Physician Health

How to help physicians cut pajama time, have “more great days”

Tanya Albert Henry , Contributing News Writer

Melissa Reily MD, a rheumatologist at Bozeman Health Rheumatology Clinic, and AMA member Melissa Wolf, MD, an ob-gyn at Bozeman Health Women’s Specialists, became friends at a time in their careers when they were both experiencing some degree of burnout.

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That’s when they decided to find ways to change that for themselves at Bozeman Health in Montana, primarily by reducing the time they were spending doing work outside of work. Often referred to as “pajama time,” these intrusions into physicians’ evenings and weekends take away from their relationships with others and contribute to burnout.

In setting out to make changes in their own ways, Drs. Reily and Wolf ultimately became co-directors of physician wellness at Bozeman Health and embarked on a journey that helps physicians throughout their organization create situations that help them work more efficiently, reduce the work they do outside office hours and regain their joy in medicine.

For example, by migrating to a system where patients’ prescriptions are renewed at the annual visit for the maximum time allowed, Dr. Reily cut prescription messages in her nurse’s inbox by 65%, and in turn cut her own work. Also, a colleague who was frustrated by how long it took him to walk to the printer to retrieve after visit summaries estimates he’s saving the organization $10,000 annually now that he has a printer in each exam room.

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The physician friends’ efforts helped propel Bozeman Health to become a recipient of the AMA’s Joy in Medicine™ Health System Recognition Program, which is designed to spark and guide organizations interested, committed or already engaged in improving physician satisfaction and reducing burnout.

Drs. Reily and Wolf recently discussed their journey to reduce pajama time by 25% over a 10-month period during an AMA STEPS Forward® podcast, “Reducing Pajama Time and Work Outside of Work (WOW).” Listen on Apple Podcasts or Spotify.

Here are three key initiatives that Drs. Reilly and Wolf have undertaken that they believe physicians at other organizations can easily replicate to make changes that reduce pajama time.

Drs. Reily and Wolf have coined their group the “More Great Days Group.” The goal is to find ways to have more great days by leaving work feeling as if all of the work for the day has been completed, that the team has worked efficiently and that patients have received great care.

The small groups of physicians, typically five to 10 people, meet four times over an eight-week period. Physicians are asked what they consider to be that “one small pebble in their shoe”—something they are doing that makes them feel as if they are wasting their time.

They then discuss a plan for how that change can be made, determining what best practices can be implemented and using AMA STEPS Forward® toolkits to help guide solutions so that physicians don’t have to reinvent the wheel.

“It empowers our colleagues to recognize there are things that they can change about their day that will really lead to more great days,” Dr. Reily said.

Drs. Reily and Wolf query their physician colleagues and advanced clinical practitioners for the top three things they want to see changed when it comes to the “stupid stuff” that the EHR system requires them to do daily. For example, every time Dr. Reily added a lab, she would receive an alert about it that she would have to click on before she could actually see the lab itself.

Some of the changes are easy ones and can be made immediately to eliminate wasteful things for a physician’s day. Others sometimes require a longer process for the transformation to happen.

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As Bozeman Health has transitioned to a new EHR, they have had trainings that have provided tips for using the system efficiently.

Drs. Reily and Wolf have, in turn, shared these with others and they also have shared information from AMA STEPS Forward toolkits that have quick tips for how physicians can save time by improving in-basket efficiency, setting up pre-visit laboratory testing and creating a system of annual prescription renewal.