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Introduction Disclosures and Acknowledgements | Burnout and Productivity
Introduction Disclosures and Acknowledgements | Burnout and Productivity
History of the Term Burnout | Burnout and Productivity
History of the Term Burnout | Burnout and Productivity
2017AVIRchaptercompletelyfull videostrategies
Empirical Phase  | Burnout and Productivity
Empirical Phase | Burnout and Productivity
2017AVIRchapterexpensivefull video
Medscape Lifestyle Report 2015 | Burnout and Productivity
Medscape Lifestyle Report 2015 | Burnout and Productivity
2017AVIRchapterfull videointerventionalmedicineradiologistsspecialties
Causes | Burnout and Productivity
Causes | Burnout and Productivity
2017AVIRchapterfull videoNone
Trainees Medical Student and  Physicians vs General Population | Burnout and Productivity
Trainees Medical Student and Physicians vs General Population | Burnout and Productivity
2017AVIRcareerchaptercomparefacultyFellowsfull videoheadedinterventionalradiologyresidents
UNC Resident Survey | Burnout and Productivity
UNC Resident Survey | Burnout and Productivity
2017AVIRchapterfull videopathologyresidents
Mayo Clinic Survey | Burnout and Productivity
Mayo Clinic Survey | Burnout and Productivity
2017autonomyAVIRchapterembolizefull videomayopseudoaneurysmradiologist
Risk Factors and Job Person Fit | Burnout and Productivity
Risk Factors and Job Person Fit | Burnout and Productivity
2017AVIRchaptercommunicatecommunicationcontrolfull videoskillsvalues
IR Burnout - Technologists and Nurses | Burnout and Productivity
IR Burnout - Technologists and Nurses | Burnout and Productivity
2017autonomyAVIRchapterfull videonursesradiologist
Resources Mayo Clinic Results | Burnout and Productivity
Resources Mayo Clinic Results | Burnout and Productivity
Career Fit and Burnout - Academic Faculty | Burnout and Productivity
Career Fit and Burnout - Academic Faculty | Burnout and Productivity
2017administrationAVIRcarechapterfull videohoursmeaningfulpercent
Why Care - 3 Myths of Productivity | Burnout and Productivity
Why Care - 3 Myths of Productivity | Burnout and Productivity
2017AVIRchapterfull videoidentifymusculoskeletalpatternsstressucla
4 Suggestions to Improve Productivity | Burnout and Productivity
4 Suggestions to Improve Productivity | Burnout and Productivity
2017authorAVIRchapterchecklistdigitaleliminateemailfull videoproductivityrule
Conclusion With Questions | Burnout and Productivity
Conclusion With Questions | Burnout and Productivity

A very excellent speaker and has been a very loyal loyal supporter of AVIR for years. So he usually does our radiation safety talk but he was getting burned out on it so we came up with his next topic. Now so today he's going to talk about burnout and productivity in the

workplace. His background...he did do some training up at the SUNY system in New York. He was originally in the as an ER doctor and then did his a IR fellowship and he is at the University of North Carolina at Chapel Hill. They

did win the other night against Duke so he's very happy. And it's amazing I don't know how he does it. But in his spare time apparently he develops golf balls. And I don't know why they're different but this is the Dixon golf

ball. And they are eco-friendly which fits in very nicely with the Chapel Hill world. And yes he did not know I was going to say this part of the presentation so he's not happy with me right now. But it is my pleasure to introduce

Dr. Dixon. You're fired. Ok so thanks. So this is a much different talk than what you just heard. You just heard three outstanding talks and most of your time here will be spent

talking...learning about procedures that we do and things like that and Dana's correct I usually talk to you about radiation safety and I've done that we think for about forty seven years so I decided not to do that. And

the...your leadership encouraged me to present on this. So I'm gonna tell you a story of how I ended up here. I feel that in a way i'm an expert on burnout and I'll explain why. So Dana touched on the idea that I was an emergency

medicine physician for a decade. And I did I got absolutely torched. And the reason is you see a lousy cross-section of the world and you have to see them and be really nice to them and it wears on you. It's a young person

sport and so I left when I discovered interventional radiology. Now most most radio...most emergency medicine doctor who leave emergency medicine and go into radiology and there's there's a handful of us...they do something smart they

go into MSK or they go into to neuro and they have a nice calm life. Maybe they learn how to do tendon repair work and and they have a very cush quiet life. I am not that smart. I went from one sort of intense chaotic

universe into another chaotic intense universe. So there's something wrong with me. So I burned out once on that specialty but I've worked hard not to burnt out on an interventional radiology. And the way this talk came to be

my division chief Charles Burke and I were speaking at another meeting and I did 30 minutes on burnout and he did 30 minutes on productivity and people came up to us afterwards and it was just like the two were meant to be together.

I couldn't persuade Dr. Burke to come speak with with me today so we're going to...I'm going to present both halves. I wasn't smart enough to look and see how change slide...the green. Ok I do some consulting work for Cook that's my

only disclosure. And those of you who have seen me I'm going to keep moving like this it depends how agitated I get. I may come down and tap you on the shoulder but I want to try to keep you awake.

