Fitter, Happier, More Productive
Productivity is great, right? I mean who doesn’t want to be more productive. Productivity means you are doing things, often important things. And getting things done is what we do. Society needs people buzzing around doing stuff to keep the hive running smoothly. Idle hands are the Devils work after all.
We get into trouble though, when productivity becomes the end goal instead of the means to achieve something. I have noticed this in the field of medicine. I’ve been an MD almost 20 years now, and I’ve seen this cult of productivity infiltrate the ranks. At first I thought it was just my burnout and cynicism distorting my perception. But after a couple of conversations with a few docs I know from around the country in different specialties and styles of practice, I know it to be true. Productivity is the new deity of the medical industrial complex. We all worship and pay homage.
In the Beginning…
Once upon a time all that mattered in medicine was doing good work. People were cared for, a living was made, and all was well (not really, but let me have my fairy tale reality). As time went on, efficiency and productivity became more important. It was no longer sufficient to just do good work; you had to get faster and more efficient at it. I suspect there are correlates in other professions.
Some of this was survival, as the friction of practicing medicine increased and payroll needed to be met. As well intended but meaningless regulations were added, so was the cost of doing business. More of the health care dollar was needed to comply with the new rules, and we started spending more resources to measure success and less actually providing medical care.
A friend lamented that new hires in his group were valued more for their RVU production than the actual global value they provided for the practice and community at large. At times, I’ve seen shades of this as well. The non-reimbursable work is just not valued as much, although in some respects it is more valuable. The problem with this shift is humans have a need to feel valued. When truly valuable but difficult to measure work is not appreciated, people will eventually stop doing it. Incentives matter.
Meet the Bobs*
Another friend of mine told me a story about how her group hired an outside consultant to analyze their practice and provide recommendations (consultants live and breathe efficiency). The group was around the 30th percentile for RVU production and this was quite distressing to them. After all, how the hell could they be below average? (Answer: Not everyone can be above average. It is statistically impossible outside of Lake Wobegon).
What no one considered was the fact that this group had more vacation time and a shorter than average workday. It was unknown if the more efficient groups were much larger or had physician extenders to offload work. The data was compiled from voluntary surveys that groups submitted which introduces selection bias into the mix in a dangerous way.
In other words: Who knows what being 30th percentile actually means.
But the most important question of all was this: Who the heck cares?
It’s not a competition. Before the consultation people were generally satisfied with the workload and the paycheck. After the consultation people were beside themselves with grief. Nothing changed except they had now joined the cult and drank the consultants Kool-Aid.
It’s difficult to say no. We all like to think we would never join cult because we are smarter than everyone else. Most people think they are less susceptible to cognitive bias than everyone else…which is actually a cognitive bias if you think about it.
Nobody wants to say no to efficiency. Why would they? What kind of lazy slacker wants to be less efficient? Now, some efficiency is a good thing. It allows you to do more with less. Efficiency is actually a principal I use for my life, but it is toxic in high doses. It is a tool that can be misused. Like any drug there is an effective dose that makes sense and improves our lives, but eventually there is no added benefit, and perhaps an added harm. The striving for more, better, faster eventually has negative consequences, but just like the frog who finds himself in the pot of boiling water, when the push for efficiency is slow and steady we don’t even notice its deleterious effects until it’s too late.
The cult of efficiency is just another crappy multiplayer game for us to play. There becomes a point where we are efficient enough; although often once we get there It is not satisfying. Kind of like the ending to this blog post…
*Perhaps the greatest movie of all time.