How to safeguard your time for scholarship

0:00 Welcome to the Clinician Researcher podcast, where academic clinicians learn the skills to build their own research program, whether or not they have a mentor. As clinicians, we spend a decade or more as trainees learning to take care of patients. When we finally start our careers, we want to build research programs, but then we find that our years of clinical training did not adequately prepare us to lead our research program. Through no fault of our own, we struggle to find mentors, and when we can't, we quit. However, clinicians hold the keys to the greatest research breakthroughs.

0:40 For this reason, the Clinician Researcher podcast exists to give academic clinicians the tools to build their own research program, whether or not they have a mentor. Now introducing your host, Toyosi Onwuemene. Welcome to the Clinician Researcher podcast. I'm your host, Toyosi Onwuemene, and it is such a pleasure to be talking with you today. Thank you for tuning in, for taking the time to be here today, because if you were not here, I would not be here talking. So, yes, thank you for tuning in. Today I am talking about how to safeguard time for scholarship, how to safeguard your time for scholarship.

1:24 And the reason behind this podcast is a recent conversation I had with a group of peers, and we were talking about challenges that we're experiencing and moving our research forward. And somebody said, yeah, you know, the requirement at our hospital is that everybody has to be in their inbox and respond to any MyChart message within, I forget, whether it was 20 minutes or something of it being sent. And I had to start laughing when I heard that because it reminded me of a situation when I first started my faculty career where I really believed every rule was law.

2:04 Everything they said I had to do, I would do. Only physicians can call prior authorizations. Well, okay, only physicians can write orders for calcium. Okay, I believed everything I was told. And I recognize now in retrospect that believing everything you're told doesn't work for children, and it certainly doesn't work for adults, right? Eventually you have to wake up and start to recognize that not everything you're told should be believed. And, you know, going back to the initial conversation we were having, it's like, well, if you have to respond to any message within 20 minutes of it being sent, that means you're literally going to be in MyChart checking messages all the time, and that doesn't foster good patient care because clearly you have more to do beyond just checking MyChart messages when it comes to taking care of patients and certainly when it comes to taking care of leading a research program.

2:59 And so I just want to pause and talk about how to safeguard your time for scholarship. I'm going to just talk about seven things that you need to think about as you are moving forward to do scholarship. Now the first thing I do want to share is that if you are at an academic medical center, no matter your title, so maybe you're a clinician or you're a clinician educator or you're a clinician scientist or a research scientist, no matter your title, if you are part of an academic medical center, there is a baseline expectation that you're contributing to scholarship. And now the requirements for scholarship depend on what you've agreed to in taking on your job.

3:39 Now for many of you in my community, you are clinicians who are trying to make that transition from clinician to clinician scientist or clinician researcher. Some of you have already made that transition where you're primarily a clinician scientist and some of you are probably just already like fully research scientists. But no matter what, scholarship is part of your portfolio as part of an academic medical center. So even if you are fully clinical, there's an expectation that you contribute to scholarship either in taking on trainees within your program, teaching a few lectures. There's an expectation that there'll be some publications, even if it's not kind of like the highest expectation as would maybe be required of someone who's a clinician, who is a scientist only or a clinician scientist who has got most of their time protected for research.

4:32 So scholarship is an inherent piece of being at an academic medical center. And so there's always got to be time for scholarship. Sometimes I'll hear people say, well, you have 20% protective time for scholarship. And to be honest, that's not really real because if you are in clinic four days a week, 20% of that time is time to finish your administrative tasks. That's not protected time for research. And to be honest, anybody who says that is protected time is not being sincere. But that's not where we're going today. Today we're talking about, well, how do you safeguard your time for scholarship no matter what? Because even if you are, as long as you have any clinical experience, as long as you have any clinical training, there's always an expectation that you're going to be able to manage and take care of patients.

5:21 As long as you have any clinical responsibility, you want to protect the time that you don't have clinical responsibility to move forward in scholarship. And why do you need to do this? You need to do it because otherwise you're going to spend your whole time doing things that are surrounding patient care, not necessarily directly related to patient care, but you're not going to be able to move other things forward. And then when it comes to time to doing your scholarship, then you're kind of biting into your nights and weekends to try to get that done. And that doesn't make for healthy living. And so that's not what I'm primarily recommending. So how do you do that where your scholarship is part of your daytime activities?