What the heck is that. So we're five minutes in and I've got golf balls and r2 d2 or something here. Ok so Charles Burke is a was part of the original yin-yang presentation and I was actually asked to present last year at SIR

once somebody saw that presentation by both of us. So we'll we'll cover the burnout side and then we'll turn around and try to cover the productivity side. And at first glance you might think that's not really

the way to solve burnout but it is part of of the solution. And the other person I want to acknowledge is a psychiatrist at UNC named Samantha Meltzer-Brody and Samantha has been doing work on burnout

maybe for a decade or so and if you're were interested in this and and google her you'll come up with a few papers including of a paper about burnout amongst residents at our


Ok so our objectives I want to make sure this is clear we're going to review the history of burnout which is a little interesting it's kind of fun and then we'll identify the three main components some of you have heard about this. Look

at some tools to see how we can improve it and then that the second half of the talk is going to be on productivity and some basic tools. And I don't expect that you will leave here being super organized but if you take away just a

couple ideas it might change the way you lead your life and it might help you get things done. So the first objective is what are the three components of burnout and it has been written about for a long time back

in the seventies and eighties. Emotional exhaustion is the first thing. So what usually happens is somebody who's in the business of taking care of people and that person doesn't have a lot of financial support a lot of ancillary

support they are stressed to the max. First you become physically exhausted. You just get worn down and then you just get detached. You like I just can't deal with this wave of problems that's coming at me. Then second

stage you become's a depersonalization stage and and then if you feel like nothing you do matters you have reduced personal accomplishment a sense of no self-worth then you're toast you're absolutely toast. And initially

they looked at people that were in the social services industry and psychology psychiatry but it's spread out to cover everybody. Everybody in medicine not just docs. Much of what you're going to see his stuff about

physicians but this translates to technologists and nurses the military. It's really scaring me. But it has to do with with working with people in some capacity. So exhaustion cynicism and then you feel like you're completely why do I come and beat my head against the wall for 12 hours.

So where did the word...the term burned-out come from. It actually comes from an old novel written i think in 1961 and it was about an

architect who was a really busy famous architect and he got completely sick of his career and he goes to work in a leper colony. He completely changes what he's doing. Now a burned-out leprosy case is

somebody who's got end-stage leprosy there's just nothing left. The tissues all destroyed it's a terrible situation. But the parallel situation was that the architect was completely burned out. And this is the first point when it

was made reference to. Now where did it also come from. So there's a very casual reference to people who abuse substances of being burned out. Cheech and Chong some of you who are old enough to remember the 70's remember Cheech

and Chong. And they that phrase came out sort of came out in the popular literature if you will. And then there were initial case reports of social workers psychologists becoming burned out and then Maslach. We will hear

about the Maslach burn out survey over and over again. And she discovered that the coping strategies how we deal with this and there's there's decent coping strategies and there's really awful coping strategies...all those

strategies have implications. So over time we started to notice that there were emerging themes. Everybody that has...that is a victim of this is suffering from emotional exhaustion and you develop this detached concern.

You use that you care but you kind of can't really care. And then it that... the degree of how much you care gets worse smaller and the degree of how to detached you are gets greater. And usually you do not have support. So the

initial survey that she developed was in 1981 and initially it was for psychiatrists people in medicine as well and it was expanded to cover business military all sorts of different specialties. And they've looked at this over over decades now.

Now the bad news is if you wanted to do a Maslach...if you said Hey I want to... want a copy of the Malsach burnout survey they protect it. I don't know how expensive it is but it's very expensive to obtain it and use

and it's very long. There are other surveys available so you could do a study with a similar but less expensive and more accessible version. They've done international studies this is not just the US has burned out. And

they're starting to look at...instead of all the negative stuff let's look at it in a more positive way. What is we've have created the concept of a "person-job fit". So you're you should identify your own assets and

try to figure out where you should be. For example if you don't really care about taking care of people you shouldn't be in medicine. And then what kind of interventions...over time what kind

of interventions can we use. And it's really tough. The question is do we fix the individual or do we fix the system that we're working in. You all are expected to produce a great deal of work and deal

with a whole bunch of stressors...we'll go over some of the stressors you have identified... and be charming. Be alarmingly charming the entire time. And it's very very difficult. And if you get exhausted and your

negative...your inhibitory neurons which would say you shouldn't yell at the patient or you shouldn't throw that pen they don't fire right on time because you're tired. And then you do something kind of stupid then you get

written up. Then your job...your job can be in jeopardy or you might just get fed up in the place you're at. So I it's hard

to say how to fix it. Now this burnout stuff is incredibly popular in the in the medical literature right now. This

has come to a head there are a couple of researchers who have really spearheaded this. But many of you probably have seen these Medscpae surveys. And they continually point to the problem that all of medicine is burned out. Some

specialties more than others and it's getting worse not better. So Medscape 2015 I've highlighted radiologists. Now I have to say we don't have good data on interventional radiologist. So I can't tell you

