My Year without Vacation
When I had the opportunity to take my first director job, I was very excited. It had been something I had been planning for my career and had been working toward as well.
My first director job
I was given a clinic and allowed to run it how I saw fit. I was lucky as well to have a boss that was semi hands off. He would give you direction but for the most part if your clinic was doing well you were free to run it as you please.
He was an extremely knowledgeable therapist and equally experienced in the business of therapy. He would implement things that he knew worked and passed them down to each of the directors. He gave you a direction and let you set off, only stepping in if you started to veer off course severely.
The successes
I felt that I could lead the clinic and make it even better than how I taken over it. I worked very hard and in the first few months the clinic saw a large growth in new patients which led to an increase in follow-up treatments.
I was also able to increase revenue per patient by making sure to bill appropriately and to maximize the patient’s visit. I built relationships with local doctors and quickly built a name for myself. Doctors would send patients directly to me and patients would search me out.
This was all I had dreamt of and worked so hard to achieve.
Things started happening for me as well. I was receiving recognition from upper management and the company as a whole. I put this small, single clinician clinic in the top 50 clinics in the company in several categories such as visit growth and revenue.
I received several awards both as a clinician and for the clinic for our work. One thing that was very nice was the bonuses that both I and the staff were receiving. My wife and I had our second daughter not long after I started this position so the extra money came in quite handy.
I was riding high and felt like I was on top of the therapy world - but I remember my receptionist saying to me one day, “when are you going to take a vacation?”
It seemed like a joke, maybe because of the tone she used or maybe because I was so focused on the job at hand. I thought, “I don’t have time to take off. I built this clinic up and I can’t step away or it will take longer to get it back.”
I continued hammering along but the more time that went by things started getting harder.
The hours
One of the first things that started getting to me was the hours. Initially I kept the clinic’s hours the same which was the first patient at 8:00 am and the last at 4:00 pm Monday through Thursday with an hour lunch at noon. On Friday the hours were shortened from 8:00 am to the last at 1:00 pm without any breaks. These hours were set by the original clinic director some 10 years before me and just continued through the next directors to me.
As the number of patients increased, I ran out of available slots with this schedule. I had a patient ask if they could come in early so they could avoid taking as much time off work. I agreed since I got to work well before then so I started offering a 7:30 am appointment twice a week just for this patient then adjusted my afternoon schedule for that same day so I would keep an 8 hour work day.
This worked out well initially, but then more people requested that 7:30 appointment so I changed our hours to start at 7:30 am every day. I could not keep adjusting my afternoon appointments so I left the last appointment at 4:00 pm.
Patients kept coming in and my last appointment at 4:00 became very popular to the point that up to 4 people were scheduled for it. Most of these patients were not actually able to get to the clinic on time due to either work or school and would be 15 to 20 minutes late.
I expanded the hours out to 4:30 just to ease that load and then eventually to 5:00 pm. There were days that I spent 10+ hours in the clinic doing everything from patient care, documentation, and my administrative duties.
The stress at home
The strain of these hours was being felt at home. I was getting in late almost every night and found such little time for myself and family. I had to fit in time to exercise, eat, sleep, and spend quality family time in just a few hours. I would rush home, change, go run, eat a reheated dinner, kiss the kids good night, unwind from the day, and then off to bed.
Every day was this same routine with my only breaks coming on the weekend. Now, I would take the occasional day off, but I filled it with work. I would visit doctor’s offices, finish paperwork, or go market.
My off day was still filled with some part of my job.
The stress at work
Another thing that started to happen was a little disdain from my colleagues. I was a newer director, so I know everyone was a little unsure about me. The other directors had all started with the company and worked their ways up to the director role, I was an outsider who was hired right into a role equal to theirs.
At first, they applauded me for what my clinic was doing, but then as time went by, it seemed like they started to get tired of hearing about me. I never did brag about what I was doing, I was doing what I felt was right to do.
This became more apparent as I got busier that no one was willing to help me. It seemed like they only wanted to take from me and when I asked for assistance, no one came to my aid. I was able to hire a PTA in my clinic due to the growth and about every other week some other clinic would request that she come fill in there. I would then ask the same thing from other clinics but I got excuses as to why no one was available.
The culmination
These things wore on me and I found myself more physically and mentally fatigued. My mental sharpness was not there which as a therapist you need when working with patients. I was not able to get patients better as quickly and more people plateaued.
At home, my runs were not as good and I started having more aches and pains. I would lie on the couch at night, just too tired to move.
I was extremely irritable to everyone around me, mainly to my wife and kids. I started to dread the next day and thought seriously of not only finding a new job, but a new career. That is when my boss spoke to me and I took some time to reflect on what I was doing.
He told me that he had done the same thing years before in his own practice. He would see patients for up to 12 hours a day, bearing the entire burden on himself. He passed down some advice to me which I will share shortly. I thought about what I was told along with some words that my last clinical instructor told me. I took a day and spent it in quiet reflection on everything that had happened and started changing things.
The lessons learned
Know your limits
This was something that I came up on my own as a combination of everything I had heard. At that time I was trying to do so much in my life both at work and at home, and both started to suffer.
I was spending 50+ hours a week in the clinic trying to see every patient that came in. I was spread too thin and some patients suffered.
I recognize that my strength is with orthopedic patients. I had been receiving orders for neurologic and vestibular patients and I felt the need to help them as well despite this area being outside of what I was comfortable seeing.
I will be the first to say that both of these areas are not strong areas for me. I have tried with these patients over the years and saw limited results. I could tell that I was frustrated, and so was the patient. I also was not able to dedicate the amount of time to these patients that they required due to the high volume of patients I was seeing.