6:01 Okay. So the first thing I want to share is that you have to recognize that the rules of any system are agnostic to your needs, right? The system is not thinking, oh, what does this person need to best succeed? Ideally, right, systems are built to think about those who work within them and make sure that they are healthy and they're well cared for. But in reality, academic medical centers are really places of extreme contradiction, right? Academics is important, scholarship matters, but also 100% attention to patient care, but also 100% attention to education. And to be honest, sometimes those things actually are in conflict.

6:44 And so if you have a system where all these things are in conflict, then no one in the system is thinking, well, how do I help the clinician who is trying to build a research program? How do I make sure that they're okay? If you are in a situation where people are actively in your system thinking about you as they're making up the rules, kudos to you. And congratulations. And please send us a message about where you are because we need to know. It's a unique situation. What's most realistic, what happens more likely, is that those who are in charge of the clinical things are making the rules for clinical things. And those who are in charge of scholarship are making the rules in terms of what's needed for a scholarship.

7:26 Those who are in administration are making the rules that's best for them in administration. Those who are educating trainees are making rules as far as what's best for the education of trainees. And they don't all go together to help you move forward. But it's important to recognize that the system is agnostic. It doesn't know what your needs are. It has no idea what you need. And so that's the first thing just to say, no one's out to get you. No one's out to get you. It's just the system works to support the system in the silos in which the system exists. So you just have to recognize that if it's not working for you, it's not because anyone's out to get you.

8:07 It's just because the system is agnostic. It has no idea who you are in its systemic and its need to take care of its own issues. The second thing is that the system is not built to care for your needs. This is different from number one. So number one is that the rules is agnostic. It just doesn't care for you one way or the other. But number two is very clearly when it comes to your mental health, your emotional health, your well-being, OK, the system is not built to do that for you. It's really great that at many institutions, there's like personal psychological services that are available to you in case you're stressed.

8:48 That's all well and good. But what I'm talking about is a system that's inherently structured to care personally for the clinician or the clinician scientist or the clinician who's trying to build a research program or a program of scholarship. It is not built to care for your needs. It's not there to say, wow, this attending, this clinician has rounded for the last seven days. Let's build in a day of rest following seven days of rounding. Oh, no, no, no. There's none of that. No one wants to know. No one's asking you. No one's saying, oh, yeah, you work seven days. Oh, of course, you should take time off. Barely anybody is doing that.

9:29 And that's why number three is that the best person equipped to handle your needs is you. OK, we've agreed. We've said that the system is not there. It's agnostic to your needs. It's not there to care for you. And so if somebody is going to say, hey, what's going on with Toyosi? What does she need after seven days of rounding nonstop in the hospital? Well, the chances are high that you're going to need to take the leadership, take the leadership of caring personally for yourself. And so when it comes to your scholarship and safeguarding your scholarship, you're going to need to take the lead because you're the best equipped person to do that.

10:12 Right. The system is not built for you. I mean, it's agnostic to your needs. It has no idea what you need, but you have exactly what you need. You know, you know what you need. And so you could wait and say, well, they'll figure out that I'm tired and then someone's going to give me a day off. You can wait for that or you can say, hmm, they may or may not figure out that I'm tired. And so why don't I just take the rest that I need and figure out a way to do that. Right. And so the person that's best equipped to handle your needs as you will always be you. And I'm glad it's you because fortunately, you know, no one cares about your needs more than you do.

10:53 Actually, maybe your mother, if she's still alive, right. Your mother, maybe your dad, a parent. Right. But other than the parent and especially now that you're in the academic medical center, it's you. And so and so take ownership, take ownership. OK. Number four is if you can't make headway, reach out to your mentors. This is the benefit of having mentors. Right. The benefit of having mentors is that sometimes you can't figure things out or sometimes you don't even know who to turn to or sometimes you know who to turn to. And they're just, you know, they're just not really supporting you like they're supposed to. So the benefit of having people you can reach out to and say, hey, this is not working. Hey, how do I manage this thing where I've been on call for seven days, but there's no time built in my schedule for me to take time off.