specifically what the burnout rate is but radiologists in general in the medscape survey were about...123456 six or seventh and half of us are burned out. Now even the best speciality pathology at the bottom forty percent of pathologists

are burned out. And the worst if you go to critical care emergency medicine family medicine folks that are on the frontline they are up over fifty percent. That's the medscape survey. How severe is it on a scale of 5...the people who are

burned out feel they're really burnt out. It's not like...I had a bad day three months ago. They are toast and they've been toast for a while. So what do we

think the causes are. So the doctors will say we have too many bureaucratic

duties to accomplish. We're spending too many hours at work. I think any IR...I just was at the health and safety meeting talking to somebody and they had to leave their practice because the family

just couldn't take the hours they're working anymore. All of us have felt it from our families that you're there too long you're there too hard you're working on a weekends. So if you're spending too

much time at work you're going to get exhausted you're going to get worn down. As you go down this long list I'll let you read it without me telling you what's on the list some of them are maybe you know you might think not too important.

You're not getting paid enough money. Well that's you know that almost seems to me like a different topic but feeling like a cog in the wheel many of us regardless of what you're doing

often you can feel like you're just one little...I often say I'm just a pawn in the army against disease. That's how I feel sometimes. I'm just in their loading the trucks doing work I can try to do the best I can and you probably

feel that same way somedays. Trainees so

I am a program director and I teach diagnostic radiology residents and interventional radiology fellows and soon we'll be teaching an interventional radiology residents as the training

paradigm changes. I look at new docs new student doctors and residents coming in and I don't think I'm as old as I am but I'm getting old enough that I don't like what i see them headed into. They're heading into headed into more and more

requirements for documentation and all this bureaucratic stuff but they are toast as well. Almost two-thirds almost three-quarters of them are are burned out and they're just they're just tired. Now maybe it's

been like this all the know through all of medicine and we're just looking at it now. But I don't think that's the case I think it's getting worse instead of better. So how how do we compared to the to the

general population. So somebody looked at that back in 2014 and if you looked at residents fellows and early career faculty members really not just faculty members... sorry early career physicians the degree

of burnout went down. I don't really think there's a difference between the residents and fellows but when you compare them.. sorry about that...when you compare them to the the controls in the general

population fifty percent versus 35 or 31 it looks like at least on this paper that we are more burned-out than the general population.

Now this is this is Samantha Metzer Brody's work from 2015. The overall

burnout rate for our residents at University of North Carolina sadly seventy percent. And interestingly radiology's number two right behind general surgery. My residents complain all the time and I think you don't work

as hard as a general surgeon but it's a different type of work. They're not... they're not going to the OR and doing a lot of on the floor history and physical of starting IVs and doing lines but they are like little hamsters on a wheel just

running as fast as they can trying to read all the CTs all the MRs all the plain films and they are completely toast. So it is different skill set but we're number... number two. Which I went into radiology so that I wouldn't be burned out. This is

supposed to be cush. And then who else all the way down even again pathology at the bottom so maybe I should have gone into pathology I think that's a take home message. Even half half of them are burned out. So it seems like it's a whole

lot of us that are that are toast. Psychiatry they're listening to us they're burned out.

Ok so Mayo Clinic there's a lot of work that's coming out of the Mayo Clinic by Shanafelt. This 2015 study is one of

the biggest ones. In 2011 they looked at it forty-five percent burned out in 2014 three years later it up the work life balance is down. And that's part of the problem. We don't have a good work-life balance. So this is their

survey...this is not the Medscape survey but it looks a little bit similar...I think we climbed up to about two three four five...radiology's fifth. And look at the yellow line versus the blue lines. Yellow line is three years before

blue lines three years later and so everybody is toastier than they were before. So the data is consistent and it looks like it's getting worse is to take home message. Now this is Charlie Chaplin in an old

silent movie. But it's sort of the classic cog in the wheel kind of feeling. And if you ever have two seconds to go to youtube and look at this is its kind of kind of funny. So what did they find out that was

bothering physicians at the Mayo Clinic. Asymmetrical rewards. What the hell is asymmetrical...Krystal what's asymmetrical rewards. Krystal has no idea what asymmetrical idea that when you when you do something right nobody very rarely does somebody say great job Bob. It's really really so nice of you to come in and work six hours and stop that

pseudoaneurysm that was bleeding with your team. Could you tell your can you take...why don't we buy pizza for your team and I'll give you guys a raise. No. They wait until somebody does something wrong in a similar case and

they say why did you embolize the wrong person or why did you drop the patient on the floor. So you you hear about all the negative stuff...don't drop patients on hear about all the negative stuff loud and clear

people will come down on you like a ton of bricks but you don't get a lot of positive reinforcement and unfortunately that a little bit of the nature of the game. Long ago when I was a young whippersnapper ER doc and I would

work with the radiologist all the time and this old radiologist said to me Dixon they will never say thank you for a good job they always will say look where you just screwed up. And that's kind of the case and it's a

little sad. So when you're tired and you're exhausted in you're a cog in the wheel if nobody says thanks it doesn't make it any better. Ok how about loss of autonomy now doctors are more and more feeling like they have

lost autonomy. And I imagine having never worked as a tech I can't speak from your standpoint but many of you may feel the same way. We...maybe you don't get along with your manager maybe you don't feel like your voice is heard you might feel

like you have no autonomy as well.Hhaving no control over your work isn't it just it's an awful awful feeling. And cognitive scarcity is the idea that you can't use your brain to do anything useful you have no sense of

accomplishment. What did I do with it there it is. So that that implies as well. So who's at

risk. Are all of us...I think all of us are a little bit of risk but some people are at more risk than others.

