.

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And the commitment to protect your time comes before there's really even any money seen.

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And that's hard to imagine.

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It's hard for many people to wrap their minds around, especially when you're starting out,

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but it's the reality.

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So it's like, okay, if I need the experience to get the job, but I can't get the job without

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the experience, how do I get the job?

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Or how do I get the experience for the job without the job?

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It's the same thing.

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How do I get the protected time when I need the grant money for the protected time, but

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I can't get the protected time without the grant?

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It's circular.

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Yes.

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Okay.

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So I just have some thoughts about it, and I'm interested to hear your thoughts as well.

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So the first thing is to be very clear about your goal.

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And this may be the hardest thing, because sometimes the goals are not clear.

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They're fuzzy.

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I wanted to do research, but I just wanted to do research.

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And people would say, exactly what do you want to do?

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And I'm not sure.

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I could do this, and I could do this, and I could do that, but I just wanted to do research.

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And so I seemed unserious to many people, because they're like, well, you want to do

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research, but you're not sure exactly what you want to do.

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How can we help you when we don't know, because we can't know if you don't know?

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And it's the reality.

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If you don't know, well, nobody else can know.

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Or they can make stuff up, which is probably worse than them just not knowing, right?

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Or just going along with the flow of you not knowing.

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But if they make up goals for you, and then they begin to hold you accountable to goals

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that you didn't make for yourself, even worse.

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And in reality, as people, we are very clear in our goals.

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Because it's just locked up deep in our subconscious, where it's safely under the lock and key of

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protecting ourselves from judgment, or ridicule, or embarrassment, whatever it is.

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We don't want to unearth all the stuff covering our true desires and our true goals.

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And so we keep them hidden under embarrassment, or shame, or just the general fuzziness of

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I don't want to acknowledge my true desires.

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But it's really important.

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And that is why it takes work to really unearth, what do you want?

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Why do you want it?

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Because along our training, we've been handed packages of this is what you should want.

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This is how you should appear.

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This is what your desire should be.

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This is exactly what you should need.

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And they don't always resonate with who we are at the core of our being.

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But we've done it enough times such that we start to forget, but we don't really forget.

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We just bury our desires under so many layers that it feels like we've forgotten.

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And it takes work of peeling back those layers to figure out what do I want?

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What do I want out of my career?

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Because sometimes the things we want are actually very, they're not socially acceptable.

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For example, to be able to come out and say, I'm a mom, and I have two children that I

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really love to spend time with.

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And I'd like my job to be able to give me an opportunity to spend time with them.

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Nobody wants to say that, but it's a true desire.

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It's mine.

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It may be yours.

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Why would you go to your division chief and share that?

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Well, you know, I haven't like protected time because I really want to be able to spend

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more time with my children.

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But instead, it seems more kosher to say I'd like protected time because I need to be able

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to move my research forward, and this is what it takes.

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That does sound more reasonable to say.

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But in reality, what is the desire that drives you?

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It's one thing to make up a different desire that seems more palatable to the person you're

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speaking to.

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It's another thing to have no idea what really drives you, because what you want matters.

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Yes, it is my goal to be able to spend time with the children I love, and that's okay.

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And it is my goal to excel in research and to lead a wonderful program of research that

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serves an umbrella as an umbrella for so many people.

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Both things are true.

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And I also want to be able to see patients, right?

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All things are true.

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But what's the highest priority?

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And how do you optimize for the thing that's the highest priority?

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And that really comes by clarifying your goals.

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Because if your highest priority is I just really want to be able to hang out with the

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kids I birthed.

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Maybe research is one strategy to have flexibility that allows you to do that, but maybe it's

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not the only strategy.

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And so when you can clarify exactly what you want, then you can start to think a little

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bit more broadly about what all the options are to help you achieve that goal.

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But the first step is being very clear about what is the goal?

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What do you really want?

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And it could change.

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Every season of life is different.

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Sometimes you don't need flexibility.

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You're like, no, the children are not home.

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Or I don't have children.

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Or I have other people who work to take care of them around the clock.

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I don't need that flexibility.

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And that's okay.

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What do you need?

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What is your goal?