11:39 This is where mentors can support you. It doesn't mean they're going to go to bat for you. Many of them don't necessarily do that, but at least they'll give you advice and say, oh, yeah, of course. After you've been on service for seven days, you can take a day off on your own. And this is who you tell or it doesn't matter who you tell. But you know, they give you ideas for how they manage it. And hopefully they're healthy in the way they live their lives so that they can give you advice that's healthy for you. And but even if they're not, you'll catch a clue based on what they say, how they're thinking about these things. But definitely reach out. Even if it's a mentor who's outside your institution and they don't necessarily have any pull within your institution, they can still give you advice that's helpful for you, that helps you move forward.

12:22 So if you cannot make headway in safeguarding time for your scholarship, this is where you really can make good use of your mentors, both internal mentors and external mentors as well. OK. Number five is to carefully craft the career you want. Now, remember at the story at the beginning, I told you the story of a young person who's part of a peer mentoring group who's like, well, the requirement of the institution is that within 15 to 20 minutes of any message being sent, it needs to be responded to. And you know, I imagine that if we actually trace that rule back to the person who reportedly said it, we will find out that maybe it was contextual or maybe it was a specific situation in which they said that needed to happen.

13:15 But as with all urban legends, you know, it starts with a little kernel of truth and then it's exaggerated and then it's distorted and then it becomes this amazing story that's really hard to believe, especially when you know the system well. And so you don't want to take everything at face value and say, well, this is the requirement. You want to ask, is it really the requirement? Is it really? Because if it is the requirement for me to be in the epic messaging all day and well, I guess until, you know, maybe in this case, it was an infusion center. Okay, maybe until the infusion center closes, then I have to ask, so when am I doing my charting?

13:56 When am I doing my scholarship? When am I doing my resident education? Right. These are the questions you ask. And instead of like internalizing it all and saying, okay, I'll just move it to the night. I'll just push sleep out of the way. Instead of doing that, you ask, hmm, what do I want for my experience so that I can show up well in the other things for which I'm called to do. Right. I mean, you're called to the institution to see patients, to, you know, take care of patients, close charts, to lead an academic experience, to take care of the trainees who are coming through your program to teach. Like, you have a job description.

14:37 It's very clear. I mean, you may not be clear about what your job description is, but the requirements are usually set forth in the AP&T handbook. So that's the, you know, promotions and tenure handbook. Usually it's like these are the requirements to be promoted. And that usually tells you about what's valued at your institution, what you're supposed to be doing. And so if you look at all these rules and they're not supporting you in the way that the institution says you should be moving forward, then you decide how to best help your institution get what they want out of you. Because if at the end of three years of being at your institution, you're like, well, I was so busy in my chart, I didn't really have a chance to close all my patient charts, or I didn't really have a chance to do any scholarship.

15:22 It's like you actually have not progressed like you're supposed to, and people will let you know that. And you cannot use the excuse of like, well, if you hadn't made this rule about my chart, I would be better. It's not, don't wait three years to try to ask someone, you know, how to move forward in a rule that doesn't help you. You decide, you decide, you've got to decide. Like this is the career I want. This is how I want to move forward. Therefore this rule that keeps me in my chart day and night, let's figure out a way to fix it. Right? So this is important for you to think about. Okay. The next thing to do is to help your senior leaders understand why it's best to support you.

16:04 Again, going back to I don't know what the origin of this story is, people will say, oh, the senior leadership wants this. And you know, many times senior leadership, they say things and the things they say are carried out of proportion. And all of a sudden people are saying, people are making changes to their academic experience or to their patient care based on what somebody may have said in an off comment or off the record in passing. Right? And this is the challenge of leadership. You do not recognize how much influence your word carries. The moment you say something, even if you were just joking, even if you were just thinking it through, people are apt to respond to it and then to tell other people that, oh, this is what the boss wants.

