Issue link: https://beckershealthcare.uberflip.com/i/1412801
106 106 THOUGHT LEADERSHIP The underappreciated value of marginal time: Freeing up the right kinds of time can reduce burnout By Alexa Kimball, MD, President and CEO, Harvard Medical Faculty Physicians at Beth Israel Deaconess Medical Center A ll busy professionals understand that time pressure creates stress, and that stress leads to mistakes. For physicians in particular, those mistakes can be truly costly. Yet physicians oen make poor — and avoid- able — decisions about marginal time and mar- ginal cost by undervaluing their time. Fortu- nately, simple strategies and a shi in thinking about spending money to create more time can improve well-being and professional performance. While the concept is related to spending money to buy more help, it is more nuanced: e key is that marginal (extra) free time has more value both in reducing stress and increasing happiness and therefore is worth spending more money to find. Understanding this concept is key to mentoring junior faculty, managing physicians and designing programs to support their career goals. I first began thinking about the value of marginal time when I was advising junior faculty about child care options. My advice was fairly simple: spend more money to build in more child care time than you think you need. For example, if you leave for work at 7:30 a.m., have your care provider come at 7:00 a.m. — not at 7:15 a.m., or 7:30 a.m. Something always happens in the morning when you are trying to get kids out the door. Someone throws up; permission slips need to be signed; you need to find $2 for the bake sale. And you want some time to huddle with that care provider to plan the day too. If by chance, you end up with 15 minutes of stress-free downtime to have a cup of coffee or talk with your kids, it's a win all around. But if you don't have the marginal time built in, everyone will be in a rush and that's when mistakes — and stress — happen. e mistakes range from irrelevant to potentially important, and include forgetting the homework or not getting the car seat buckled right. But even if they aren't important, they leave everyone in a bad mood. More recently, I have expanded this concept into a series of interactive questions, designed to get my audiences thinking about money-time trade- offs, and reducing physician burnout. As I have delivered this exercise to multiple audiences, some interesting themes emerge. Loss aversion — the disproportionate fear of losing something compared to the value of gaining something — appears to play a role in how people think about these trade- offs, and most people don't make rational decisions where loss is involved. Time vs. money Put yourself in the following situations. How much are you willing to spend? 1. You are at the airport. Your flight leaves in three hours, but for a change fee, you can get on an earlier flight now, and catch up on some work you need to do at the office. What is the cost you would pay to switch? $5 $25 $75 $125 $250 2. You are at the airport. Your flight is in three hours, but for a change fee you can get on an earlier flight now. You've been gone for a week and if you take the flight now you'll be able to get home to see the kids before they go to bed. What is the most you would pay to switch? 3. Your commute home usually takes 20 minutes. But about once a week, and you can't predict when, it takes 45 minutes. Sometimes that delay makes you stressed because you need to pick up your kids from their sports activities. What is the most you would pay per week to make it a predictable 20-minute commute every day? 4. Your mother-in-law calls. She's fine but if you are the one who an- swers the phone, it's almost always a 45-minute chat during which the state of the living room upholstery comes up. What is the most you would pay to have your spouse answer the phone every time? 5. You are applying for a passport and the form asks you to fill in every country you have visited and every place you have lived in the past 20 years. Your trusted assistant is out sick and it will probably take you at least an hour and a half to fill out the annoying form. How much would you pay to have someone else go through your files and fill in the information for you? 6. You really like your book club that meets monthly; it's a bunch of friends and the conversation is always interesting and satisfying. e group decides to move to a venue where you will have to pay for the space. What is the most you are willing to pay per two-hour session to continue to participate? Time vs. money: The answers — and what they mean Rational choices around marginal time and marginal money aren't intuitive and explain to some extent why some physicians and their organizations can be slow to realize their own level of burnout symp- toms and how to address them. Whether I give this quiz to physicians or leadership groups, responses have been consistent. In almost no case have participants been willing to spend what is likely a rational amount of money for the value of their time; however, as we review the responses to each question from the quiz, some important obser- vations become clear about what people value the most: 1. Most of the time, people say they are willing to pay around $50-$75 for a flight change that gives them a few hours to finish office work, which is, incidentally, less than what most airlines charge (at least pre- COVID) to change a flight. Even $100 is probably too low when com- pared to the value of a physician's time, especially since getting home in a timely way on a plane that is in front of you is more certain than one that hasn't even arrived yet to pick you up. e clinical analogue to this scenario is the scribe. Many places suggest that physicians should either pay for the expense of a scribe or increase productivity to cover the expense. At roughly $20-$25 an hour, if a scribe allows a physician to complete ambulatory session notes one hour earlier, he or she should probably do it. Yet when faced with this trade off, in my experience, many physicians decline. Loss aversion, the concept that the negative impact of loss of money outweighs the pleasure of gain for the same amount of money, probably plays an important role in this choice. 2. For most people, a flight switch to see their kids before bed is worth a lot, and certainly worth more than scenario one. (Although some have joked that they were in no rush to get home!) A year ago, I was at the airport and faced this scenario with a two-hour gain and the chance to have dinner with my family. e attendant looked at me when I asked if I could switch and, shaking his head woefully, said, "it will be a $75 change fee." I grinned with delight and to his surprise handed him a credit card. I guess most people price this time differently. e clinical scenario is similar to the first one with the scribe, but the perceived value of the time is higher because of the chance to spend it with your family.