In this episode, we hear about doctor life and learn time and stress management tips for the holidays with Dr. John Crosby.
“If someone needs to talk to you in that hour, they need to call 911.” -John Crosby MD
In today’s episode, we have a special treat. Dr. Jen Barna talks to Dr. John Crosby, a Canadian Family Practice Doctor practicing in Ontario. Dr. Crosby has spoken worldwide 124 times on curing burnout by using time management. He shares his proven tips and tricks for better time management, the secret to loving paperwork and getting it done and how he handles the holidays and comes out looking like a prince. We also learn some fun facts about Canada and their contribution to medicine.
Dr. Crosby is a family doctor in Cambridge, Canada near Toronto. He is an Assistant Professor of Medicine at the University of Toronto and Family Medicine at McMaster and Queens Universities. He is a graduate of the University of Western Ontario in London. He is also a consultant to the Ontario Medical Association on physician efficiency and the Canadian Medical Protective Association on avoiding malpractice and college complaints and also a Royal College specialist in emergency medicine.
To get Dr. Crosby’s ebook and audiobook or free mentoring, email Dr. Crosby at [email protected]
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Please enjoy the full transcript below
Dr. John: If someone needs to talk to you in that hour, they need to call 911.
Jen: I’m Dr. Jen Barna. Welcome to DocWorking: The Whole Physician Podcast. Today, I have a special treat. I’m here today with Dr. John Crosby, a Canadian family practice doctor, previously an emergency physician, practicing in Ontario, a frequent contributor to the medical post, a peer reviewer for the College of Physicians and Surgeons of Ontario, and Dr. Crosby as an author, blogger, and mentor to many, many physicians. It is such a treat to have you on the podcast with your level of experience and wisdom. Dr. John Crosby, welcome to DocWorking: The Whole Physician Podcast.
Dr. John: Oh, thank you, Jen. That’s great to be here. This is actually my very first address to American doctors. So, great to see you, folks. I was born about a mile away from the United States in Sarnia, Ontario, right on the border just above Detroit. So, I grew up on American television and radio. So, I know a lot about you, guys. I was born in 1947, so I’m 74, I’m old. I’m still working in family practice after 49 years and loving it. So, I like to share that with people, how to still love being a doctor after 49 years. I went to the University of Western Ontario in London, Ontario. And then, I was an emergency doctor in Cambridge, Ontario. 150,000 people here. So, I did 20 years of Emerge and love that. And then, I couldn’t really hack the night shifts anymore. So, I’ve been a GP here for the last 29 years and still loving it. I have a nice elderly practice, and they have two nursing homes. So, I have to do a lot of time management to stay on time.
Jen: Fantastic. Just to understand where you’re coming from and the type of practice that you run. How does empathy factor into your choice to be a family practice physician and also your ability to love medicine as you do?
Dr. John: That’s a really good question, Jen. I started off actually as a GP for a couple of years and then went into Emerge Medicine. I wasn’t empathetic at all. So, I’ve had to go from non-empathetic to empathetic. Because I was this 26-year-old, unmarried guy with no problems in the world, and just living the life and happy. So, I had no problem. I had no empathy for patients who came in, who couldn’t lose weight, and who couldn’t stop smoking, and who had a terrible marriage, or having in-law problems, or hated their job. How can you have empathy if you’ve never done it? It’s like empathizing having a baby. Men never will know what that’s like. So, you can tell us what it’s like, but we’ll never know. But now that I’ve been at GP for the last 29 years, and I’m married, I have three kids, and grandchild, and I’ve had people die that I love. So, you can really start to empathize with people, how hard it is to stop smoking, how hard it is to stop eating. So, I’ve just learned how to do it by living and getting older.
Jen: Speaking of empathy, and family, and life outside of medicine, I’m interested in hearing your tips about time management in relation to the holidays. Any specifics that come to mind for you?
Dr. John: What I do personally is, I always volunteer to work between Christmas and New Year’s. And everyone thinks I’m wonderful. Like, “Aren’t I a great doctor?” They all think, I’m this fabulous guy and none of them realize how quiet it is. I take call for five other GPs, my two nursing homes, and I get like two or three calls a day, because the patients don’t think you’re working, the nurses don’t bother you because if they get an order, then, they have to process it, and the patients get miraculously cured between Christmas and New Year’s. When I was an Emerge doc, the quietest day of the year was Christmas Day because everyone got miraculously cured. Like no one wanted to go to the hospital, no one wanted to get sick. And then, the busiest day of the year was always Boxing Day, which I don’t think you have in the US.
