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A Thousand Times No

Have you ever joked “I wish I didn’t have to sleep so I could get all this done”? Missed a deadline or personal event because you just had too much going on? Wondered if you’re burnt out?

Maybe you’re beyond that and you already KNOW you’re stretched too thin—your planner looks as chaotic as the staff lounge when there’s free food out, and you know you must cut back somewhere. All of us in medicine are good at time management and getting things done; it’s how we got here, after all. But we still have limits. Further, a lot of us, especially women, feel pressured to always be agreeable when approached with a new project, regardless of whether we have the time, energy, or even the desire to do it. In this article I will discuss my personal game plan for deciding how to allot limited time. As an undergraduate medical student who would ultimately choose to go into family medicine, I was, unsurprisingly, interested in many things. Over the first three years of medical school I became involved in many projects and leadership positions. I started to miss deadlines, perform lower-quality work, and spend less time doing things that made me happy outside of medicine. My usual pre-med strategy of “JUST DO ALL THE THINGS” wasn’t working for me anymore as a person on clinical rotations who also needed to eat regular meals and get a full night’s sleep most nights. I realized I needed a method to prioritize my commitments, and this is how I did .

Step 1: Be realistic with your schedule There is so much pressure to do it all: see our friends, sleep, volunteer, publish research, serve our communities, sit on committees, eat healthy, study, be leaders, mentor, exercise, pass whatever looming board exam there is, get accepted for whatever next thing we’re applying for. Each of these is a good thing—necessary, even—but there are only 24 hours in a day. At some point you have to prioritize how you will spend those hours, and no one else can do it for you. Everyone has unique needs and goals, and works at her own pace. One of my favorite quotes from Girl Med Live 2018 was Dr. Suzy Feigofsky (@DrSuzyFeigofsky) saying “Every time you say ‘yes’ to something, you are saying ‘no’ to something else.” This is the heart of why we must be intentional with how we prioritize our time.

Step 2: Know your values Some of the biggest contributors to burnout are feeling ineffective and conflicts between action and personal values (Maslach and Leiter, 2016). So, it stands to reason that tailoring our actions to keep them optimally in line with our values may minimize burnout. It’s also just a way to enjoy how you spend your daily life! Knowing your values serves as a screening tool to pick which commitments to agree to and which to step away from. Getting paid is a value. Serving a vulnerable patient population is a value. Building your professional network is a value. Being well-rested is a value. Is saying “yes” to this new thing more valuable to you than the thing you must then say “no” to?

It may not always be obvious what you would be saying “no” to, or it may not be so simple as to just look at your existing obligations like budgetary line items and cut one out to make room for an important new project. But take some time to think: how much of your time is actually unoccupied? If the answer is: not much, then something has to be removed to make time for whatever you’re thinking of adding.

The biggest issue is that oftentimes, the thing that gets axed is our own time for self-care. That project requiring the weekly morning meetings may mean you get less sleep, or that you miss your workout that day. This is why many people advocate specifically scheduling your personal time, like in this article from The Muse. Having it marked out makes it easier to protect yourself from being overbooked.

Of course we all have lives to live, and sacrifices will have to be made. It is key however to not let anyone else tell you what your values are, or worse,: what they “should” be. You can value helping others, maximizing self-care, anything! There is no right or wrong answer to the question: “what do I value?”. To explore my values, I ask myself these types of questions: what lights a fire for me? What do I feel glad about when I’m going home at the end of the day? What do I want to call my mom and tell her about when it’s going well?

Once I feel confident in what my values are, it becomes easier not only to find fulfillment in activities that work in line with my values, but also to bow out of activities that don’t.

Step 3: There’s going to be a chart, isn’t there…

Yes, there is.

The thing I love about this decision-making process is that it not only keeps me strategic when offered opportunities in medicine, it also keeps me in check when I get the idea to start a new project. Even if I am very passionate about a project, I can’t complete it well if I don’t have the energy, time, or head space for it. Sometimes this means putting things on hold until other projects are completed, or until I have more energy, and that’s ok. Give yourself permission to say no, and to say “yes, but…”. Give yourself permission to cultivate the environment you need for success, and to take total ownership of where your time goes.

When you need to prune as part of that environment cultivation, remember these wise words of Dr. Carmen Landrau (@DrLandrau) from Girl Med Live 2018: “no” is a complete sentence. You don’t have to explain a “no.” You don’t need to say “I’m sorry, this committee position doesn’t align as much with my values as the stuff I’m already doing.” If just declining and leaving it at that is uncomfortable, try taking the opportunity to give some professional sponsorship by suggesting someone else in your stead. Dr. Arghavan Salles (@Arghavan_Salles) offered me this gracious example: “Thank you so much for thinking of me for this opportunity. I unfortunately do not have the time to give this project the attention it deserves. Person X would be perfect for this, though, and I’d be happy to introduce you if you like.”

While it’s a nice problem to have to be choosing between more career opportunities and activities than you have time for, there are only 24 hours in a day and we have to narrow it down somehow. In this article I’ve outlined my personal strategy for deciding where to focus my time, based on this fundamental premise: time spent on things that align with your values is more fulfilling. By pruning out unfulfilling commitments that aren’t necessary--think taxes or returning that thing you got online that didn’t fit--, you leave more energy for the things that really light your fire and keep you feeling passionate about your work. Resources Maslach, C. & Leiter, M. (2016). Understanding the burnout experience: recent research and its implications for psychiatry. World Psychiatry, 15(2), 103-111.

For anonymous, free self-tests of burnout, stress level, and other measures of emotional well-being:

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