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Why Efficiency Expectations Harm Physician Well-being

Why Physicians Should Rethink the Idea of Efficiency

When founding Physicians Angels, Dr. Afser Shariff believed that Virtual Scribes could add more “slack” back into the busy schedules of physicians. And, according to a recent article by Farnam Street, that’s a goal worth striving for.

As documentation demands reach an all-time high and burnout continues to tighten its grip on the healthcare industry, momentum is building for the notion that doctors need time to “slack” to be effective.

What exactly is slack? And more importantly, why is it so important that physicians prioritize it? The idea of “slack” was introduced 20 years ago by Tom DeMarco, author of Slack: Getting Past Burnout, Busywork, and the Myth of Total Efficiency.

DeMarco defines slack as, “The degree of freedom required to effect change.”

In other words, slack is breathing room. It’s the space we often mindlessly fill just to avoid sitting still. It’s giving ourselves the permission to just be. To think. To reset. To remember why we started.

As the Farnam Street article explains, “There’s a good chance most of the problems in your life and work come down to insufficient slack. If you ever find yourself stressed, overwhelmed, sinking into stasis despite wanting change, or frustrated when you can’t respond to new opportunities, you need more slack in your life.”

Physicians Bear the Brunt of Burnout

While every profession could benefit from some additional slack, it’s undeniable that the plates of clinicians today are packed to the brim. With the current weight of the physician’s workplace and the deterioration of their work-life balance, it’s no wonder that burnout is tightening its grip on the medical industry.

But what about productivity? In his book, Demarco adds that, “Slack is the natural enemy of efficiency and efficiency is the natural enemy of slack.” This sounds like a negative, until you dig a little deeper.

Doctors who are using their valuable time to do their own charting are only "efficient" on the surface. In the end, the energy that they put towards documentation and paperwork consumes all of their time—leading to less efficiency and more stress down the road. In other words, the short-term productivity gains you might think a doctor is giving you by doing their own charting are soon negated with longer-term burnout.

Productivity Isn’t Always Positive

Somewhere along the way, we’ve conditioned ourselves to believe that if our days aren’t 100% productive, we’ve failed. Our society has come to believe that busier equals better—but as the Farnam Street article explains, this notion is not only incorrect, it’s unhealthy.

“As individuals, many of us are also obsessed with the mirage of total efficiency,” the article continues. “We schedule every minute of our day, pride ourselves on forgoing breaks, and berate ourselves for the slightest moment of distraction. We view sleep, sickness, and burnout as unwelcome weaknesses and idolize those who never seem to succumb to them. This view, however, fails to recognize that efficiency and effectiveness are not the same thing.”

Because the idea of efficiency has become so glorified, it can be difficult to recondition ourselves to think otherwise. Sharing the load among several well-qualified individuals doesn’t just benefit one employee—it impacts the entire office in the best possible way.

When an office runs like a well-oiled machine due to an appropriate amount of employee support, the positive downstream effects are massive. Quite often, the added slack that each employee experiences as a result can mean the difference between burnout and a brighter outlook toward the future. Giving ourselves permission to think and live this way is the first step in taking down the toxic belief that busier automatically equals better.

For Physicians, There’s No Slack Without Support

In the Farnam Street article, the author paints a picture of a typical office environment, using fictional characters by the name of Tony, the boss, and Gloria, his secretary. He explains that while seeing the office in a flurry of activity would be expected in today’s day and age, the place is far from it.

Instead of frantically moving from task to task, Gloria is observed cleaning her desk and making small talk with employees from time to time. She’s working, and she’s doing what needs to be done, but she is far from overwhelmed and she certainly isn’t stressed. And why is that? Because the office has cut themselves some slack.

As the article explains, “Gloria does indeed do nothing much of the time. But every so often, a request, an instruction, or alert comes from Tony and she leaps into action. Any time she has a problem, she solves it right away. As a result, Tony’s day goes smoothly and efficiently. Every minute of his time goes on the most important part of his work—making decisions—and not dealing with trivial inconveniences like waiting in line at the post office.”

Much like in this example, today’s clinics are in desperate need of creating some slack to run more smoothly. Whether it’s hiring a Virtual Scribe to take care of their charting in real time or the addition of back office help (either via added staff or virtual support) to assist with insurance claims and medication requests, there are a myriad of ways in which a physician’s office can find some added slack.

With the right support system in place, the glorification of busy-for-busy’s-sake can become a distant memory. The spinning hamster wheel can slow down—or maybe even stop now and then. The workday can end when it’s supposed to again.

All it takes is a little slack.

Physicians Angels is the industry’s first Virtual Scribe company, providing real-time documentation directly into the physician’s EMR, along with Virtual Back Office services. Our services save the physician an average of 10 hours per week, thereby improving patient throughput and contributing to a better work/life balance for the physician and office staff. To learn more, visit or contact us.

About the author

Physicians Angels

More time for physicians to see more patients, provide better care, and live their lives. Physicians Angels provides one-of-a-kind EMR data management services to healthcare providers through our real time Virtual Scribe service.