If you can't speak to people you are in big trouble. They think that... communication skills are incredibly important to try to communicate with your peers communicate with patients communicate with your boss. Communication

skills are really important. Lack of management skills that's a little bit to do with the productivity thing so that's why I'm going to touch base on and that. I love this one. Low levels of hardiness. So if you're not robust tough you can't

take it then you might you might collapse under the pressure. External locus of control that's the idea that you have no control somebody else is controlling your life and if you already don't have great self esteem that puts

you at more risk. So the job-person fit... if you look at the workload the control issues the rewards...the asymmetric rewards... community. Do you have a sense you...right now you are experiencing a good sense of community but back home you may not have

that. everybody fair to you. And values...are good ethical strong values in place or are your values lost. And so workload's related to your exhaustion. Control reduced accomplished Same with reward. Chronic conflict

with others if you don't have a good solid community then you're going to be in conflict. Fairness you become cynical. And your values being respected or not also impact multiple levels of this.

So we have no data on IR but I suspect

that we're somewhere...we could be somewhere around a surgeon's level of burnout because we work like surgeons. But we might be a little better than the surgeons because a lot of us we love our work and it's it is creative and maybe

we're working within a structure where we don't have the autonomy we think we should have but we have some autonomy and some creativity. And I think we might be less burned-out than the diagnostic radiologist because they are sitting in

a room and reading as fast as possible and we are working as fast as possible to but it's a little bit different. So actually if anybody wants to help me with a research project we should do a survey and figure out how

burned-out we are. How about burnout and you. Well the reasons you get burned out mostly it turns out from a study...this I got online this i you were pulled

maybe some of you answered this poll it's through the a ASRT. And the number one reason for being...feel like you're under stress. The question wasn't about burnout but what is stressing you out the most. Management was number one co-

workers was number two. And workload patient and some people this...I'm old enough that I feel this it's tough to keep up with the technology. And so a small percentage of folks felt that the biggest stressor was actually a new

equipment or new technology. And how about our nurses next door. They looked at job satisfaction retention safety sense of moral cohesion. Burnout affects all of those things and they have a toolkit that promotes case

discussion to facilitate discussion about how things could be better. So both worlds...all world...all three worlds the docs the techs the nurses are looking at this and hopefully we can come up

with something. How am I doing so far Krystal. Okay nobody's

So what can we do to impact burnout. So

we talk about the individual versus the system. Can people learn coping skills. Sure we can go to mindfulness courses we can learn how to meditate we can speak with our colleagues we can do all sorts of stuff that is absolutely doable.

We can do that. Can they apply these skills at work. So if you meditate before you go to work if you learn how to commiserate with your coworkers maybe you can apply that stuff at work.

But do these impact burnout not so much. Studies have shown that even if you do this it might not impact your...your own burnout as much as you would like. Now back in North Cackalacky...I'm in North Carolina. The North Carolina

medical board actually has really taken this to heart and there's a there is a link where we can go and find stuff. The AMA has a website and there are TED talks on positive psychology and there's a reference there to Martin Seligman

who's looked at the...he's the guy who says you know sit down at night and write down 3 happy good things. I don't know that I subscribe to that but there are resources available along those lines. So one thing you can

do and I think it's very important is to stay healthy. Two Chairman's ago there was a phenomenal neuroradiologist at UNC who's the nicest man in the world. He actually met Seldinger. Who the hell is Seldinger. Who's Seldinger.

Yeah yeah the guy who came up with that technique about sticking a needle... yeah the Seldinger Technique... what kind of doctor was Seldinger. You're right he was a radiologist. And so this old guy knew Seldinger.

What year did he describe that 1953 a long time ago he described it. My...that former chairman Dr. Scatlif met Seldinger. That former chairman until very recently was at the gym every day. Now if he knew Seldinger in 1953 went over and

visited his lab...Scatlif has to be ancient. Scatlif is 90 years old and he still he still...he was he was still working. I saw him a week ago giving a lecture to medical students. But he was in the gym every day that I was in the gym and

so that's number one stay healthy. Now you're going to say I don't have time to stay healthy. Well start small go for a walk around the block it will take five minutes and then the next day walking around 2 blocks.

Try. Find out what keeps you going whether it's riding bicycles or the elliptical or yoga or the heavy bag whatever it is. Try to learn better time management skills and we'll talk about that a

little bit in the next section. And developing engage your support system whether it's your spouse your friends your kids your buddies friends at work. You have to have some sort of support system you should not you should not try

to go it alone and tough it out. And we'll touch base on that. Many of us just try to tough it out. And try to improve the system. Don't give up completely so taking care of our own is the program that

we have you and at UNC. I assume that these talks will be made available to you so you could follow that link. And they have... they've been doing this for years and are developing it more to try to find

some physicians to work as coaches for other physicians who are in trouble.

