I'm a resident physician in internal medicine at a large research institution. I'm struggling to make deep work part of my routine. For me, deep work consists of doing clinical research, staying up to date on the literature, and studying for board exams. The structure of my days changes every two to four weeks, with some blocks of intensive 10 to 12-hour shifts, other blocks with a more typical 9 to 5 schedule, and very occasional, quote unquote, "research blocks" of unstructured time.

My one day off a week varies from one week to the next. When I'm at work, I do have unpredictable periods of relative quiet, but my door is open, my pager is on, and there's always the possibility it's truly an emergency. In order to become so good they can't ignore me, I aspire to become a productive researcher in addition to a skilled clinician.

How should I approach this? Well, it's a good question. I get asked these type of questions a lot. There's a lot of concern/interest right now among physicians when it comes to issues of concentration and distraction. You would be surprised, for example, how often I'm invited to speak at Grand Rounds.

I get a bunch of these invitations, because doctors care a lot about this. So I want to start with that. You're not alone in having this question. The second thing I want to do here is a reality check. Your clinical schedule setup right now, as described, is very demanding.

That is a lot of work you are doing, and it is difficult, cognitively demanding work. The reality is the reality. I don't know that it's possible for you to prepare for boards and do a significant amount of original research at the same time that you have such a difficult schedule.

Because it sounds like you're doing shifts, these 12-hour shifts, and then you have 9 to 5 clinical hours sort of outside of those shifts, and you're only having one day off. That's actually quite a heavy load. So I don't know if this is good news or bad news, but I'm basically giving you permission to slow down here a little bit.

If boards are the next thing that's coming up, that's what you should be focusing on. And then after boards, if you want to figure out how to do research, again, you can work with these existing research blocks and be highly effective in the time. That might work for you.

But you might have to find a way to reconfigure your situation. I mean, you have to keep in mind that the really killer MD research types that have the great academic positions at the big schools, I mean, they work a lot, but they probably aren't working the same schedule that you're talking about here.

I mean, they have research labs. They have more significant time when they're just working on that research. You're already starting from a high point of view. So this is what I want to say to you here, is let's reality check, have a little bit more self-compassion here. You can't do all those things at the same time.

Work on your clinical skills, pass your boards, figure out, OK, what's the next research thing I want to do? Do I have time for it? If not, are there changes I can make that would free up more time for it? And if the answer is no, the type of clinical position I have makes it very hard to do research, then maybe you say, let me just focus on killing it-- that's probably the absolute worst adjective to use there-- but killing it in my clinical work and doing that really well.

Or shifting to an academic position in which a lot more time is given for the non-clinical work. But it's all about reality checks here. It's easy to fall into a trap where you say, it would be great if I could do x and y and z. But oftentimes, it's impossible to do x and y and z at the same time.

Take it from someone who falls into that trap all the time and constantly has to step back out again, constantly has to re-simplify things again. There's only so much time you have. And I think it's OK. I think it's OK to recognize that. (upbeat music)