Tagged Working Hours

Where Does the Time Go? How to Keep Track

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How busy are we, exactly?

The author and time management expert Laura Vanderkam decided to answer that question for herself. She tracked her time for an entire year (8,784 hours in a leap year), and in doing so learned her life was a bit less hectic than she thought. Ms. Vanderkam, a working mother of four young children, recently wrote in The Times about her experience.

The article, “The Busy Person’s Lies,” was widely viewed and shared and generated hundreds of comments. But it also left some of us with questions for Ms. Vanderkam, whose latest book is “I Know How She Does It: How Successful Women Make the Most of their Time.” I recently spoke with Ms. Vanderkam to find out exactly how she did it, the best apps for tracking time and why some people have been critical of her time-tracking advice. Here’s an edited version of our conversation.

Q.

How did you do this? Break it down for us — did you use a datebook, or an app?

A.

I used a spreadsheet. It’s just an Excel worksheet, with the days of the week across the top and then blocks for the time, from 5 a.m. to 5 a.m. in half-hour increments. It’s on my laptop, and it was pretty much open all the time.

Q.

How often did you update it?

A.

Most weekdays I probably updated it between three and six times. If I wasn’t at my laptop during the day, I kept a sort of a mental tally all day and filled it in in the evening. As long as you’re looking at half-hour blocks and paying attention, not estimating, you’re not likely to make big mistakes, the way you do if someone asks you, how much to you sleep, or how much do you work, and you just guess without any data. If you’re tracking, you’re going to be off by minutes, not hours, and you’ll still get the information you want.

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A chart showing how Laura Vanderkam spent her time. <a href="https://static01.nyt.com/packages/pdf/health/KJ.pdf">See a larger version.</a>

A chart showing how Laura Vanderkam spent her time. See a larger version.Credit

Q.

What’s the first step to tracking your time? How long a period should you track?

A.

Just choose a tool to use. The tool itself doesn’t matter. You can use a spreadsheet, or one of a million time tracking apps, or a Moleskine notebook if you want to look all artsy. The key is to do it consistently. And a week is great, or even a few days. The longer you do, the more insights you get, but a week is enough to see patterns.

Q.

Any apps you recommend?

A.

Toggl is free for the basic version. If you want to use an app, I suggest using that for a while, and see if you feel like you need any extra bells and whistles. Once you know what you like, you look for a paid app.

Q.

What kinds of categories did you use?

A.

I didn’t categorize until I was finished. I just wrote a brief description of what I did during that half hour — feed baby/email, speech, church, shop Target, work on train, things like that. I categorized later. I looked at work, sleep, exercise, housework and errands, TV, reading and time in the car, because those were the things I was interested in. Different people will have different categories. I could have pulled out different things, like child care, but as a mother of four who often works at home, so much of that is nebulous. I’m pretty aware of it. But if I were concerned with whether I spent enough time with my kids, or wondering what those numbers looked like, I would have tallied that.

Q.

Did you expect to be able to account for every hour out of your 24?

A.

No. Some people get hung up on this. I’m not a perfectionist. If I ran on the treadmill for 27 minutes and spent three going upstairs and getting water, I’m calling that 30 minutes of exercise. And the time that’s sort of unclassifiable is fine with me — hanging out watching kids play, or flipping through a magazine. The big categories won’t go wrong.

Q.

Is there an issue with being honest with yourself? People always say, “I never watch TV,” but they seem to know everything that happens on “Game of Thrones.” Do you have to make a commitment to not lie to yourself to make this work?

A.

When I do this, it’s just for me. Which means that I don’t think there is any reason to lie on it. If you’re not happy with the amount of TV you watch, or whatever, time tracking is a good way to notice that. Just because you know where the time goes doesn’t mean that you need to punish yourself for wasting it or feel bad about spending it the way you do. Are you happy, or not? If you’re happy, celebrate that. There’s nothing wrong with sitting on the porch drinking a glass of wine and staring at the trees.

But if you have open time and you don’t ask yourself, what would make me happy — if you just spend that time mindlessly on Twitter because your phone is in your hand — then maybe this is your chance to ask what you want to do with that time that is meaningful. Life is what it is. It’s just a matter of asking, now I know this. Do I want to keep it, or do I want to change it?

Q.

One of the concerns in the comments on your “The Busy Person’s Lies” piece is that time tracking is a luxury of the upper class. Is time tracking useful for people who don’t have white-collar, flexible jobs?

A.

I think it’s still very useful. With some jobs, you know exactly how many hours you work — it’s right there on your check. But it’s still easy to have the rest of life go by mindlessly. Some of us need a reality check on work. Others want to check other things in their lives. We have only so many hours and a life is lived in hours. I think we all share an interest in figuring out where they go and if we are spending them in ways that are meaningful and enjoyable.

I did see the comments that sort of relegated this to first-world problems. I could understand that better if I were complaining, but I’m not. My point is that I see life as a working person in a prosperous country as very doable, and I think that is a good story to tell ourselves.

Q.

What’s one of the most important things we can learn from tracking our time?

A.

Sometimes we don’t want to own up to how much of time is a choice. But for many of us, there is a reasonable amount of choice in how we spend our days. Using the language of being “busy” lets us avoid responsibility for those choices.

I always use the example of a woman whose water heater broke during the week when she was tracking her time, and it took her seven hours to deal with it. Any of us would say we don’t have seven hours, but when we have water all over the basement floor, we find seven hours.

How do we figure out what really matters to us, and how we can treat it like a broken water heater? That’s the big question.

If you choose to track your time, and the results push you toward changes in how you spend time or how you think about it, let us know. Email us at wellfamily@nytimes.com, and we might use your story in a later post.

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The Longer You Work, the Greater Your Risk for Heart Disease

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Credit iStock

The more hours you work, the greater your risk for heart disease.