Why do we have trouble getting fixed. Because there's a stigma. We all think that there's something wrong with you if you're burned out or you're depressed or

you're suicidal. A few years ago a resident killed themselves at UNC and it really sent a ripple through the whole the whole place. But we think that many of our colleagues will hold stigmatizing

views about depression and mental health and that stigma that problem keeps us from reaching out saying hey I'm completely toast somebody give me a hand. And the barriers we become ambivalent we avoid

it and we've deny it and it just it just keeps going. And both the faculty and the trainees have misconceptions about this. And we're concerned about confidentiality. But we are most concerned about is letting our

colleagues down. We're a little bit concerned about letting our patients down but we do not want to let our team down. And we're worried about will that impact our career and how confidential is all this.

Now nobody wakes up in the morning and

says hey I'm gonna shoot myself in the foot and just destroy my career by becoming an alcoholic or stealing drugs or whatever it is. We don't do. It's kind of an insidious onset. So when you have good coping mechanisms you can

stabilize and maybe get healthier. But if you decide to cope with this by having one beer well maybe that's two beers maybe it's a bottle of wine oh and I need a night cap on top of those three beers it could it

could become a real problem. But people who end up having that problem do not just all of a sudden one day very quickly say boom I'm going to become a drunk. No they kind of ease into it and its really it sneaks up on

you it's very very bad.

So this is the group back at UNC and that's Samantha Meltzer Brody on the left. And she's actually...she's not burned out that she's really in high demand right now. She's being asked to speak to

surgeons she spoke to radiology two weeks ago she's in demand. Now there's other things besides the literature that I just shared with you the links that i just shared with you. This guy Dr. Drummond has a whole

website with all sorts of tools and ideas about how to get better and actually a burnout proof app. And the idea is to lower your stress level and try to build a better work-life balance. One of the first projects he has it's

very simple. You have a... you have a circle that is the job you have now and then think of another circle what's your perfect job and the idea is to try to overlap those two and a Venn

diagram and make the overlap as much as you possibly can. That sounds really simple. It is not simple but it's a good way to start thinking about it. So this is another resource. The three things that they

identified the Mayo Clinic was having some choice having camaraderie. They started having meeting monthly and if you just got together and talked about that help and also being involved in something that led to excellence. The docs want to

be involved in something that leads to a good outcome. They want to be part of the new project they want to take care of patients they want to improve turnaround time in clinic. We want to do good we don't just want to be a cog in

the wheel we want our voice heard and we want to be a part of the team and we want administration the hospital to

listen to us. Ok this is pretty important. The idea is that...again about career fit amongst

academic of faculty. This again is Shanafelt. And he identified back in 2009 that if you were spending less than twenty percent of your time on your favorite thing... what is your most meaningful activity...

what you think it is for physicians what's the most meaningful activity a physician would. Taking care of patients. We want to take care of patients. So some would also say research. Some would say education. And a few of us knuckleheads would say

administration they really enjoy administration. Who the heck would enjoy administration but some people do. So if you're not spending twenty percent of your time doing something that you care about you are at very high risk of getting

burned out. And so the question is what trips your trigger What is your twenty percent and for us it's usually taken care of patients. For me I really liked teaching so I try to make sure...and so what does

twenty percent day a week. One day a week you should be doing what you want. 8 hours 10 hours 12 hours you should be doing what you want. So

changing the organization is tough we've gone through

these six things before but if you can build engagement set a positive goal and try to make a difference within the organization that will help. This is a pretty good way to finish. Maslach herself in 1982 said this...if

all the knowledge and advice about how to beat burnout can be summed up in one word that word would be balance. Balance between giving and getting stress and calm work and home. And I think that's probably true. It is very hard to

establish that balance but I think that's probably true. Alright so I'm going to take a break and have a sip water. We'll hold questions for the end. You guys are probably burned out on this talk but when do I stop.

10-1015 Uh Oh Kristin you don't know. Ok alright. So what is productivity. Completing action to bring you closer to your goals is one way to to define it. And step back a little bit further it's...the idea is that rather than

just like floating floating down the streams like a leaf in the river you know have have an idea what you're trying to do. Set some intention living with intention and work on doing good work rather than a whole bunch of work.

