A year into my own practice, doing everything I had been trained to do, and barely keeping my head above water. The medicine wasn’t the problem. It was everything else I didn’t know went into running a practice. I was stumbling through running a business.
Here’s what I learned. The answer was not working harder or more efficiently. I’d already mastered that. The answer was learning to run my practice differently. Little by little, I made changes that gave me my time back. My time, and with it, my life.
Years of small changes later, the “better” is possible. And I help other physicians get there too. But first, let me tell you how it started.
Lying in the dark, the mental 3am Rolodex was running. The leg wound from Tuesday. Remittances that needed to be submitted. Had anyone ordered printer paper? That patient’s eyelid I was worried about. The ink cartridges. Had the liquid nitrogen delivery for clinic on Thursday been sorted.
This was one year into practice. I was doing everything I had been trained to do, and I couldn’t keep my head above water.
So at 3am, I found myself desperately Googling things I’m a little embarrassed to admit now. Not the clinical stuff. The other stuff. How to get through a week without feeling like you were one dropped ball away from everything falling apart. How to be present and not frustrated at home. How to feel like you were doing enough.
What I found was advice that was too big and too vague. “Embrace technology.” “Get your systems in order.” Get my systems in order? I didn’t even know what systems existed, much less how to get them in order. And I certainly didn’t have the bandwidth to figure it out. Nothing I could do right now. Nothing that would make even a small difference in clinic tomorrow.
Then our group dynamics changed overnight. Another full practice got folded into mine and one other colleague’s. A practice that was already bursting at the seams. This meant taking on more patients, more fee-for-service dynamics, more admin tasks, with nothing changing about the hours in a day or the bandwidth I had left.
The 3am Rolodex became the 2am Rolodex. Weeks ticked on.
I’d sit down to dinner and find myself thinking about notes I still needed to finish. In the middle of a conversation, my mind would drift back to clinic, remembering the pile of insurance forms or wondering if something had slipped through the cracks. I was physically present. The rest of me was absent.
I was sprinting faster during the day and my mind was running longer at night. My patience wore thinner. Small frustrations lingered longer than they should have. I could feel the strain bleeding into the rest of my life.
I remember thinking:
What I really wanted was to have time and be present for my own life. I wanted to remember birthdays and anniversaries. I wanted to remember that a friend’s grandmother was sick and ask about her weeks later. I wanted the energy and interest to stay engaged with the people around me. I wanted to be someone others enjoyed being with.
As the admin work grew, the documentation piled up and the task list got longer, that version of myself got further away.
Listening to an audiobook on the drive to work, and I heard something that changed my life. It was just one question. And it stopped me so completely I had to pull over, rewind and listen to it three more times.
Not: what is the most efficient way? Yet, at the time, efficiency was the only language I knew. Like all of us who survived medical training, I was very good at being efficient.
Apparently what I wasn’t so good at was realizing just because I could do something, didn’t mean I should. Or that I should do all of it.
Like every day of residency and group project in school, it felt easier, faster, more efficient if I just did all the things myself.
Efficiency served me well. Until, I realized, it was now my downfall.
So I started small. I rewrote the patient instruction sheets so we were no longer fielding the same post-op calls over and over. I built more note templates to cut down my documentation time. I stopped being the person who tracked the liquid nitrogen, and I started being the person who gave clear guidelines to my team so they could manage the liquid nitrogen. So it was being done the way I wanted without being the one doing it.
In the beginning, I was getting seconds back. Then pretty soon, it was 15 minutes a day. Then 30. Then I experienced whole evenings where I never opened my EMR.
The first Sunday that passed without charting I didn’t know what to do with myself. The 3am Rolodex got shorter, then quieter, then mostly stopped. Even as volume went up, I was more present with patients, not less.
Slowly, the non-doctor parts of me started to come back. I talked to my parents without simultaneously reviewing notes, and our conversation went deeper than just superficial updates. I started showing up as a real partner, a daughter, a friend, and not just a physician who was a shell of a human.
I started to feel, for the first time in a long time, like I was becoming both: the doctor and the person I had always wanted to be.
All those years of training. All that delayed gratification. All that stress. It started to feel like it was all worth it.
If any part of this sounds familiar, you’ve felt the cost of a practice that runs you. The 3am Rolodex. The dropped balls. Never feeling like you’re doing enough. The version of yourself you’ll get to…one day. This is what I wish I found at 3am. This is Practice Rounds. Practical tools. Real conversations. The unglamorous, but life-changing work of building a practice that supports you as a physician, a person and a friend.
And that is the “better” we were promised.