When I had the opportunity to take my first clinic director job, I was very excited. It had been something I had been planning for my career and had been working toward as well. I never planned that my first year as a director would eventually be known as "my year without a vacation."
My first clinic director job
I was given a clinic and allowed to run it how I saw fit. I was also lucky 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.
I felt that I could lead the clinic and make it even better than how it was when I took over. 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.
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 was riding high, and felt like I was on top of the therapy world - but I remember my receptionist asking 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.
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. I saw patients Monday through Thursday with an hour lunch at noon. On Friday, the hours were shortened from 8:00 am to 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 director, then 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 8:00 am, so I started offering a 7:30 am appointment twice a week, just for this patient. I then adjusted my afternoon schedule for that same day so I would keep an 8-hour work day.
Patients kept coming in, and my last appointment at 4:00 became a very popular slot. It hit 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 often arrive 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, covering 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 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 head off to bed.
Every day was this same routine, with my only breaks coming on the weekends. Now, I would take the occasional day off, but I filled it with work. I would visit doctors' offices, finish paperwork, or go the market. My off days were 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, while I was an outsider who was hired right into a role equal to theirs.
It became more apparent as I got busier, as nobody seemed willing to help me. It seemed like they only wanted to take from me, and when I asked for assistance, nobody came to my aid. I was able to hire a PTA in my clinic, due to the growth, but she was in high demand. Practically every other week, some other clinic would request that she come fill in there instead. I would then ask the same thing from other clinics, but I got excuses as to why nobody was available.
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.
He told me that he had done the same thing years before, while running 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 had told me. I took a day and spent it in quiet reflection, thinking about everything that had happened. I decided to start changing things.
My year without a vacation: 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, despite feeling somewhat uncertain about how to approach their dysfunctions.
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, but usually saw limited results. I could tell that I was getting frustrated, and so were the patients. 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 forward.
I explained my rationale behind it, and gave them places to direct these patients. Now if it was a special case, then I told them to call me and we could determine what would be best approach for this patient. I was able to narrow my patient population, which led to improved outcomes.
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 extra tasks onto my plate. Moving forward, I did not start by saying no to everything, but I did spend some time reviewing what I was being asked before automatically agreeing.
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.
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 "leave work at work," but many may not understand what it 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 personal time.
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 also try to tackle all my administrative duties 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 clinical instructor 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. If you don’t travel, then you’ll always wonder what if.” He took that to heart, and would take time off each month for some sort of vacation.
I told myself to step away, which I now do every 2-3 months. During those times, 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, I have made 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, then give them notice of the date to implement the changes.
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.