Efficiency as the enemy of flexibility: a drawer’s maximum utility comes at 2/3rds full.


Time will flee by the slice

A slower pace would be nice.

All work and you’re dull,

If your day is too full

Efficiency comes at a price.

Synopsis:  I’m a family practitioner from Sioux City, Iowa.  In May 2010, I left my position of 23 years, and honoring my non-compete clause, traveled for a year doing locum tenens work.  In June of 2011 I joined up with the Community Health Center, which provides care for the underserved.  I’m now working part-time, which, for a doctor, means 48 hours a week.

The throes of student poverty kept me from owning a motor vehicle till I was 29, and I learned a lot about bicycles.  Efficiency rose with tire pressure as rolling resistance fell, but the efficiency came at a cost.  The extra hard tires did poorly on rough roads, skidded dangerously in the wet, could not be ridden at all on dirt, and punctured with the shortest of thorns.

My first vehicle, a Karmann Ghia, sported a Volkswagen engine, known for accessibility.  I soon found I could tune and tinker and get exceptional mileage, but I could only maintain 32 miles per gallon in ideal conditions.  Head winds or tire pressure loss from a drop in ambient temperature would shave 5 to 8 miles off of a gallon of gas; carrying a passenger made things worse.  And if the car sat for a week between trips, evaporation of gas from the tank dropped the road efficiency noticeably. 

Any system that gains efficiency loses flexibility; a drawer’s maximum utility comes at two-thirds full.

Our health care system stands as a paragon of inefficiency but it does well for flexibility.  Most years, our hospitals meet influenza’s challenge head on.  We have enough overbuilt infrastructure to handle a 30% rise in hospital cases.   

In the dark days when I worked 84 hours a week, I did so with tremendous efficiency.  I knew as soon as my foot hit the floor in the morning where my steps would take me till I dropped into bed that night.  Yet I paid a terrible emotional cost for the tiniest of delays, and I always ended up running behind before the last patient finished.

At that time I learned great efficiency in making rounds on hospital patients, but my system doesn’t tolerate glitches well. 

I need an early start.  On first arising, people don’t talk much, but by 10:00 AM the urge to speak has come to full flower.  It doesn’t spare doctors in general, nor nurses, nor this doctor in specific.

I used to joke about MYF, Morning Yack Factor, a hormone that drives people to verbosity.  Others have asserted it has more to do with caffeine finally reaching a threshold level.  Yet I don’t use the stuff and I still lapse into eloquent excess at midmorning.  I do my best to avoid physician conversations between 9:30 and lunch if I don’t have a morning running on leisure.

If our government in Washington doesn’t hold the world’s record for inefficiency, it should.  Note that we were able to wage not one but two wars without noticeably increasing the personnel in the capital. 

If the Affordable Health Care Act brings efficiency, our system will lose flexibility

Life comes down to a series of tradeoffs.

But realistically, I’ve never seen government regulation increase the efficiency of anything.

 

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2 Responses to “Efficiency as the enemy of flexibility: a drawer’s maximum utility comes at 2/3rds full.”

  1. a1manrme Says:

    hey, I recently found your blog and see that you’ve tried locums in the past. I’m graduating residency next June and looking into locums companies. Do you have any insight into which companies are good?

    • walkaboutdoc Says:

      I’ll email the names of companies. The following is good advice for docs doint locums: Don’t put up with high pressure. Watch out for bait-and-switch. Compensation is negotiable. If you give the go ahead to be presented, tell your recruiter that you’ll put your lines back in the water if you haven’t heard back in 48 hours. If you say yes to an opportunity and it falls through, and if you really, really like your recruiter, let them present you a second time. If two fall through, you need a new recruiter.

      I know of three agencies that recruit for New Zealand: Vista, NZLocums, and Global. I’m familiar with NZLocums but I’ve talked to docs who worked with Global.

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