What Is Really Keeping You at Work? 4 Reasons Physicians Work Late

Your last patient leaves. You think, “I just need to finish a few things.” All of a sudden, an hour - or several hours - have passed. You take work home, log back in after dinner, or spend part of the weekend catching up. Many physicians assume the problem is simply not being efficient enough. In reality, there is no one universal reason physicians stay late. THe real question is: What is actually keeping you at work? Let us explore with four lenses: workflow, external distractions, internal distractions, and mindset.

Lens #1: Workflow - where is work accumulating?

Sometimes, the problem is not how fast you work. It is how the work is flowing through your day. Examine your typical day and explore. Are charts piling up until the end of the day before you tackle them? Are you repeatedly switching between patients and other tasks? Are you leaving certain tasks to do until everyone else has gone home? Are there tasks someone else could be doing? Are you using your EMR in a way that creates unnecessary or redundant work? Are you constantly reacting rather than intentionally moving through your workload?

Where does work begin accumulating during your day - and why?

Even a well-designed workflow can be disrupted when your attention is constantly being pulled elsewhere. 

Lens #2: External distractions - what keeps pulling you away?

Your day may be full, but not all of that time is actually spent doing the work that needs your attention. Are you paying attention to each EMR notification in real time? When you get phone calls and messages, are you answering them right away? How do you handle staff interruptions? What about the unexpected questions from patients or from the staff?  Emails - they come all day long. Do you have the audio notification on? And the patient portal messages - are you reading them as they come, in the middle of seeing patients? Are you constantly checking the inbox? Are you saying yes every time someone needs something? 

Small interruptions compound. One interruption may seem insignificant. Repeatedly stopping, switching tasks and restarting can leave important work unfinished until beyond the end of the day. 

The question to ask yourself: How often am I choosing what to work on, and how often is something else choosing for me?

Lens #3: Internal distractions - what is taking up space in your mind? 

Not every distraction comes from outside of you. Physicians may be physically sitting at their computer while mentally somewhere, such as replaying a difficult patient conversation, worrying about a lab result, thinking about something happening at home, mentally reviewing everything still on their to-do list, or thinking about seven unfinished tasks while trying to complete one. Unintentionally, several mental open loops are created. As a result, you may have an hour available, but you do not have an hour of focused attention. When you are not focused, it is difficult to complete even one task well. 

The question to ask yourself: When I sit down to finish my work, what else is competing for my attention?

Lens #4: Mindset - what makes it hard to stop?

Sometimes the biggest barrier isn’t the workload. It is what you believe about finishing. You may believe that you should finish everything today. Or, if you do not do it, it will not be done correctly. There are also these other beliefs:

“My patients deserve my absolute best.”

“It’s faster if I just do it myself.”

“Others cannot do it as well as I do.”

“I can rest after everything is finished.”

“Leaving on time means I’m not working hard enough.”

“There’s always one more thing I should do.”

This is where perfectionism, over-responsibility, guilt, and difficulty in setting boundaries can keep physicians working long after the workday was supposed to end. 

It is important to recognize that leaving work on time does not mean caring less. It means learning how to care for your patients without sacrificing every evening and weekend to medicine.

Maybe your workflow needs attention. Maybe interruptions are consuming your day. Maybe your mind is overloaded. Maybe your beliefs are making it difficult to stop. Stop looking for one missing productivity hack. You cannot change what you have not noticed. Before downloading or adopting another productivity app, trying another time-management technique, or promising yourself you will “work faster tomorrow”, get curious. Ask: What is really keeping me at work?

For the next few workdays, when you find yourself working for hours after your last patient, pause and ask:

What went well today?

What am I doing right now?

Why didn’t this get done earlier?

What pulled me away?

What am I telling myself about getting this done?

What could I change tomorrow?

I invite you to look for patterns rather than perfection. The goal is not to overhaul the entire workday overnight. The goal is to identify the one or two things creating the most unnecessary after-hours work and start there. 

Working late does not have to be an inevitable part of being a physician. You do not need to work harder, wake up earlier, or squeeze more productivity out of yourself. You may need to understand what is actually creating the extra work and then change the systems, habits, distractions, or beliefs contributing to it. Your evenings are not supposed to be the overflow space for your workday. You became a physician to care for people - not to spend every night finishing what did not get done during clinic. The path to leaving work on time starts with understanding what is keeping you there. 

If you are consistently staying late and cannot figure out why, if you have tried productivity strategies but still find yourself charting at night, or if you know you want your evenings and weekends back but do not know what needs to change - I invite you to explore our 1:1 Physician Coaching Program, where I help physicians identify what is keeping you at work and create changes that actually fit your workflow, practice, personality and life - so that you can have your evenings and weekends.