Time Management Strategies for PGY1

There are two main reasons to focus on time management when you transition into your residency program. The first is to decrease your chance of burnout, and the second is to deliver higher-quality patient care. Time management can improve both of these challenges.

Medical students are often ill-equipped in time management skills to successfully negotiate their busy environment during postgraduate year one (PGY1). Up until now, you’ve been focusing on knowledge and skill acquisition over individual time or work-life balance. You may be thinking you can pull through and think about time management after residency, but lack of time management skills will decrease your productivity and your continued education. If you don’t start working on it now, time management problems can be a contributor to professional failure.

How to Get Started with Time Management

The first thing you must do when starting to practice better time management is to change your attitude. You must be willing to take the steps necessary to manage time, which means investing some time in yourself. There are steps, like making lists and writing goals, that take time in order to make time, and you have to see these actions as having worth. Prioritizing time management is the solution to professional and personal limitations.

Secondly, stop thinking about your limitations as too many things to do and too little time. It is about your activities and your results, not about how many hours there are in a day. Focusing on getting things done and prioritizing those things increases productivity.

Steps to Time Management

Identify and prioritize current tasks: This means writing down a to-do list and identifying what needs to be accomplished, what should be accomplished, and what could be delayed. The more detail you put into this list, the more effective your time management will be.
Set goals: Before you go about analyzing your current tasks, identify or set goals for what you need to accomplish. This includes work-life balance. What is important in your personal life? Is it time with friends or time spent doing a hobby? Is it family? Is it connecting with nature? Make sure you include yourself in your goals, not just your residency and professional goals.
Track yourcurrent time expenditures: Be honest when you do this. How much time did you spend on social media? How much time did you spend dragging your feet to get to the hospital when you could have arrived early? Time management is about looking for those morsels of time that are wasted every day and turning those into productive times. Part of productive time is relaxation, but it is often replaced with distraction.
Consider behavior: Many physicians report that interruptions are a big time challenge in the medical profession. A behavior as simple as closing your office door or silencing app notifications on your phone can increase productivity. Don’t let yourself be that person that doesn’t have time to use the bathroom. It doesn’t result in beneficial outcomes in the long-run.
Manage Your Schedule and Behavior: Of course, the duty to patient care gets in the way of time management, as it should. The challenges of the human body are unforeseeable, but prioritization of your schedule combined with the elimination of time-wasting behaviors makes room for the challenges of variable schedules and unexpected changes.
Don’t try to multi-task: Nobody can multi-task efficiently. Studies show that multi-tasking actually results in a loss of productivity (possibly around 40%). It also increases the chance for errors and increases mental fatigue. Instead of multi-tasking, focus on one task at a time. If you have to break up your attention into 30 or 60 minute segments, that is fine. Those segments will be much more productive.

Time management capabilities are a huge indicator of job satisfaction in the medical field. Being satisfied in your career prevents burnout. Therefore, if you want to be successful in your medical career, you must invest in yourself by engaging in time management efforts.

Other Recommendations from Residents and Physicians:

Make to-do lists
Set goals
Be part of the team
Network
Ask for help early
Establish a handover system for patients
Avoid procrastination
Learn your IT system
Say no when necessary

As you can see, preparation is half of the battle when it comes to time management. A good support system along with some attention to the baseline knowledge you need to function in a facility can go a long ways toward minimizing time spent on overwhelming jobs such as bureaucratic tasks that must occur alongside patient care. Additionally, making sure you have a network of support on a personal and professional level helps to maintain connections and make sure you have a life outside of your profession. Many consider the medical field to be a lifestyle, and in many ways it is, but there is still room for your own personal lifestyle if you manage your time effectively.

The Key to a Successful Match Could be in Networking

Networking is communication among people in a similar profession or interest typically in an informal setting. It is networking that lets people become interesting because of its casual tone. If you want to avoid being passed by as “just another applicant” for a residency slot, you need to engage in networking.

It can be difficult to network as a foreign medical graduate (FMG), which is why you need to pursue every opportunity for meeting residency staff and faculty.

5 Ways to Network

Conventions

One great way to get to know people in residency programs you are seeking is to go to conferences. Bring business cards and get out there and mingle. MDlinx.com is a great place to find conferences that cater to the specialties in which you are interested. After you network, follow up with the people you meet. If you are in their area, visit the hospital. Ask a faculty member if they wouldn’t mind giving you a quick tour. If you do this professionally, they will remember you, and you may have moved your way up their rank order list.