Refer out when needed
Every patient deserves the best care possible and I knew that they would not receive it from me. I called local clinics and built relationships with them to have avenues to direct these patients. I told the receptionist and the scheduler that I am not going to see neurologic or vestibular patients going further.
I explained my rationale behind it and gave them places to direct these patients. Now if it was a special case, then call me and we can determine what would be best for this patient. I was able to narrow my patient population which I have seen an improvement in outcomes.
I then limited my time in the clinic. I removed the late appointment times and set boundaries on the schedule. I was only going to be available during set appointment times and I made sure to let everyone know exactly when they were.
I did this at home as well. I planned my exercise routines better and let my wife know what they were. I limited the races that I ran as well. I also stepped out of some roles that I had volunteered for previously. I found that this gave me more time at home.
Learn to say “no”
I know many people deal with this issue. When people find out that you are willing to do something, they believe you are willing to do everything. I felt that every patient who was sent to me deserved to be seen and I would be the one who bent over backwards for them.
I would double and sometimes triple book patients. I came in early or stayed late for them, called them to follow up, or provided extra material for them. I extended myself to other areas of my job by adding other areas to my requirements. I did not start by saying no to everything but rather spent some time reviewing what I was being asked.
If I was asked to see a patient I was not comfortable with, I would explain why I cannot see them but gave them options on who they could go to. I did have to say no to several patients because it would add too much to what I could handle at that time.
If I was asked to stay late or come early, I would review what was needed and not hesitate to decline if it placed an increased burden on my schedule.
At home, this was more difficult because so many people knew they could turn to me. I would decline offers or opportunities but made sure to explain that currently it was not a great time for me due to my schedule.
The biggest person to say no to was to me. I would find different things such as projects around the house or new things I wanted to do. I had to stop, take a moment and think it out.
How much time would it take? What would I need to give up? Do I really have the ability to do that right now? If I had to justify the answers to these questions then I declined the project. I am still continuing to work on this area because it is still easy to overextend myself.
Set a schedule
This applies to every area of life. In my clinic, I set schedules for patients’ appointments both for me and fellow staff members. I set schedules for when I was to do my administrative work, market, or perform my other job duties.
At home, I set schedules for how we get everyone ready in the morning, how I exercise, and how I spend my free time. By spending just a few minutes a day and a little extra time once or twice a month reviewing or setting up a schedule, I have been able to free up my available time. Having the schedule you will be able to see if you are available to take on any new project.
Find a hobby
This applies to all aspects of life. Having something to do outside of work and your regular duties gives you a chance to get a mental break. Things like exercising, playing an instrument, reading, writing, sewing, or drawing are just a few examples of things that you could do.
Coming home from work and giving this hobby a bit of your time is a way to escape and relieve stresses. I have found that running or working out are ways that I can get some time to myself to think about whatever I want. I come home feeling refreshed and revived.
Leave work at work
We all probably hear this but many may not understand what it exactly means. In today’s world of technology, we can easily access everything from the clinic from our home. I found myself doing notes, checking email, marketing, and performing all my administrative duties more and more at home on my time.
I felt that if I was not connected to the clinic at all times, everything would fall apart. What I started doing was leaving my phone in another room when I got home. That way I would not have the temptation to keep following up with my work duties.
I would also leave all notes in the clinic. If I did not get them finished, then I would have time the next day to get them done. I will say that since I started doing these things the clinic has not fallen apart and everything continues to run smoothly. I also admit that I still will occasionally access my work computer from home but it is only in certain cases such as weather causing a closure of the clinic.
Learn to delegate
I found myself bearing so much of the burden and work. I would not allow patients to be seen by any other therapist because I was afraid the care would not be adequate. I would try to tackle all my administrative duties as well without any help.
Even at home, I would not allow anyone to do things around the house because I had the mindset of “if you want it done right, you have to do it yourself.”
Letting go of that mindset freed me up and it also allows others to be empowered. The other therapists I work alongside will provide excellent care and if there are any questions they will come ask me.
My wife and I sat down at home and talked through different tasks around the house. We both agreed to look for help from the other to which we both found helped our home life.
Take a vacation
My last CI told me the story of how he was treating a lawyer early in his career. My CI said that at the time he was running his own clinic and working as an administrator in a hospital so he was working 60 hours a week and never took any time off.
The lawyer, who had since retired from practicing, told him that he was working 60 hours a week and never took any days off when he was working. He then would ask my CI if he had taken a vacation to which my CI would respond with “no.”
One day the lawyer told him, “Take a vacation because when you go on a vacation you will always have the memories with you but if you don’t then you’ll always wonder what if.” He took that to heart and would take time off each month for some sort of vacation.
That came to me in my reflection. I had not taken any real time away from the clinic. Any time I did take was filled with work activities both around the house and for my job. I would be busier on my off day than when I did have to work.
I told myself to step away which I do every 2-3 months and during that time I do not do anything work related and even limit myself on the projects at home. The home projects I try to take on one at a time. I work one to completion before starting on the next.
These changes did not happen overnight, because honestly that would have been too big of a shock to everything around me, but rather are gradual changes. By having these be gradual changes, they are more likely to stick and become habits.
I did not come in on a Monday morning, throw my old schedule out and take a vacation. I had to inform the staff of the planned changes and implemented a date of the change so that way everyone knew what was happening and when.
I happen to be married to someone who is nearly an expert in planning and scheduling so she has been helping me get my daily schedule taken care of. I did plan a short vacation for myself, or rather a staycation. I have found the stress level at both work and home has decreased since taking these steps.
My patients are doing better, my work is improved, and I am at home and engaged at home more often. If you happen to feel that you are in this same boat, take a break, step back and take a look at what is going on. You may need to make a few changes as well.