But Boxing Day is the day after Christmas and that’s our British tradition. The British aristocracy used to give gifts to their servants the day after Christmas. So, that’s a staff holiday for us in Canada because we still have the queen on our money and our stamps. So, Boxing Day is the busiest day because everybody who used to be sick on every day of the year has pushed Christmas day into the day after. So, I volunteered at work on the days between Christmas and New Year’s and everyone thinks, I’m wonderful, I don’t have to work at all, and then, I can take a week off in summer. So, I’m always playing my cards and no one’s figured me out yet in the last 20 years. My wife is a workaholic and she’s always doing way too much and then exhausted. So, I have to time manage her without her getting mad at me. So, I’ll say, “Honey, let’s have Chinese takeout or a pizza on Christmas Eve.” Because she wants to do a big meal on Christmas Eve, a big meal on Christmas night, all our family comes, she’s exhausted, and we’re cleaning dishes till midnight.
So, we get takeout on Christmas Eve, so no one’s crabby, and then, we make all the kids help us do all the dishes and clean up Christmas night. We also just give one gift in our big family. Everyone has lots of money and we don’t need any of this clutter. So, we just choose a person and we pull from a hat in the summer, and we just give one gift to one person in the family, a nice gift and then give the rest of the money to charity. You should look light around Christmas, like don’t be doing any physicals, or well babies, or counseling. Just easy little stuff around that time of the year. If you are a family doctor or an internist, you can control your workflow like that. Now, you Jen, as a radiologist can’t do that. It just pours in all the time, I’m sure. So, it depends. If you’re an Emerge doc, you can’t really change that. You just see everybody that comes through the doors. We always up staff. We knew Boxing Day was going to be busy. So, we would always double our staffing for them. So, you can usually predict when it’s going to be busy.
Then, January 1st, what do I do? I sit down with my wife every year, and we take out our calendar, and we plot the whole year. What are our vacations going to be for the next 12 months? Because if you don’t set your vacations, other people will set them for you. So, we figure in February, we’ll go to Mexico alone. No children, no phones, just the two of us alone. March break, we’ll take the kids, go to Florida, or go skiing in New York State. Then in summer, we’ll go to the cottage alone, no children, and they go to camp, and then, in the fall, we all go to a conference in Toronto, or Montreal, or Vancouver or Boston. I actually came down to wonderful Boston and had a wonderful time there. Gorgeous city. We love New York City and LA. So, we love your country.
We plot that out and we send an email to everyone in our life. Our friends, our family, the hospital, the nursing homes, the nurses, administration, my secretary, my nurse practitioner, everyone knows when we’re going to be off in 2022. Because if you tried to take a week off in July when you’re in June, people are not going to cover for you. But if they know you’re going to be off for the first two weeks of July, they can get their head around up. So, that’s a good time management tip for holidays.
Jen: Yeah, that’s a great tip and also, something that you’ve mentioned, which I think we often fail at in the US anyway, is the staffing. We tend to understaff which results in people having a very heavy load when they’re covering call or potentially covering holidays. So, I think the idea of overstaffing, of course, there’s the dilemma with overstaffing is that then less people can be on vacation if it’s a popular holiday. So, that’s a bit of a dilemma. Do you have any suggestions on that?
Dr. John: Yeah, that’s a great question, too. Everybody wants Christmas off, everybody wants New Year’s off, everybody wants spring break off. So, our spring break is like the third week of March in Ontario. People with kids, we always let them take spring break off because first of all, we’re being nice. We also don’t want to take spring break off with all the brats. It makes us look good but we’re actually avoiding jamming the airports. It’s brutal. The busiest day of the year is March 13th, which ironically was when the COVID started two years ago, we were in Florida. At the time, I remember watching TV and they canceled the Boston St. Patrick’s Day parade, and I looked at my wife and I thought, “This is truly serious.”