Away Rotations

If you can find an away rotation at a place where you’d like to stay long-term, this is a great way to become a shoo-in for a residency program. This gives the program faculty a chance to get to know you and know whether or not they think you are a good fit. This does make away rotations a bit risky, but if you are a good fit, this should elevate your status when it comes time for a match.

Connections

As a FMG, you may not have a lot of family in the area, but surely you have some friends and other connections. Make sure you scour your contact list for connections with residencies, and then talk to those people. You may be able to meet a residency program member in a casual setting prior to having your application reviewed. This may get you an interview.

Current Residents

There is nothing wrong with reaching out to current residents. After all, you may be working with them in the future. Hang out with them, and find out what they think of the program. If you befriend some of the residents, they will put in a good word. Remember, everyone that works for the residency program has some influence over whether or not you are considered for the residency. Whether it’s a physician or a file clerk, use your connections to make yourself stand out.

Letter of Intent

If you’ve already interviewed, and you know you’d be a good fit for the residency program, you may want to send a letter of intent. This lets the program know that you are very interested in pursuing their residency and that they’ll be on your rank order list. There are varying opinions on whether or not this will move you up on their rank order list, but the overall consensus is that it won’t do any harm. Basically, if you weren’t being considered, it probably won’t change that. But if you were being considered, it could move you up on the list.

Selling Yourself

Networking is a big part of a successful match, but it can be done in the wrong way. Don’t be pushy, unprofessional, or desperate. This is not the way to sell yourself. Instead, be genuine and show true interest. Don’t be afraid to boast about specific research or clinical experience that makes you a great candidate. Don’t be braggadocios, but be proud of your accomplishments. Highlight the things you have done, and don’t let test scores hold you back. Even if a residency “requires” a certain score, they will make an exception for a candidate who is likable and whom they could see working with in the future.

Getting Over Nerves

If networking makes you feel stressed, you are not alone, but you need to practice. Talk with your friends about your accomplishments and get over any reservations you have about selling yourself. Then, move on to people you don’t know as well. You need to be confident when you meet residency faculty whether this meeting is at a conference, at a café, or during an official interview.

Is it too late?

If you are already in the Match, there aren’t likely to be conferences with residency program directors in attendance because they are very busy looking through applications and making their own rank order lists. However, it’s not too late to engage in other networking methods. The biggest thing to remember is that you need to stand out among a pool of applicants with a similar background. The best way to stand out is to meet people outside of the work setting, so they can see you as a real person who would make a good team member, and not just another applicant.

Foreign Medical Graduates Filling Primary Care Gap

There is a primary care provider shortage in the United States that is only growing as elderly and obese populations grow and increase demands on the medical community. Much of their treatment involves a heavy concentration on family or internal medicine to help patients adhere to effective health maintenance strategies. Yet, most U.S. medical graduates seek careers in sub-specialty medical fields where the pay is higher, and the paperwork is less.

While it is understandable to want a higher paying career with less paperwork, primary care physicians are not low income workers. The average income of a primary care physician in the United States is over $200,000 per year. Primary care workers also get the advantage of knowing their patients, and they get to take part in the continuance of care where real results often take place. Their place in the medical community is essential for all populations, and primary care doctors should be proud of their role in society.

Opportunity for FMGs

The current predicament of low numbers of U.S. Medical Graduates seeking primary care positions is an opportunity for Foreign Medical Graduates (FMGs). The number of family medicine positions available, for example, has increased each year since 2008. However, the amount of U.S. Medical Graduates seeking those positions has remained stable. This means that there are more available family practice positions, but U.S. Medical Graduates are not filling them.

Foreign Medical Graduates frequently struggle to get into residency programs during the Match. This is hopefully becoming less common, as the nation (and program directors) realizes the advantage of adding physicians who have been trained abroad to the mix of U.S. health care providers. However, it is still a struggle.

A lot of this struggle has to do with the unknown, and different areas of the world have different requirements and different demands for excellence. The Educational Commission for Foreign Medical Graduates (ECFMG) tries to alleviate the number of unknowns by using its own set of credentials including requiring that medical schools belong to a list of accepted schools. However, there is still a bit of uncertainty about exactly how one country’s approach to medical education compares to the United States’ approach.

There is also a want to give opportunities to medical students who received their education within the United States in an effort to better the country’s resources. If U.S. Medical Graduates aren’t seeking primary care professions, this ability to give opportunity will have to be shifted to FMGs.

Rural and Underserved Regions

One of the biggest challenges to providing primary care to all individuals within the U.S. is getting care to those who are in rural or otherwise underserved areas. Physicians who specialize are often in or near the city. There are also a lot of primary care providers who live or work in the city. This leaves little care for those who live in rural and underserved areas.