So why should we care about this. Well you'll reduce stress help your work-life balance and possibly reduce that whole burnout thing that I just went through. So what are some myths. Let's talk about some myths of productivity. You're

more efficient when you multitask. That is absolute BS. Why. It's not really multitasking you cannot do two things at one time. You can go back and forth really fast but you cannot do two things well at one time. And they looked at

this...Strayer looked at this... just two simple things talking on the phone and driving a car and the analogy is that talking on a phone and driving a car some people were impaired so much they look like they were drunk. You

really can't multitask. We're going to come back to that later on. UCLA study this is a little funny but they asked people to look at a series of cards to identify patterns. In one group they

just let them look at the cards identify the patterns and then they asked them some broader questions. Like if you saw these patterns go from there what else could you figure out and then... so one group they just showed them the

cards. The other group they played these tunes at different frequencies. A low and high and you were supposed to count how many times the high-frequency thing fired while you're looking at the cards. Seven ok and they could not do those two

things well. Meaning they could identify the patterns but when they were... asked more advanced questions they couldn't answer them. So I submit that there is evidence that you can't really multitask. So on those days and you think

you're firing on all eight cylinders and you're going to multitask you're probably not really doing that you're switching back and forth. Busy is the same as productive. Well if I go to work and I've got 25

things to do on my checklist and I'm doing them all at once and I get 20 of them done that day that's pretty good. That's probably not really what we're talking about. And I'll explain why. It's not the time you spend but the results that you

get. You have to figure out what's really important out of those 20 things and set your intention on and that. This is a favorite slide of mine many of us sit down we have a list of things to do and we can go we could get something to eat

we could change the font we could change our desktop we can do all sorts of things before we do the thing we really have to do. I would submit that what you should really do is figure out what is the most challenging difficult thing you

have to do and do it first thing in the morning. Mark Twain is credited with a live frog first thing in the morning and nothing worse will happen to you the rest of the day.

Now that sounds a little silly but it's true. When I have say I've got a big meeting coming up or I've got a manuscript due. And I've got some other things to do I got to talk to some residents I gotta go bah bah bah...if I don't do that big thing

in the morning the day just takes off gallops away and you don't do it. So I really like if you're going to take a couple things home think about this one. Think about to eat the frog comment. How about working longer hours. I am

a good example of things...of somebody who thinks that if I just work till ten o'clock at night every night I will get things done. Usually by about eight o'clock I am so exhausted that I'm not being efficient.

So working longer hours doesn't get more done. In fact they looked at this and overtime as...the x axis is the longer hours... the longer you work the less productive you are. And it's been shown again and again.

So on longer hours leads...working longer hours leads to a few things. Increased fatigue and safety risks. When I'm really tired I say to my team keep an eye on me because I'm tired I don't want to I don't want to do

something wrong during the procedure. And stress and the stress leads to...can lead to cardiac events cognitive events. We have...a lot of us have musculoskeletal problems back problems from working so many long hours. So

how can we improve productivity. This is another simple thing to take home. So eat the frog first thing in the morning and then reduce clutter. What kind of clutter. Well we have all sorts of clutter. Physical clutter stuff on our desk

stuff in our office. Digital cutter and mental clutter. So this is somebody's office with stuff everywhere. I's not very organized and the idea is that walking in and seeing your office like this...maybe you think you're okay with

the whole thing but it creates a sense of uneasiness. It adds to your stress level. So try to take care of the physical clutter. Digital clutter busy desktop email inbox inbox messages and multiple devices. You've got might have your desktop at home your desktop in the office your iPad your phones your other phones. So you have lots of...And if you have a desktop that looks like this

that's insane you can't find things to try to organize it. Some people use tags Have at least one backup. Say this computer blows up and you've got that manuscript and the residency evaluations that the only

thing you are you are toast. Inbox you shouldn't have it at 1 million but try to get it down to zero. Managing email try to batch the task sit down at one time and do a whole bunch. Delete delegate or act. So if you have

something that's not important boom gone. You have something that somebody else could help you with delegate. Or act on it. The two-minute rule. The first thing you should take home is eat the frog. The

second thing you should take home is the two-minute rule. What the hell is the two-minute rule. The two-minute rule can manage folders too... this is a just a brief synopsis of different ways you can

manage things I don't want to spend spend too much time on that. You can write things down. You have to do lists task managers reminders. You should set goals. If you don't set goals...what did Yogi Bear say...if you don't know where you're

going you might wind up someplace else. So doing lots of things will not make you productive. This book the whole concept is identifying the one thing that if you were to do that one thing everything else would get easier.

You should apply this rule this author says to come up with a five-year plan a three-year plan a one-year plan one month plan and what the heck you're going to do today. What can I do today that will make the rest of the day

easier. If you have time and you're managing your time better you might want to read this thing...this book "The one thing". Seek to eliminate try to get rid of things. There's an author who talks about the 4-hour workweek if you're

really efficient you could eliminate stuff. The key to elimination there's two rules. The Parkinson's rule. This law states that work expands to fill the time available. So if I have a talk to give to you and I have given myself 17

hours to write that talk and and prepare it. It will take me 17 hours. If i say I got four hours to put it together you can complete it in four hours. So if you set these huge long horizons you could possibly fill that

hole. And then the 80/20 rule. This is a this is a rule that came up when somebody....when somebody discovered that eighty percent of the land in Italy was owned by twenty percent of the people. The idea is that eighty percent

of the stuff that gets done at work is done by 10 or twenty percent of the people. You know who keeps getting tapped to do things. You might be one of those people. So if you're looking at eliminating