16:48 This is what the leadership wants. And it may not even be what the leadership wants. And so it's an opportunity to go before your leadership, whether that's your division chief or your department chair and say, hey, I heard that there's this new rule that keeps us in my chart all the time. Hmm. What were you thinking when you made this rule? Right? And then you really get to understand what was the intent behind the communication, what is realistic, what is expected. And if they're completely oblivious, right, because many leaders in physician organizations now are not necessarily physicians and they don't understand the impact of some of the requirements that they're bringing forth, you help them understand to say, well, if you are optimizing for me being in my chart, here are all the things that you're not optimizing for and you help people see that whatever regulations or whatever rules are being promulgated or being made up are not supporting you so that they can decide if they need to reinterpret the rules, if they need to clarify things for you, if they need to say, hey, we thought it was a great idea, clearly not a great idea.

17:57 We did not mean to X, Y, Z. And so you're really helping your senior leaders support you and helping them understand why it's best to support you. It's like, well, this doesn't meet the mission. This doesn't help the bottom line. This is what helps me move forward in a way that supports you and your role as a leader. And so you help your senior leaders understand why it's best to support you rather than just making rules that actually don't help you move forward. And what I see a lot of people doing, especially people who are underrepresented in the academy doing is just resisting, right? We're not going to say, we're not going to face it head on. We're just not going to do this thing. And you got to do what works for you. But if you can, it's always useful to have these conversations so that the people who are making these rules are connected to the consequences of the rules that they're making.

18:48 So do what's necessary, but you help your senior leaders understand why it is in their best interest to support you. And then the final thing I want to say is that no matter what, you're going to need thick skin to move through the system. So you're going to be able, you're going to need to stand up for yourself. You're going to need to recognize that there are always going to be people within the system who don't stand up for themselves, who don't say, no, that rule doesn't make sense for us. We're not going to do that. This is how we're going to do it. There'll always be people who are like, no, no, no, no, no, just keep your head down. Just, just do it. No, they say you should be in my chart all day. You better be in my chart all day. And then you just do the work in the middle of the night when nobody else is looking.

19:28 And it may be working for them. But if it's not working for you, you don't have to go with that flow, but recognize that the moment you make a different choice, you are not going to be liked by the people who have decided not to make that choice. And you've got to be okay with that. So if you're going to make changes that allow you to create space for your scholarship, you're going to need to have thick skin and you're going to need to recognize that you're going to be doing things differently from some people around you. And it's okay. And this is where community comes in, right? People who are doing what you're doing or moving around in the system the same way you're moving through the system so that you know that even if at your local institution, things, you know, are not necessarily, you're not supported to do that way, to do things that way, then you have a bigger community that supports you to do that.

20:20 Okay. So the first thing I said is to recognize that the rules are agnostic to your needs. This is summarizing everything. Number two, the system is really not built to care for you. It's not built to really meet your needs. Number three, the person best equipped to handle your needs is you. Number four, if you cannot make headway, it's an opportunity to reach out to your mentors to support you. Number five, carefully craft the career you want so you can decide how you show up in your career. Number seven, help your senior leaders understand why it is best to support you. That was number six. And then number seven, you're going to need thick skin to move through the system because no matter what, you're going to be doing things differently from people around you. You're going to want to be feel like you're supported to do that.

21:02 Okay. So I want to invite you this week to think about some requirements that you've been invited to take on that don't actually help you. They don't meet your needs personally. They don't meet your needs emotionally. Maybe you're being asked to lead a meeting that starts at 6 p.m. and daycare closes at 6 p.m. And you know that you can't afford to not take your kids out of daycare on time. You know, those kinds of things. What opportunities do you have to change, to actually address those requirements that may not be meeting your needs today? And so I invite you to just think creatively about how can you do that?

21:44 How can you, instead of just saying, okay, I guess I will just pay extra money for an au pair that picks up the kids at 6 p.m., how can you address the requirements so that your institution helps you meet your needs? Right. I mean, they're not thinking about it, but you are. Anyway, so that's my call to action this week. And I'd love to hear about some strategies that you have put in place to do that. All right. It's been a pleasure talking with you today. Thank you so much for listening. And I look forward to talking with you again the next time. Thanks for listening to this episode of the Clinician Researcher Podcast, where academic clinicians learn the skills to build their own research program, whether or not they have a mentor.

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