What does this mean for FMGs? It means the ability to start your own rural healthcare practice with little competition. It means being on a first-name basis with most of your patients. It also means having time to care for your patients and not having to run them through your exams like they are cogs on a wheel. Rural healthcare has lost its appeal for many entering the healthcare field who want the chaotic urban healthcare environment, but there are many benefits to rural healthcare that are taken for granted.

Choosing Primary Care During the Match

If you are a FMG with dreams of a particular sub-specialty, you should follow your heart and your brain. However, if you think providing care in a rural area, or providing general care to the public, is within your realm of happiness, opt for primary care. Not only do you have a better chance of getting into a residency because of the larger number of slots available for FMGs, but you would be filling a gap in the U.S. Healthcare System that is badly needed to be filled.

What about pay and paperwork?

The average pay for a physician in a rural area is enough to support a very comfortable lifestyle, pay off student loans, and save for retirement. Rural areas of the U.S. generally have lesser living expenses, so average physician salaries amount to higher amounts when all things are considered.

As far as paperwork, EHRs have made data entry a requirement for the job, and primary care providers seem to have to highest amount of information to enter because all body systems are involved in the primary care wheelhouse. There isn’t much that can be done about this chore, but hopefully the act of caring for a patient in his or her entirety makes up for the paperwork somewhat.

In many cases, the occupation of a primary care giver is what made medical graduates choose their profession in the first place. You will know your patients, and they will depend on you in order to take care of their medical needs.

The Misguided Importance of the USMLE Score

Most people would agree that one test score does not declare the success of a physician, but for medical graduates applying for residency, it can mean a successful Match. The average number of residency applications per applicant has increased from 79 to 91, and according to the Association of American Medical Colleges (AAMC), residency programs may receive 1,000 applications for only a handful of residency slots. They have to sift through these candidates somehow, so test scores receive an elevated importance.

Sifting Through Scores

Instead of looking at each candidate as a whole, residency programs cull program applicants by eliminating those with low test scores and only considering those with scores well above passing. The result is that quality applicants may be removed from applicant pools based on a number instead of more important skills that can be understood through experience and in-person interviews.

A Necessary Evil

This year, the Invitational Conference on USMLE Scoring (InCUS) convened and discussed ways to improve the USMLE. One of the recommendations they created was to make USMLE Step 1 pass/fail. Another idea was further examination of the reliability of USMLE scores in predicting residency success. Lastly, the conference sought to find ways to address racial disparities in test scores, as white students statistically have higher test scores than any other demographic.

Ultimately, there was no solution that eliminated the value of a real test score. In order to handle the number of applications, program directors have to eliminate candidates by some quantifiable measurement regardless of talented physicians who score poorly on the USMLE exam.

Negative Impacts of USMLE Now

There are other negative impacts of the USMLE besides removing otherwise talented physicians from applicant pools. The biggest one is mental health. USMLE test takers suffer insurmountable stress because of the importance placed on test scores during the Match process. If you are currently getting ready for the Match, you have already suffered this predicament. The score predicts your future success, and placing that importance on ONE TEST creates a level of stress that is difficult to pile on the stress of the Match process and the future of a medical career.

This is the type of stress that causes medical students, residents, and physicians to burnout, which is why there are efforts to change the test to possibly pass-fail or something that would reduce mental health issues and increase equitable acceptance into residency programs.

Accepting the Way It Is…For Now

Right now, medical students don’t have a choice when it comes to the importance placed on USMLE scores. If you score poorly, you can retake the test up to six times. This may not reduce stress, and it takes time to wait for another test to be available, but at least one bad test score does not have to equate to the end of your medical endeavors.

The only other thing you can do is make sure that a lackluster score on the USMLE test is met with exemplary training, volunteer experiences, and excellent interviewing skills. If your scores qualify you to get into a program, you’re going to have to shine the get an interview. A little pre-planning by volunteering or being an intern at locations that are top picks for your residency applications can also help you to stand out above the rest.

Especially for FMGs, USMLE scores are very important because FMGs are considered a little bit of an unknown due to different education systems. The Educational Commission for Foreign Medical Graduates (ECFMG) has done its best to ensure that only quality medical graduates are accepted by U.S. medical residencies, but it is not infallible. Program directors may have biases against foreign applicants, so high USMLE scores ensure that you won’t be automatically dismissed for a U.S. medical graduate who has known medical training.

Preserving Mental Health

Hopefully, the future of USMLE testing will result in the best applicants being accepted for quality residency programs and promoting the best results for the healthcare system. Until then, we work with what we’ve got, which means USMLE scores are very important.