things keep two rules in mind. And then have some sort of system. It doesn't matter what you have it can be an index card with the checklist it can be an app that you like using but don't spend so much time finding a

productivity system to help you because that will take that...could take forever if you just want to let it take forever. But it doesn't matter what it is. It could be a hardcopy checklist it could be an app that could be your

outlook system whatever you want. Getting things done is kind of an an advanced of productivity system. This slide looks a little busy but the idea is that if you identify something you can delegate it scheduled

it eliminate it and apply the 2-minute rules. So we'll come back to the two-minute rule. The two-minute rule says if it can be done in less than two minutes do it right now. That mean's stop what you're doing and finish

it and that rule along with eat the frog has really helped me and I would advise you to try to employ the two-minute rule. Now the problem is if you guess wrong and it takes longer than two minutes you could get sucked down some rabbit hole.

So try to be very selective. I have to call so-and-so and do this today it'll take two minutes let's do it right now. Productivity systems do not mean that you will be more productive. So any of these apps work some of you maybe have...

already are using them. I don't...nobody cares which one you use but these are all available and are positive...are possible to use. Not too

bad. So in summary productivity is about

accomplishing goals try to reduce the clutter clean up your email inbox clean up your desktop and clean up clean up your office. And if you want to come and clean up my office that would be helpful. Look for opportunities to delegate. Put

things in place that are automatic and eliminate them if you can. And do one thing at a time. Don't try to multitask. Try to figure out what that one important thing for the day the month the year the three years

the five years is. One thing at a time. Ok I think I'll stop there I know I'm supposed to talk to 1015 but this will allow opportunity for questions. Or comments questions or comments. And if you have a question I've been asked by

Angel and Co to come up and use the microphone. Wow I've completely toasted you guys. I'm sorry you're all burned out. Nothing you got nothing. Ok. Good morning I'm Cheryl from North Dakota and I just want you to know that

in the last five years I've seen a great difference in our work field. You know 25 years ago...I mean we were able to have a two-hour lunch... yeah seriously. And I know that it's a national thing. I know that if I we're not

the only ones up there. And now we're multitasking and we're doing two to three procedures know intensive patient at once. So anyway I really appreciated your talk and I just want you to know that you know as of

five years ago I made sure that you know people need to check their attitudes. You know and you're right about if it's too much for you you need to think about a different job because our first priority and the reason why we went into it was

to help individuals. And for instance we had a person that had been in my department for 29 years and her attitude was bad for the last four years and once she did decide to leave there was like an air and everybody was communicating

more and we're not afraid of speaking up. Yeah so thank you. You're welcome so it's really it's really tough and I appreciate your comment. When what you're talking about is what we're all experiencing right. We all are doing more

with less. You do we do more with less time less staff. I am doing cases without a fellow I'm doing high-end cases. And I got in trouble because I asked...i had an on-call tech I had that crazy case

going six hours and I we had the techs scheduled and I asked the on-call tech to help me. And because I was using more hospital resources I was sort of called into the carpet Monday morning...why why did you do

that. Well we couldn't let him bleed to death and die. I needed a hand with some detachable coils and I just need another hand. Where was your fellow. Well my fellow went home sick.

He was actually vomiting so much we had to give them two liters of fluid and send him home. So sometimes you just don't have everything you need.Aand it's very tough to stay... I just call it your shock absorber. You said check your attitude. When you're crispy when you're toast when you're tired your attitude is gone and your shock absorber your ability to deal with one more thing is diminished. If you're healthy and well rested and have

some support and have checked your attitude then when you get that one more thing like a crabby patient or the complaint or a one more procedure to do you can absorb it a little easier. So that's why I think it's easier if

you're in trouble to take care of yourself first and then try to work in the organization. And it is like pushing a big huge ball uphill it's really difficult to fix the organization but I think it's worth trying.

You were just kind of answering what I was going to ask too...but since I'm already up here. Let's do it. So that 80/20 rule applies to our lab. I say all the time twenty percent of us are doing eighty

percent of the work. And a lot of your advice was to delegate tasks. But we're the ones being delegated to so we don't have as much control so I was just going to ask kind of what some strategies would be as the people who are not the

delegators. So I think that you're really in a tough spot because we we all have that. And sometimes its 10... like a 90/10 rule right. There's just a few of us. But so one way to way to fix it is you're in a leadership

position you're being asked to do things because you're productive you've been successful and so the one way to work on that... and it would take some to look across the staff. And who got the

lights on and somebody's home. And who what young person has shown up and it's like Johnny on the spot or Janie on the spot. Who could you mentor in other words to come up and in a year or so be

one of those maybe make a 23-percent. I think mentoring is really gratifying to watch somebody who's junior to you become successful. To teach them good rules how to navigate your system. And all of our systems are complicated and

you have to know who the players are. You could's not gonna fix it this week...but it might it might fix it in a long run. Asking for money and more help doesn't really help because even if you hire 8 more people only one of them is

going to be helping you out. And its really tough to tell in an interview who's good. So I would try to find somebody and mentor them. You're welcome. So thank you so much for your lecture. One of the things I wanted to ask is you know many

of us working large university settings but it sounds like we're all in our departments dealing with similar situations where you're finding your coworkers are leaving in droves to smaller smaller hospital settings

different fields going into you know anything. Like we heard this morning that going into industry and everything like that. You're losing your skills and your knowledge and your big base of strength. So one of the things

that I wanted to know if you were going to think about taking your presentation and publishing it because it takes it... helps to take it helps to take information back to leadership to say hey look at this.