Several observational studies have found an association of long work hours with an increased risk for cardiovascular illness. Now a new retrospective analysis has found there is a dose-response relationship: more hours, more risk.

Researchers began following 1,926 men and women in 1986, tracking their health and work history through 2011. Over the course of the study, in the Journal of Occupational and Environmental Medicine, 822 were given diagnoses of cardiovascular disease.

After adjusting for age, sex, income and other factors, they found that for each additional hour of work per week over 10 years, there was a 1 percent increase in the risk for heart disease.

Compared with working 45 hours a week, working 55 hours increased the risk by 16 percent, 60 hours by 35 percent, 65 hours by 52 percent, and 70 hours by 74 percent. Working 75 hours or more doubled the risk for a cardiovascular problem — angina, coronary heart disease, hypertension, stroke or heart attack.

Still, the lead author, Sadie H. Conway, an assistant professor at the University of Texas School of Public Health, does not recommend that anyone alter work hours based on her study.

“I would never tell a person ‘don’t work long hours’ because of this risk, but it’s something that shouldn’t be ignored from a public health standpoint.”

Should Doctors-in-Training Work Fewer Hours?

How many hours should medical residents work?

Hospital care is a 24-hour-a-day enterprise, but the question of which doctor should be there — and how long he or she should already have been there — is among the most controversial and unsettled in medicine. It’s a question that comes up almost daily among my peers, and my own feelings about the issue often depend on whether I’m trying to grasp details about a new patient or struggling to stay awake at the end of a very long shift.

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Dr. Dhruv Khullar

Dr. Dhruv KhullarCredit Tom Fitzsimmons

In 2003, at the genesis of the modern patient safety movement, the Accreditation Council for Graduate Medical Education mandated that residents work no more than 80 hours per week. In 2011, it limited individual shifts for first-year residents to 16 hours. Since then, research has been mixed on whether reducing the length of shifts or total number of hours worked has improved resident health, medical education or patient outcomes.

This year, two large national trials, known as iCompare and First, aim to shed new light on the issue. Researchers randomized first-year residents at internal medicine or general surgery programs across the country to work either 16-hour shifts, the current maximum, or longer shifts of 28 hours or more. Shortly after the iCompare trial began, two advocacy groups sent an open letter to the Office for Human Research Protections, calling the trial “unethical” and arguing that it exposes patients to dangerously sleep-deprived residents while exposing residents to a greater risk of car accidents, needlestick injuries and depression.

These trials come at a critical time, amid mounting evidence of serious mental health concerns for medical trainees. A recent study found that almost one-third of residents exhibit symptoms of depression; other studies show that almost 10 percent of fourth-year medical students and 5 percent of first-year residents admitted to having suicidal thoughts in the previous two weeks — with higher rates among minorities.

And yet, it’s not clear whether more restrictive work hours will make things better for residents or patients. When residents work fewer hours, there are more patient “handoffs” — when a patient is transferred from one doctor to another. The process makes it more likely that important details are overlooked, and intimate familiarity with a patient’s recent clinical course is often left behind. And residents may not even be reporting their hours accurately. Whistle-blower protections are lacking, and the penalty for work hour violations is loss of program accreditation, which could hurt the resident reporting the problem.

In the face of uncertainty, we need more data — and we’re starting to get it. Results from the First trial, published yesterday, found no significant differences in patient outcomes, resident satisfaction or educational quality when surgical trainees worked longer shifts. (Results from iCompare, which is looking at internal medicine residents, are expected in June.)

But I worry about how to interpret the results of trials like these, and what positive or negative findings may mean for residency training discussions going forward. In a profession driven by evidence, data is useful. But it’s important to recognize data’s limitations.

Many patient-care metrics we use to evaluate the impact of duty hour restrictions — mortality, procedural complications, adverse events, readmission rates — are crude. They might make sense for hospitals and health systems designed to increase efficiency and insulate patients from human fallibility. But they fail to capture the nuances of care delivered at the doctor-patient level. Good patient care is about more than surgical infection rates and medication errors. At the end of a long shift, am I the kind of doctor — and person — I want to be? Do I make time to sit with a suffering patient? Do I snap at a well-meaning colleague?

Well-being is similarly difficult to study. Research suggests that one’s judgment of happiness and life satisfaction is surprisingly fickle. For example, people interviewed on sunny days report being more satisfied with their entire lives than those interviewed on rainy days. So if you ask me about my training program after a particularly bad 16-hour shift, I’m likely to rate it worse than during a particularly good 30-hour shift.

Medical educators also worry that work hour restrictions force residents to see fewer patients and miss important educational experiences. At the same time, we allow residents to spend hours scheduling appointments, faxing medical records, gathering vital signs, obtaining prior authorization, and completing many other nonclinical tasks. We don’t learn to do these tasks in medical school; we shouldn’t be spending our time on them as residents. If we’re concerned about resident education, let’s focus on increasing quality time spent on direct patient care and educational activities.

The right answer on how many hours residents should work may be more nuanced than we’ve been willing to accept. It isn’t the same today as it was 20 years ago, as the complexity of caring for patients and medical technology continue to evolve. It varies by subspecialty — discontinuity may have graver consequences for neurosurgery, say, than for radiology. And it hinges more on the character of work than the length of it — I’d spend twice as long at a patient’s bedside if I could spend half as long at a computer.

Ultimately, the answer may be as philosophical as it is empirical. What kind of doctors do we want to be? What kind of doctors do patients want us to be? And does what we can’t measure still matter in a profession that’s now judged and motivated by what we can?

Dhruv Khullar, M.D., MPP is a resident physician at Massachusetts General Hospital and Harvard Medical School. Follow him on Twitter: @DhruvKhullar.