If Boston is canceling St. Patrick’s Day, this is a true emergency. Coming down through Atlanta, it took four hours to get there in February, it took 45 minutes to get home. But there was zero traffic at the end of March. When we got to Detroit, there wasn’t a human being around. We just drove across the bridge into Canada. It was like a nuclear war. You didn’t see a single human being of your 330 million people.
Jen: Wow. And speaking of COVID now that we’re into it a couple of years, has that affected your practice in a large way?
Dr. John: Yeah. Every single human on the planet has been affected. I’m lucky. We’re on salary here in Canada. So, the fee for service doctors got slammed like, the surgeons couldn’t operate, it was brutal. Some fee for service doctors lost 80% of their income or Emerge docs lost a lot of money. People just weren’t going to the doctor. They weren’t going to Emerge. They were afraid. We did a lot of virtual care over the computer. We slipped into that within one day.
One thing we found that we didn’t realize, we could do a lot by audio. You didn’t have to see people as much as you would have thought. You can do blood pressure. They can do their blood pressure and tell you. But it was a lot quieter. Now, it’s going up and everybody’s back out in a boat. We’re pretty lucky because we’ve got 92% vaccinated in Canada. So, that’s good. Canadians follow the rules more than Americans. We didn’t rebel against England like you guys did. So, we’re not rebels.
Jen: Well, you’re certainly better off in a pandemic with that mentality for sure. So, I’m curious too, whether that ability to do telemedicine once you fully embrace that, has that contributed to time management and are you using that as a way to better manage time?
Dr. John: Yeah, it’s actually easier because there’s an end. When you’re in the office with the patient, it could go on forever. They just keep bringing up problems. I had one lady with 15 problems one time neatly typed out double space that she handed to me. So, I’ll tell you how to time manage the dreaded list. But when you’re doing a virtual visit, it’s slotted in. So, they know they’re talking to you from 10 to 10:20 in the morning, and there’s another patient. And so, it is a little easier to wind up the consultation. But we found it’s a blend and I think everyone has in the world found this out. Some things you need to examine the patient like belly pain and stuff like that.
Other things are good, virtually, you can do counseling virtually. So, it’s good and bad. It’s like everything in life. There’s good and bad to everything. I always say, “You can take a hammer and hammer a nail and build a house or you can hammer your thumbnail.” It depends on how you use the tool. So, we’re grappling with that and everybody is everywhere. They went from 5% to 80% overnight. It was incredible, the change.
Jen: What percentage would you say it is now, now that you have the option to see people in person?
Dr. John: Both 50-50, I think. Some patients like it and some hate it. You go with what the patient wants, and some doctors liked it and some hate it. We’re getting more virtual clinics too where patients could phone in. The biggest problem in Canada with healthcare and I need to warn Americans about this, because when you talk about Medicare for all, we’ve had Medicare for all for 55 years here just north of you. It’s a great system. There are wonderful things about it. But one of the bad things about it and you’ve got to watch out for if you ever go here with us is, wait times are brutal. Because it’s free, everything’s free medically here in Canada. There are no copays, there’s no maximum, there’s nothing like you can get a CAT scan or an MRI for free, and you never pay for anything. Emerge, the hospital specialist, GPs, everything’s totally free. Even medication for welfare patients like Medicaid and Medicare, there’s like a $2 Canadian copay, which is like a buck American.
When you have a free system and it’s the only free system in the world, by the way, even the British, and Europeans, Japanese have private systems along with public systems. So, Canada is the only free system in the entire world other than Cuba, North Vietnam. But the only first world free system and we have terrible wait times. You wait seven hours to be seen in Emerge, you wait two months for an MRI, two months for a CAT scan, 14 months to see a gastroenterologist, nine months to see a psychiatrist. So, it’s brutal. I always say to patients, when they bitch to me about it being a long wait, I go, “It’s free. If you went to a nice restaurant, it was free, what would happen? There would be a huge lineup outside the door.”
Jen: Great analogy.
Dr. John: That’s a big stressor for us because the family doctors have to look after patients while they’re waiting to see a specialist. If you have a depressed patient not responding to antidepressants and counseling, it takes nine months to see a psychiatrist. So, I have to look after that patient for nine months, and they’re mad at me, and I’m trying to do psychotherapy, and I got 10 minutes a patient. So, you can see, that is our number one cause of burnout in Canada, you know where it isn’t as big a problem in the United States. I don’t think you guys have wait times like we do, do you?