You know I can talk about your presentation but I'm not you and I don't have your knowledge and I don't have your enthusiasm. And I...but I want to take all that you spoke about to my leadership and sound like I know

what I'm talking about. And I so... but i wanted to also be able to maybe like you use the resource or something like that. I know that you're very busy yourself. I'm burned out.

So I just want to take it further like take the information you know it so that I can...that's why I said like please publish an article...because when I could take it to them. Even if you publish it in our journal. You would would be great

if you could be published in our journal that we have. Ok. Then we can take the informationand say look what we've learned and can we replicate this can we do some of this at work so that we can salvage our staff and keep our staff.

Yes so I thank you for the very kind comments. And I this is something I'm gonna teach you. You have to learn when to say no. And so and so it's an art form it is an art form and and rather than say

no because I know you and I want to help. What I'll say is well I can't do that right now but know in six months ask me or if you can't find anybody else use it to do the job come back and ask me again. Okay so-so

first solutions. Always have solutions. So first you should get...if you don't get to get a copy of the talk I'll give you my copy of the talk. Second in the talk there are there are resources and that guy Shanafelt from Mayo

Clinic Shanafelt data...he has written about for years and he...that is the data to bring to your hospital. I'm happy too when I have some time in a few months write a review article for your

literature but what I would really like to do is do a survey of IRs and then we could comment on all this. Now now maybe you could maybe you could help me out because I want to survey the docs but we could also survey all of you. And I

have to figure out which survey metric is something I can get a hold of. I was talking to Samantha Meltzer Brody I said help me out. She said no. I said help me out with a study I want to do a survey of IR docs. And she said no

I can't but maybe those other people could help me and it would be a great project for you and one of your fellows and she's absolutely right. So I could do the docs but maybe we should do the techs and maybe we should go next door and

do the nurses. Because when I look at the data for the the techs and the nurses...I just came up with a couple things and I suspected this is this is a real problem. And i suspect that all three groups have a problem and maybe we could write more

about it. I think i'm supposed to shut up now because now I was worried I wouldn't have enough to talk about but now I think...he's worris about everything. Can I just say one more thing. When you mention I definitely think

that you should whoever does it should survey both the nurses and the techs. Because I've worked in the field long enough and I love my job and I know what I'm doing but sometimes when techs or nurses sweet-talk doctors they get...they

don't quite see who really is doing the job. And for instance I was proof of it when a co-worker of mine and myself we're doing the late shift. And basically the times that we could not stay late instead of having the call team you know

that's when the stuff hitsthe fan if you understand what I'm saying. And the the majority time we were staying late and basically what it came down to was the doctor didn't even pay attention who was really staying late all the time. But

when we couldn't do it that's know so I mean...we weren't rewarded or you follow what I'm saying. I do. Yeah so that's why I definitely think that taking a survey of the techs or

nurses is a good idea because I'm sorry but sometimes I don't think the doctors really see the big picture. You don't have to apologize. Okay. Than you. You're right that's that asymmetric reward stuff. Yeah and if we don't hold in our eyes...

it also has to do with communication. You are an integral part of my life and I treat the techs really well but I know that some of don't have to apologize. Thank you. I know. Thank you for your comments.

Uh oh. We're going over and we're not even. I'm so sorry but I just have to mention this. We're good. There's a break after this. I just can't help myself i have to mention this. Thought about it it's...if you want to check out one of the

poster to our institutions from my colleagues we talk about solutions while we colleague is going to be presenting somewhat of a solution that we are working on. it's about staffing engagement it's about documentation

it's about proof that the staff is engaged. In fact you have to document to earn a tech level. So we instituted some tech levels and there's no tech level level two level three you have to apply for this you have to document it it's

proof it's the whole portfolio you put together and you earn this reward. So if something to engage everybody. Okay may I ask your name. Oh Jenna Clint. Ok and where you from Frieder in Milwaukee. Ok so then the posters

here. Yea it's from my colleague. You can see it at 11:30. Who's your colleague. Deborah Barnes. Okay so we'll look for Deborah Barnes out in the poster room. Our award of excellence winner by the way. Yes please go see it. Thanks so much for speaking up I think

it's these kind of things...sort of ground level efforts grassroots efforts that make the difference. Whether it's a group of doctors getting together once a month or tech level project so that you get some positive rewards instead of only

negative rewards you get some acknowledgement. And I think it all makes a difference. The problem is the 20-percent cannot give up. Do not give up. If you're hanging on by a thread take care of yourself try to reach out to other

people and try to get involved and I'm happy to get you involved you're clearly burned out. I'm just kidding. Thank you thank you very much Dr. Dixon.

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