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What do you want?

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I want my research program to give me intellectual stimulation and allow me to grow.

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Or I want my research program to be a place where I can support underrepresented faculty.

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Whatever your goal, once you are very clear about it, then you can take the steps to actualize

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it.

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So I know we're talking about protected time and understanding your goal is important because

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it helps you be strategic about how you protect your time.

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And it gives you something to look forward to.

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Right?

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There's joy set before you.

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This is the thing I'm going to get.

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Oh, this is all the work I have to do to get there.

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But that's the thing I'm going to get.

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And oh, wow, there's a long journey there.

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But that's the thing I'm going to get.

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And it allows you to keep your eyes on the prize so that even when challenges come, and

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invariably they do, and they try to derail you because someone says maybe your goal is

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not so important, you're very clear.

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Like, that's my end goal.

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That's what I'm gunning for.

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And you stay focused.

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Okay.

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Number two is to assess your basic clinical requirements.

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What do I mean by that?

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What do you need to do?

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The minimum you need to do.

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I know, I know, I know.

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I just want to take a step back and say, you like to give your best, your maximum kind

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of person, not a minimum.

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So this is not me asking you to lower standards.

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It's just me asking you to do a thought experiment.

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Just think about it.

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You don't have to commit to it.

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It doesn't have to be true for you.

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Just think about it.

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No judgment.

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Just thoughts.

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What if you thought about what is the minimum viable clinical work you need to do to be

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able to succeed?

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For example, maybe you're 80% clinical.

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What is the minimum amount of RVUs, right?

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Usually a lot of institutions put that numeric value on this is how much it takes to generate

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one relative value unit and you need 5,400 relative value units, right?

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You want to be very clear about that.

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Why do you want to be clear about it?

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Because you want to understand what's the ceiling.

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I mean, there may be no ceiling, but what's the ceiling?

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And I'll speak a little bit more about the ceiling.

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But what's the floor?

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What's the minimum you do and you're still successful in that way?

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And the reason you want to define it is because you want to be strategic.

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It's kind of like having money in the bank.

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How do I deposit a million dollars in dollar bills?

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I mean, to this, I don't know, maybe you're doing a money exchange.

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Just work with me here.

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I'm not sure I pulled out this example, but you want to know how many $5 bills versus

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$1 bills versus $20 bills, $100 bills am I going to pull together?

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But you don't know how you're going to pull together the full amount for this ransom unless

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you're aware of how many denominations you have that are $5 bills or $10 bills.

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So that's the exact same thing.

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It's like, how do you strategize the time that you have unless you understand what kind

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of denominations of time you have available?

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So let's say you are doing, for example, a procedural based service and you just do,

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you know, a half a morning of procedure.

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And that half a morning of procedures generates 300 RVUs.

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I know, a little bit of an exaggeration probably, but just work with me here.

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Half a morning of procedures, 300 RVUs.

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Half a morning of clinic, maybe 15.

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You want to know because as you start to think strategically about your time, you want to

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know what produces what.

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What's the basic?

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And then what produces what?

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And actually evaluating the relative value of each contribution is number three.

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So number two is assessing what are the requirements?

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What's my basic?

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Like what's basic and what is like the maximum?

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And there's always a maximum.

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You're like, oh, no, no, no, you just keep getting bonuses or there's a maximum.

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If you're not at an academic medical center for the most part, there is usually a ceiling

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or hit where the bonus doesn't get bigger no matter how much more harder you work.

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You should find out before you work too hard.

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And again, it varies.

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Maybe your institution has no cash, but I'd be surprised if it does, if it doesn't.

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For me, I found out that our bonus was budgeted at the beginning of the year.

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It didn't matter how much you excelled beyond that level because when the budget was done,

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the budget was done.

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And kudos to you for working so hard, but the budget is done.

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And there's not much more money coming out of your extra 30 hours of work, right?

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You want to know these things.

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How do you know by asking questions?

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You say, hey, hypothetically speaking, if I was going to max out the bonus this year,

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what is the ceiling?

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You want to know because maybe you were thinking you put in an extra 35 hours and you realize

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that, wait a minute, you're two hours away from max.