Jen: We do have wait times that are significant for the people who have access to our system and some people don’t. So, for the people who really don’t have access to anything, but the emergency room because of financial constraints, it’s a great system for people who have full access. There can be long waits even within that subset of people here. So, somewhere in between, I think would be ideal.
Dr. John: Yeah, I think, we have to take the best from each and we do that. We borrow stuff from each other all the time. We invented insulin a hundred years ago. Did you know that? Insulin was invented in Toronto?
Jen: I did know that because we had talked about that before. But I did not know it before I met you.
Dr. John: We invented the intensive care unit and we invented the pacemaker. So, Canadians invented all these wonderful things. The way I teach doctors to deal with burnout from wait times, because that’s our number one burnout thing. I think the number one burnout cause in the US is electronic medical records. I’ve read that in malpractice years and things like that, and insurance company hassles, which we have no trouble at all with insurance companies were always paid, we have no bad debts, my wife does the billing two hours a week. So, what I say is to never apologize. Don’t say, “I’m sorry, you have to wait nine months to see a shrink” or “I’m sorry, you have to wait two months for an MRI.” You can drive to Buffalo in two hours and get one for $1,000. I’ll say, there’s nothing I can do. All I can do is see you as your family doctor.
If you want to complain to somebody, complain to the Minister of Health of Ontario or the Premier of Ontario, because healthcare is provincial. So, put the blame where it is with the politicians that you know, pay for all this stuff. But never apologize and never take the blame for wait times. It’s not your fault. If you do something wrong, it’s your fault or you’re a poor time manager, and they’re waiting to see you, then you should apologize.
Jen: That is a really wonderful point. For things that are outside of our control to acknowledge that we can’t change that, and direct conversations to the person and/or group that potentially can control or change that factor. So, that’s a really terrific point. Another thing that you mentioned just briefly there is paperwork, and how American physicians certainly have a lot of burnouts related to charting and overwhelm from charting backing up. One thing that I know you are particularly good at and have some time management tips on is how to avoid the charting backup and overwhelm.
Dr. John: That’s my in-basket. Today, I am the only doctor in the world that loves paperwork. You can tell your grandchildren, you met me. And I have a real approach. It’s in my free eBook. So, please, you’re welcome to email me for my free eBook and I have audio. Because a lot of doctors say, “I don’t have time to read your eBook Dr. Crosby.” So, I got an audio book you can read while you’re commuting or jogging, and three-minute videos you can watch.
In my eBook and audio books, the way to love paperwork is the following. Number one, you have to schedule time for it in your schedule. It’s got to be in your calendar, on your iPhone. Most doctors do it between patients, or at night, or weekends. I had one obstetrician I was mentoring that used to take it to Florida with her. There would be suntan oil and sand in her charts, which is bad medicine because you can’t remember anything, and bad for your burnout, and bad for you recharging your batteries. So, you have to have a time in your schedule. That’s all you do and protect that time, guard it with your life like Dike Drummond, who’s a guru on burnout. He says, “Guard your time off with your life.” Because everyone wants a piece of you, your secretary, the nurses, the patients, your family, your friends. So, what I do is, I’ll do eight till nine weekday mornings. So, that gives me five solid hours. The phones are off, my secretary isn’t here, no one can touch me. I’m sitting in my office here, I don’t answer the phone, I literally have five pure hours to do my paperwork, and I lump in computer work, and imaging, and consult letters, and labs, all that crap that drives us crazy. Filling out forms, off-work forms, lawyer’s letters, all this stuff that destroys our life. So, I have five solid hours where I’m not distracted. I’m not checking my Facebook, I’m not checking texts and emails, I’m not reading the newspaper.
And then, I reward myself at 9 o’clock with a coffee and I get to read the newspaper. I’m old. So, I read The New York Times and Kitchener-Waterloo Record on paper, but you can read it on your Kindle. So, now, then you’ll say, “Well, I’m a young mom and I got three kids at home. So, I can’t do 8 till 9 in the morning like old Dr. Crosby.” I’ll say to them, “You have to do it at lunchtime, 12 to one, five hours a week. And you can eat your sandwich here doing your paperwork. And don’t let anyone bother you. Put your phones on answering machine. If someone needs to talk to you in that hour, they need to call 911. Everything else can wait for the hour.” So, if you’ve got chest pain down your left arm and you need to talk to Dr. Crosby and interrupt his lunch, you need to call 911 and chew two baby aspirins. My secretary isn’t allowed here on pain of death. So, no one can bother me. That’s what I say to young moms and dads with kids, “Never do it after hours, never do it at night, never do it on weekends, never do it holidays.”
