getting deep work done
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[00:00:00] Hello and welcome to the Academic Medicine Strategy Podcast. If you have been able to lay it, listen to our last couple episodes. We're talking about time management and we've been talking about three different kinds of work that we work on. So reactive work, which is a lot of the stuff we do every day that's more urgent.
Collaborative work, which is the things we do with other folks, and deep work, which is what I wanna talk about today because I wanna talk about how to actually make deep work happen. And if it only happens ever after everything else, it will never happen. So let's come up with a plan if you want this year to look different than last year.
If you want to feel like you've really moved your career forward, this is the way to do it. Set aside the time to get your deep work done, and then also recognize the mindset shift that needs to come. Many of us are kicking ourselves because we didn't get the grant done or the paper done, or like it's a self.
It's, a discipline problem or I'm just not a good enough [00:01:00] person, or I haven't figured out how to do this stuff. It is not because you are a bad person or you don't have discipline. You are be kind, be behind. 'cause the structure of your week was never designed to protect the work that actually moves your career forward.
And a lot of that is because academic medicine is a clinical job and it is not designed for most of us to move our career forward. We have to be intentional in order for that to happen, and we have to take advantage of things like academic time, as promotion time, as the time to work on the things that we care about.
Now this distinction matters more than most academic physicians realize, because the fix to a discipline problem is willpower. The fix to a structural problem is redesigned, and this is a structural problem.
So this isn't about, I wasn't good enough. I couldn't make it happen. This is about restructuring your time. And until you do it correctly, you are gonna feel like you're stuck and you're not productive, and you don't have the willpower and you need more time. You need to find the time. Nobody [00:02:00] finds the time.
Al Newport, who's a computer science professor at Georgetown, and the author of the book, deep Work Rules for Focus Success in a Distracted World makes an argument that lands with particular force for me and many in academic medicine. And it is that intensive distraction-free focus on cognitively demanding tasks.
IE Everything that moves our career forward is increasingly rare. And increasingly valuable. And I'm gonna tell you, and none of you needed me to tell you that you already know. It's hard to find that time, and it's useful when you find it. But the ones who do the best are the ones who protect it consistently, intentionally.
Don't let it get displaced by those reactive demands. Or else years down the road, you're gonna be looking at your cv, trying to figure out, why isn't my hard work reflected here? Why doesn't the promotion committee think I deserve this? I've been working my butt off. You have been. You just need to do it in the right place, and you need to build the [00:03:00] architecture.
Now, I know I've mentioned it before, but not all work time is equal, and that is the foundational insight. When you talk about Cal Newport, he builds his entire framework around this. And this is one that we ignore most of the time. In academic medicine, our schedules are not designed around this. He contrasts deep and shallow work, so he talks about the stuff that's logistically necessary, but cognitively undemanding tasks that fill almost every academic calendar.
This is responding to the results, responding to the emails, responding to the patient calls, and in our week, shallow work is everywhere. It's standing meetings, it's administrative documentation. It's everything that feels at least implicitly urgent, even if it's not been told to be absolutely urgent. And we're not saying it's unimportant, but it may not be something that needs to be on your plate.
And it consumes most of the hours that could be deep work or scholarship. Now, deep work in his system is defined as [00:04:00] professional activity performed in a state of distraction free concentration that pushes cognitive capabilities to the limit. So that's writing a manuscript, writing a grant, doing your data analysis, thinking through a study, analyzing that complex data, writing a curriculum.
Creating the work that's gonna help your trainees learn. These are the things that create a career, that tell your story that are your niche, but they cannot happen, at least not nearly as easily if you do them in fragments. So the research on cognitive performance is unambiguous. Every time you shift attention to check an email, to check a message, to look at the results, to answer the door.
Or you glance even at a notification, you introduce almost 10 minutes before your brain regains that full focus. And in fact, some studies say it's up to 23 minutes, which is crazy. So that means if you use scattered 15 minute blocks between meetings, [00:05:00] most of us are not even getting into flow until we have five minutes left, and that is hard to accomplish.
That makes 'em, quite honestly, mostly functionally useless. In order for us to do deep work, quite honestly, this might be better time to say, I'll do the reactive work. Now I'm gonna look at the results or the email or the page, which we can't really get away from. But if you spend that entire window trying to get back in focus, it's really not that useful.
So Newport's formula is this high quality work produced equals the time spent multiplied by our intensity of focus. So if we have intense focus with lots of time, high quality work, right? That makes sense. Time without intensity, shallow output, intensity without time actually produces nothing. Complete partial stuff, this is where I get stuck.
Honestly, both burials rules have to be protected. The intensity of the time and the time itself. [00:06:00] So that's a structural requirement, not a personal discipline challenge. That is something that we need to build into our work, into our day, into our lives. And in a 2019 study in academic medicine, they found that faculty who reported unclear role expectations were more likely to experience burnout and consider leaving academic medicine within two years independent of the total number of hours they worked.