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Don't do the extra 30.

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And if you go back and listen to the most recent podcast episode I did about not pursuing

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the productivity bonus, you'll recognize that that's it.

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It's just how, what is the ceiling?

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What is the floor?

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So that you're not overworking, but also so you know when you've made it.

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So you're not like, oh, I'm feeling guilty because seven more people have reached out

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wanting to be seen.

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I don't want to double book my clinic.

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If you know that you've already reached the minimum, then you might not feel as pressured

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to double book or triple book in a way that doesn't serve you.

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So that's what I'm talking about.

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Almost the basic and then evaluate the relative value of each contribution.

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And that's what I was saying earlier, where if a half a morning of let's say colonoscopy

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gives you, you know, maybe even 50 RVUs compared to a half morning of clinic, 15 RVUs.

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And you're done with the morning's worth of colonoscopy visits and you do the notes, which

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are mostly templated, add the pictures.

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Gosh, your morning is over before 2 p.m.

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As opposed to your clinic, which may or may not run over.

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And you also have to follow up the lab results and you need to call back patients and you

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need to do prior authorizations.

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And I'm not judging clinics now.

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This is not my goal.

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I'm just trying to contrast.

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Your half a morning of procedures with a half a morning of clinic.

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You recognize that both are not graded equal.

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One generates more for you in less time.

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So then now you can begin to structure each contribution.

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But not before we go to number four, which is to calculate the energy value of each contribution.

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Now, what do I mean?

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Well, on the one hand, on number three, what we're doing is calculating the relative value

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of each contribution.

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OK, half a morning of colonoscopy colonoscopies scopes.

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Half a day of scopes gets me X versus half a day of clinic versus half a day of running

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the hospital.

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Calculate all of that to say what gives me the most bang for my buck.

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But then you also want to calculate the energy contribution.

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How much energy do I feel I've expended after a half a morning of scopes versus a half a

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morning of clinic versus a half a morning of running the hospital?

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How energized am I feeling at the end?

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Now maybe you're a proceduralist and you just love to scope.

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You just love it.

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You're like poop doesn't bother me.

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I just love to scope.

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And at the end of a half morning, you're like, give me more to scope.

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I need some more colons.

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This is great.

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Wow, the energy expenditure matches up with the relative value.

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Patch made in heaven.

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Or maybe your thing is clinic and you're like, you know what?

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I just love talking to people and it's so awesome, so energizing.

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At the end of the clinic day, I'm like, bring more people.

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This is great.

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You know that even though it has fewer relative value units, it really energizes you.

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That's important because then you're able to weigh the two.

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You're able to weigh, okay, how much RVUs, how much relative value units does this give

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me, this activity give me, how much energy does it take, how much time does it consume?

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You may make different decisions based on how much energy you get from doing something.

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But if you can overlap short period of time to achieve the same RVU or the same relative

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value target and you're energized at the end, that's a win-win-win.

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And those are the kinds of clinical activities you should stack up in your favor.

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Now, you may be like, wait a minute, I don't get to choose.

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These things are just handed to me.

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And I would just say, you always get to choose.

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And that brings me to the next one, finding allies to support your goals.

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If you're ever going to succeed in getting protected time in research, you don't get

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it because someone just looks at you and says, oh, I feel bad for you.

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I would love to do this for you.

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You get it because you recruit allies to your side.

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You're not going to make it by yourself.

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You're just not.

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Life doesn't work like that.

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Life works in community.

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And academic life works in community as well.

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And so if you say, I want to succeed in research, who else is rooting for you?

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You're like, oh, my division chief doesn't want me to succeed.

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Maybe, maybe not.

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But if you don't feel so, who does?

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There's always going to be someone who wants you to succeed.

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How do you get them as allies to help you strategize or to help you advocate for yourself

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or to advocate on your behalf?

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How do you do that?

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How do you find allies that support your goals?

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People who've been there done that.

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People who know how much time it takes to succeed in research.

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Find your allies.

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Or maybe it's PhD collaborators who want to work with you because you have clinical expertise

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that they could use.

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Who are the allies who can help you?

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You're like, I've never written a grant.

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They're like, well, I've written 300 grants.

