Many of us remember the first few months of being an attending. Sitting in an empty office, waiting for patients to come. Years of waking up at 4 am during training has been so ingrained, so instinctual, that you’re sitting in your office at the crack of dawn every day, realizing you have nothing to do. So while you’re waiting for patients, as the go-getter new attending you are, you start filling up your time. You start signing up for committees, both at the national and local levels. You volunteer to give talks to the residents and mentor medical students. You offer to review papers and participate in research projects. And over time – word gets out that there’s a new surgeon in town and the patients start calling. Suddenly, you’re booking cases, filling up your clinic, saying “yes” to the add-on clinic patient on your OR days, running to the office in between cases, or doing telemedicine visits in the parking lot of the hospital on your way to yet another committee meeting. And this doesn’t even take into consideration family and social commitments. Your Outlook calendar now looks like a horrifying Tetris screen of multi-colored blocks.
And you look back and wonder how did this happen? We’re all taught the 3 A’s of building a successful practice – being Available, Affable, and Able. As surgeons, we are inherently people pleasers. We want to do what’s best for patients, to help out other physicians. Being “available” is key to building a good reputation and successful practice. And with that, comes saying “Yes” to what’s asked of you, right? We are Yes people – and we find it very difficult, if not sometimes impossible, to say no.
Why do we have such unease with a simple 2-letter word? As surgeons, we have a strong sense of duty – to our patients, to our departments, and our families. Saying no comes with a fear of disappointing the asker. What will they think of me? And subsequently, the risk of looking less able. There’s a fear that if I say no, other opportunities in the future won’t come. This especially comes when the one asking is a superior, such as a division or department chair. But over time, the propensity to say yes to absolutely everything – being over-committed – can lead to stress, burnout, and job dissatisfaction.
Ask yourself – is saying yes (to this specific project, committee, etc.) helping my ultimate professional goal? Does it align with my personal career interests? In the words of one of my mentors, saying yes to one thing, is saying no to something else. Your time is limited and can only be piecemealed in so many different ways. Saying no isn’t a failure of yourself or make you less of a surgeon – in fact, it’s key to mastering the art of prioritization. Being smart about when to say “No” will create a more sustainable work-life balance and job satisfaction. I, by no means, have mastered this (I have said yes to many tedious requests simply to avoid saying no), but over the years, have tried to break things down into 3 categories to better concentrate on my responsibilities without losing focus.
On a day-to-day basis, there are obviously tasks where the answer is always yes. Operating on an emergency, attending meetings pertinent to your role. These are obligations that come with being an academic surgeon – taking care of patients, teaching, research – and these commitments are an automatic yes by default. Then there are the requests – for example, if you have an interest in medical education and are asked to run the surgical clerkship, you will be more willing to carve out time for commitments that align with your interests, which will (ideally) promote your professional goals. What will I learn from the experience? Will this opportunity lead to more beneficial ones in the future? In the words of Marie Kondo, will this spark joy? If the answer is yes, then you’ve made the right decision.
What about if it is something you are interested in but just don’t have the time commitment for? We often have a fear that saying no may close the door on future opportunities. However, if your bandwidth is already stretched thin and you are asked to, for example, chair a project that you just don’t have the time to fully engage in, is it worth putting out a sub-par product or one that is not reflective of your best work rather than just saying no to focus your time and energy into your other commitments? Again, keeping in mind, what is the potential cost of this endeavor and how will it take away from your other responsibilities. If you are starting a basic science lab and just getting your research off the ground and asked to be part of the IRB committee which requires a 2-hour weekly meeting, how would you respond? Being part of the IRB committee would provide exposure to other surgeon-scientists, be involved in the research community, but you’re already in the OR or in the lab till 8 pm every night, barely staying afloat, and on top of that, have a grant due in 2 weeks. This request may coincide with your professional goals, but you just don’t have the time commitment for it…right now. One way of responding to these types of situations would not necessarily be to decline right off the bat, but perhaps, provide a timeframe where you may be more available – I can do it starting next month. Or if the request is for a weekly meeting, but you only make it every other week. Your schedule may lighten up when the acute issue (ie your grant) is completed. A “no” right now, but a “yes” later on (or with provisions).
These are requests where you may not be interested in at all or clearly have no time for. If you are a busy surgical oncologist but asked to sit in on the Wound Care Committee of your hospital as their surgical representative…does that align with your professional goals or would this take away from something of more value and interest, such as running the hospital tumor board? Rather than just saying no, this would be an opportunity to engage junior faculty or residents around you to be involved. Leadership is not just promoting yourself but supporting others. “Sorry, I don’t think I can make those meetings, but Dr. X who just joined the plastics division may be a great person to represent the surgical department on your committee.” Alternatively, over the years, I’ve learned to ask more about the specifics before answering right away. If it is a minimal time commitment that you would be able to make, though it may not be the most exciting meeting to attend (like a budget meeting, for example), and it may not truly align with your goals, you can make it work in your schedule and still be a good steward to your hospital and department.
At the end of the day, saying “no” is a skill, one that I have yet to master. However, over the years, I’ve learned to pause first and truly weigh the costs and benefits before answering. It’s given me the ability to better prioritize my responsibilities and objectives and focus on my career goals. In the words of Tony Blair, “The art of leadership is saying no, not saying yes. It is very easy to say yes.”