So the problem is not volume, it's structural ambiguity about what work actually matters and having the time to do it. I don't need to tell anybody what reactive calendars look like. Most of us know we have clinic, we have meetings, we have to check our email. We look at administrative stuff. There's results that we have to figure out, and whatever little time matters and is left is what we put towards scholarship.
Now, Newport calls this operating from the principle of least resistance. That makes sense, right? It's easy to do that stuff because it's all right in front of us and it looks urgent. And in the absence of clear feedback about what matters. People default to doing the easiest thing, running your life outta your inbox, running it out [00:07:00] of your EMR, finishing the clinical stuff.
But in academic medicine, that principle is turbocharged by a culture that equates busyness with productivity. We are all busy all the time. There is no lack of work to be done and no lack of reactive work, especially attending every meeting feels collegial, responding to everything immediately feels responsible.
Keeping inbox zero feels efficient, but Newport calls this busyness a proxy for productivity and the clear absence of indications of what it means to be valuable. People turn to this industrial substitute, which is visible. The results feel like hard work, but your CV will tell a different story. There is no promotion there.
Even for those of us who are interested in clinical advancement who are on a clinical track, there needs to be some scholarship to show the clinical work that we're doing or the clinic that we're developing or the outcomes that we're following to show the clinical work is useful and the cost in academic is serious and specific.
[00:08:00] The work that gets perpetually displaced is the stuff that gets us promoted research. Manuscripts presentations, curriculum. I realized that was five, not four, but not RBU's, not collections, not committee attendance. Inbox responsiveness does not equal promotion, and so a contribution cannot be built reactively a few minutes at a time, and i'm really gonna encourage you to protect and develop that deep work. Deep work intentionally. I'm gonna give you one more study in 2012. In academic medicine, again, they documented that a majority of faculty across US medical schools reported feeling institutional values were misaligned with their own goals, promotion criteria.
Opacity cited as a leading driver of disengagement, meaning they didn't really understand what they were supposed to accomplish, and they thought all this busy work they were doing, especially in the clinical tract equaled promotion. The criteria existed. They didn't get a lot of time or direction to look at that criteria, and translation [00:09:00] did not actually move into protected daily time.
Now, Newport identified four scheduling philosophies for protecting your deep work, and one of them is the monastic approach, getting rid of shallow obligations entirely. This is super unrealistic. This is like a sabbatical. Most of us don't have those in academic medicine, but if you do, this can be really valuable.
And he showed it's really useful. Now the other is something called the journalistic approach, and it's where you fit things in reactively, wherever possible. So if you are the person who can spend 15 minutes at a time and write your paper and get your paper, you know your research done and do data analysis, then that may be fantastic for you.
But again, most of us are not very successful at this journalistic approach. And as the day moves on, especially by the afternoon, we're so tired and we have so much decision fatigue, it doesn't work great for most of us. So the two that are most viable are bimodal and rhythmic. So bimodal means dedicating specific days or half days entirely to deep work.
This may be your [00:10:00] administrative half day, and it might happen once a week, once a month, once, hopefully not once every two months, but wherever it happens. Treating that way like it's a clinic or an OR block, so it is blocked in advance. It's just defended against the inclusion of anything that's not that deep work and it's non-negotiable unless there's a genuine emergency.
Now the other approach is the rhythmic approach, and in that rhythmic scheduling, you take a deep habit. At a fixed time. So maybe every day at 6:00 AM I'm gonna do my deep work and I'm gonna spend an hour and do it. So rhythmic is consistent. Regular bimodal is certain times every week, every other week that I'm gonna take bigger blocks and try and get those things done.
But either approach requires time blocking scheduling every hour of the day is what he recommends in advance and assigning activities to each block. And honestly, this sounds crazy to some people, but this is clinic, this is, or this is meetings. All you're doing is adding an [00:11:00] intentional block for the deep work.
It is not micromanagement, but it is the way to move your career forward. And it is a structural decision that you need to make proactively and then tell the people around you that it needs to be held sa sacred so that it's not given. So in our work or world, it might be deep work during your cognitive hours and for many of it's in the morning, sometimes it's earlier than you wanna go in.
Or if you have obligations in the morning, maybe it's the first hour or two that you're there, but two to three hours in the morning, once a week, once a month, whenever you have time labeled specifically, don't write research time. People will steal that. But draft results section for sleep outcomes manuscript or develop specific aim for R one or.
Put whatever on there that you need to so that people won't take it. And more importantly, tell the administrative people, this is non-negotiable. I'm not gonna be answering my phone. If you're on call, do it. But if you're not on call, I'm not gonna be answering my phone. I'm not gonna be looking at my notifications and be specific for yourself, so you make sure you get the right thing [00:12:00] done.