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You help me do this.

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I'll help you do this.

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And then it's like a match made at heaven.

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It's like synergy.

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So find allies.

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People who are in your corner, people who are not afraid to reach out and help you,

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find allies.

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OK, number six is buy back time strategically.

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What do I mean?

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Well, you know, the things I laid out earlier are really in thinking about, OK, I might

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not have protected time right now, but how do I maximize the value of the time that I

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do have?

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I mean, how do I optimize my clinical effort so that I am spending the least amount of

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time doing the thing that has the highest bang for my buck so that I can squish my

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clinical time down into this space where it fits well, energizes me, doesn't drain me,

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and then I can go do the work that allows me now to buy myself a protected time.

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So that's kind of in the background.

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I haven't said it explicitly, so now I'm making it explicit.

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As you start to build that momentum and you start getting fortunate and getting, well,

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actually, as your preparation meets good fortune and you start buying back that time, having

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done that math early allows you to recognize which ones you're going to leave behind.

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For example, let's say the inpatient role, oh my goodness, it doesn't take too much time

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and it gives a lot of RVUs, so awesome, but at the end of it, you are super exhausted.

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You don't want to talk to anybody.

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You don't want to be around anybody.

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You just need three days to get out of the funk of having been in the hospital for seven

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days in a row.

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That may be the first on the docket when it's time to buy back time strategically.

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Don't let other people make the decision for you and say, oh no, no, no, no, no, you can't

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let go of the inpatient time.

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I know that's a thing that sucks for you.

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You can let go of your procedures and you're like, no, I've done the math.

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No, nobody takes my procedures from me.

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When you're buying down your time, be very strategic.

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Don't let anybody just say, okay, let's take away all the other stuff and leave your clinic.

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You're like, oh no, no, no, no, I've done the math.

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I've done the math.

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I've done the math.

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This is the time I want to buy back.

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You want to be strategic about that and you can be strategic about it when you know the

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relative value of each unit and how much time it takes and how much energy it consumes.

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Number seven is to be fierce because the moment you get any time protected, there will come

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a gaggle of geese or ducks, their cousins and their brothers and their friends all coming

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to take your time back from you.

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Dr. Lamina, I heard that you have nothing doing on Thursday mornings.

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Would you care to come see three or four patients just to help out?

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You're so kind.

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You're like, yeah, I'm in my office and I have writer's block anyway.

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Sure, I'll just come see one of them.

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Then eight hours later, you're there wondering what happened, who stole your time.

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That's where fierceness comes in where you say, no, I'm not budging.

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I took this time back.

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I'm not budging.

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It really takes you protecting the time.

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Even when no one's giving you protective time yet, even when you haven't earned it or you

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haven't received it, how are you protecting the time you have now?

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How are you being very strategic about the time you have today?

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How are you making the most of it?

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That's part of the fierceness of protecting your time.

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Nobody else will do it for you.

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Maybe you have a mentor who will go to bat for you, but for the most part, you're it.

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How can you be fierce about protecting your time territory as you buy it back down?

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All right, I talked about seven things.

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Number one, be very clear about your goals.

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Number two, assess what are the basic clinical requirements.

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Number three, evaluate the relative value of each contribution.

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Number four, calculate the energy expended for each contribution.

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Number five, find allies to support your goals.

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Number six, buy back your time strategically.

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And number seven, be fierce about protecting your territory.

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All right, it's been a pleasure talking with you today.

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Thank you so much for tuning in.

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Please share this episode with somebody else who needs to hear it.

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00:22:30,060 --> 00:22:33,820
It has been an absolute pleasure talking with you today, and I look forward to talking with

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you again next time on the Clinician Researcher Podcast.

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Thank you for listening.

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Thanks for listening to this episode of the Clinician Researcher Podcast, where academic

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clinicians learn the skills to build their own research program, whether or not they

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have a mentor.

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If you found the information in this episode to be helpful, don't keep it all to yourself.

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Someone else needs to hear it.

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So take a minute right now and share it.

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As you share this episode, you become part of our mission to help launch a new generation

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of clinician researchers who make transformative discoveries that change the way we do healthcare.