And then, the second way to love paperwork is to charge lots of money for it. So, I charge $300 an hour to do paperwork. If I have a lawyer’s letter or an insurance letter. So, $300 makes me feel very happy. Now, Canadian dollars’ worth 80 cents American. So, that’s like about $250 an hour. But we tell the patients upfront. If I’m doing their forms for benefits and stuff, my secretary tells them, “Dr. Crosby charges $300 and he doesn’t give credit. So, you have to pay it. You don’t get credit at the liquor store, you don’t get credit here.” And so, that’s made me hundreds of thousands of dollars over the last 48 years, always, always getting paid. S, I have a fun fund. I stick that money in a fund, and then, I take my wife out to dinner to a nice restaurant, and we go to Toronto and see the Raptors win a world championship or the Toronto Blue Jays or the Toronto Maple Leafs lose. Did you know this Jenna, that the World Series was only one outside of the US once in history? And that was in 1993. It was won by the Toronto Blue Jays in Toronto. We won it in 92, but that was in Atlanta.
Jen: I did not know that.
Dr. John: There’s another Canadian factory right there. So, it’s truly the World Series. There are two countries of the world playing in it. You put your money in your fun fund, and then when you’re at a Blue Jays game or at a live theatre in Toronto, or Vancouver, or Montreal, or New York City, you’re going instead of hating paperwork that got me to New York City. So, you turn it into a happy time. When you’re on vacation, come back a day early to do your paperwork. Everyone thinks I’m crazy. I remember it was Labor Day, it was 40 degrees Celsius, you know 110 degrees Fahrenheit. I left the cottage at early morning. My wife thought it was nuts. My kids thought I was nuts. I said, “I’m going to the office to get caught up on paperwork.” I did eight hours of paperwork. I took myself out to a wonderful dinner at a fabulous restaurant and rewarded myself. Tuesday morning, I started with a clean slate unlike every other doctor in the world who flies in Monday night and is exhausted, crabby, and has a huge in-basket Tuesday morning. And then, they need a vacation from their vacation.
Jen: Excellent advice. Those are fantastic tips. I really appreciate you coming on and sharing those ideas with us. An opportunity to take what you’re offering as tips that work, and put those to action in our own lives is very valuable. So, thank you very much for coming on and sharing those with me, and I’m looking forward to our next episode, which will be another conversation with you, and we’re going to talk about some meaningful time that you’ve spent working during the holidays, a Christmas story from the doctor’s perspective. So, thank you, Dr. John Crosby and tell me how can people reach out to you to get your eBook?
Dr. John: Please use my private email. Everything’s free. Your name will not be given to some company to sell you duct cleaning or anything like that. It’s [email protected]. C-R-O-S-B-Y at R-O-G-E-R-S dotcom.
Jen: Wonderful. How would they find your articles in the medical post?
Dr. John: Just email me for everything and I’ll send you all my stuff. Jen, I also offer free mentoring too, if anybody wants that. So, I’m happy to help out.
Jen: Fantastic. I think you will find a lot of takers for that absolutely. Thanks for joining us on DocWorking: The Whole Physician Podcast.
Dr. John: Thank you.
Jill: Life as a physician can be packed with pressure. Let’s face it, it’s stressful. And everyone says, you should manage your stress. But how do you do that? I mean, everyone needs to be less stressed, but it could be a mystery how to get there. The good news is there are proven ideas and techniques that you can put into action today that can lower your stress. You just need the right coach to help you put those tactical-practical tools into action. And you need an experienced coach who’s worked with physicians and helped countless doctors put these ideas into play in their daily life to see big results.
Amanda: I’m Amanda Taran, producer of DocWorking: The Whole Physician Podcast. Thank you for being here. Please check us out at docworking.com and please don’t forget to like and subscribe. Thank you for listening.