And then batch collaborative time into the afternoons, if you can try and batch 'em together. Maybe have a lab meeting if you can try and do all of them together, or a department divisional meeting so that everybody can work on theirs together, especially when there's a lot of collaboration between colleagues and then that shallow work.
Should be contained to designated windows and or put in those times between cases or at the last half an hour of lunch. But try and do some specific Windows. Newport recommends processing email twice a day at six times and closing it entirely outside those windows. I will tell you, I actually do this for the most part.
I have three windows and I find it really useful. I just tell people if they actually need me in real time, don't use email. Newport also recommends what he calls productive meditation. So using physically occupied but mentally free time. Commuting, exercising, walking between buildings to work through a specific scholarly problem.
I'm gonna tell you, when I was a medical student, I used to go running and I would actually visualize anatomy while I ran. I actually used a time, it worked great actually. [00:13:00] And so even now when I'm driving, I'll be talking to chat TBT and working on a chapter of my book or when I'm. Going between places I am talking or thinking through a problem, and this extends your deep thinking beyond formal blocks without requiring a lot of additional hours and regains time.
That would oftentimes just be scrolling or something that's not useful. A constraint is that it usually requires a defined problem to work on, not some vague rumination. So have something in mind during that deep work or just plan for it at the beginning of the day. So before you leave your desk name, the question you're gonna work on while you're walking.
And then finally, Newport argues what he calls the shutdown ritual. And this is honestly where I need more work. But defining the end of your workday, and that might be reviewing the open tasks, looking at your schedule for tomorrow, making sure that there's nothing urgent from today was unaddressed. Take a quick look at your email box or review your results.
Confirm nothing urgent is unaddressed, and then genuinely stop. And its [00:14:00] purpose is psychological. Incomplete tasks often fill up our bandwidth. We ruminate on and we think about them. And so when there's infa work, we wanna make sure we've cleared it. It's okay, it's not urgent. I don't have to work on this today, this will be tomorrow. And that shutdown ritual closes those loops so that you protect some of your recovery time.
I know for me what I do is I actually go over, 'cause I work outta my house a lot and I work on a puzzle. And it just turns my brain off just a little bit. But for academic physicians who carry work constantly, practice is less about leaving the office and more about establishing a mental boundary that makes sustained focus possible in other times.
Now, a 2021 article in JAMA Network Open found that among physicians who left academic positions, the majority lacked, cited a lack of autonomy and inability to pursue meaningful work. It wasn't about the compensation, it was about the ability to actually take the time and use it in a way that you cared about.
So I want you also remember, retaining our colleagues and our faculty is a structural problem before it's our financial one. So what [00:15:00] does thinking differently look like now? Newport's own experience in academics is instructive. He said that his research productivity quadrupled when he refined his ability to work deeply.
That is an amazing game. I don't know that I could say a mine. Actually, I could say the same thing when I went from three or four papers a year to 12 to 20, it was the same impact, and it was really just saying that this is sacrosanct time. So what I want you to do to try and accomplish this is do some reorientation.
I want you to audit before you optimize. Spend one week tracking not just what you did, but the category of work. It served reactive, collaborative deep. And then also is it clinical administrative teaching scholarship service. Most of us are surprised about how little of our time is actually spent Talk, touching the work that drives promotion.
Then name your niche, name your scholarly thread. Tell me your story. What do you wanna be known for? Promotion committees evaluate coherence, not volume. So you should be able to say I did this, and it led to [00:16:00] this, and it led to that. So this is the arc of me working in this one area. Focused identity is a structural prerequisite for that deep work.
You cannot protect time in a very constructive way unless you know what you're working towards. And then negotiate the protection, not just the time. Meaning make sure people know not to interrupt you, not to ping you not to walk in, not to knock on the door. Closed door means I really need the time to get work done and measure the lead indicator rather than optimizing for lagging measures like publication count or tracking.
Those kinds of things. Track the lead measure. How many hours did I spend in uninterrupted deep work this week? Publications will follow, but you wanna start with is really looking at, did I protect the time? So here's some things to sit with. When's the last time you had two uninterrupted hours for your most important scholarly work?
And. Can you tell everyone what your most important scholarly work is? In one phrase, if it didn't work the way you wanted to, what can you change about this coming week or in three or four weeks when your schedule's a little bit more [00:17:00] open so that you can treat the deep work the way you treat your clinical time?
And are you measuring your scholarly productivity by hours spent in genuine deep work or just how busy and responsive you are? The career you're building requires a calendar design to build it. The calendar does not appear on its own. And you have the opportunity to change it. This is a structural problem that requires institutional solutions.
So for chairs and deans, please schedule a faculty retention initiative call so that we can talk about how to implement these frameworks department wide, or go to my [email protected] faculty, please request that your institution provides systematic career development support. Individual coaching is available for those without support and please share this with friends or colleagues if you found it useful, and rate and review because we absolutely appreciate getting the word out.
Thank you so much. I look forward to talking to you next week.