USMLE Step 1 and 2 should be completed before applying for residency programs through the Match. If you want to shine a little more, consider taking step 3 as soon as possible. This will give further confidence to residency program directors that you’re a good fit for their program.

Other than that, you can preserve your mental health with proper diet, exercise, and sleep regulation to ensure that your body and mind are in as good of shape as possible to handle the demands of the exams.

It May be Misguided, But it is Important

Suggesting that the USMLE exams should be pass/fail does not diminish the importance of these exams. The ability to pass this three-step test does determine to a certain extent whether or not you have learned the skills required to practice medicine competently in the United States. Until the format is changed to one that more accurately represents medical knowledge and skill, your score will remain an important part of the Match process.

6 Prejudices All Medical Graduates Must Avoid

Having a certain attitude about a group of people grounded on assumptions and preconceived notions of reality based in fiction has a negative impact on the quality of care given by medical professionals. Foreign Medical Graduates (FMGs) are very familiar with receiving prejudice. They face it during their residency match, during training, and by patients and colleagues. They are criticized because they are unknown, and these prejudices affect their medical training experience. However, FMGs are not immune to having their own prejudices. Each physician, no matter where he or she went to medical school, must make a concerted effort to avoid common prejudices toward patients. In this way, you can ensure you are giving equitable care to all human beings.

6 Prejudices All Medical Graduates Must Avoid

Weight Prejudice

An August 2019 article from Medical News Today notes that physicians may be prone to unfairly judging patients based on their weight. It told of a study where medical students used obesity simulation suits to appear like a diabetic patient with a body mass index of over 30. Researchers performed an Anti-Fat Attitudes Test (AFAT) to measure prejudice. The test was a 5-point Likert scale to rate statements about obesity. The statements blamed people for being fat, denied genetic variables, and linked obesity to laziness. Students reported that the suit enabled normal stereotyping of obese individuals. Females were stereotyped more than males, and previous research has shown that these attitudes make physicians less likely to pursue alternative treatments to weight loss. This could greatly reduce efficacy of treatments for obesity where depression or other health conditions were the root causes of obesity.

Sexuality Prejudice

According to Flórez-Salamanca et al., there are negative health outcomes for homosexual people due to feelings of discomfort, communication problems, and the inability to develop a positive alliance between a provider and patient (2014). These authors also pointed out that homosexual people received unequal and lesser quality care. They recommend identifying these prejudices as a first step in eliminating them. Logically, it can be assumed that this would apply to all non-heterosexual preferences.

Age Prejudice

Geriatric medical practice comes with its own set of challenges, and the elderly may have multiple morbidities that require complex treatment in an environment of poor understanding and compliance. However, not every elderly person has the same level of ailments, and those in the community may function as well as young adults. In either case, it is important to have compassion for those suffering from cognitive decline while also acknowledging that age does not automatically equate to cognitive decline. One of the very apparent results of this is under-treatment of geriatric patients because of an acceptance that their decline is inescapable.

Cultural Prejudice

Foreign medical graduates come from different cultures and may face cultural prejudices every day, but they cannot extend those to their patients without risk of compromising care. The goals of medical outcomes for people from different cultures may differ from patient to patient, and this must be acknowledged by physicians in order for those outcomes to be positive. Additionally, the customs and etiquette of different cultures must be understood in order to properly communicate and come to a treatment that will be effective and the patient will understand.

Education Prejudice

Education prejudice may cause a physician to dumb down language to a level that is insulting to a well-read patient. It may also be insulting to use elevated language in a way that offends the person with lesser vocabulary. Both of these situations can be frustrating and cause prejudice. A physician may feel that a person will not be inclined to comply with treatment if they view them as “lazy enough” or “dumb enough” to have not pursued education. Instead, physicians should try to see all people in a manner that requires “effective” communication instead of viewing it as substandard or elevated.

Poverty Prejudice

Lastly, medical graduates may feel prejudice toward people who come from impoverished backgrounds, and they may not elevate treatment options like they would for a patient with private insurance who seems affluent. Sometimes, these treatment options need to be removed from the table since insurance nor the patient may be able to cover them, but they should still be considered as options until financial barriers are confirmed by the patient. Patients with less resources are no less worthy of care, and physicians must make sure they do not practice medicine with this prejudice clouding their judgement.

Prejudice Isn’t Always Known

Many physicians get involved in medicine simply because they want to help people, and these altruistic purposes do not coincide with prejudice. However, prejudice may be unknown and stem from environments where one was raised or exposures one has had to particular communities. The first step in eliminating their impact on medical outcomes is to identify them, and these six prejudices are common even among the most well-intentioned physicians.

Author: Brent Hermansen