How Should I Balance My Time During Residency?

Do you have any strategies and/or advice about time management as a resident?
Residency is demanding not only in terms of time but also in the expenditure of physical and emotional energy.
One of the most challenging aspects of the internship year is understanding the expectations of the senior residents and attendings and accepting the sacrifices you will have to make to meet these expectations.
A resident’s day begins very early and ends very late. The scant free time enjoyed by the resident must be squeezed in between academics, family obligations, a social life, and recreational activities. Many residents feel overwhelmed as they attempt to juggle all these aspects of their lives, and as a result, they often pare each element down to its bare minimum. A coworker recently described how these responsibilities can take their toll:
"I came home so exhausted that I collapsed in my bed with a loaf of bread, woke up in a pile of crumbs, and rolled over onto a stack of undictated operative reports."
It is very easy for the intern to fall into a pattern of working, sleeping, and eating and not much else. But residents who find ways to be more efficient and effective in their work are able to achieve balance in their lives.
In an article in the Journal of the National Medical Association titled "Time Management: A Review for Physicians," Brunicardi and Hobson^[1] outline several interesting theories about time management and give practical advice to new physicians. One strategy that I found particularly interesting was Steve Covey's time management matrix technique. This technique sorts all activities into 4 quadrants:

• I -- Important and urgent
  
• II -- Important and not urgent
  
• III -- Not important and urgent
  
• IV -- Not important and not urgent.
  

The activities in quadrant I are the emergencies, deadlines, and crises that consume vast amounts of energy. Although physicians are trained to deal with emergencies, these activities waste time and tend to spill over into other areas of life. According to Convey, it is better to tackle the activities in quadrant II. "Quadrant II activities focus on planning, prevention, creativity, building relationships, and maintaining increased productivity."^[1] Moreover, Convey maintains that "many competent people spend 90% of their time on tasks they consider important and urgent -- quadrant I -- and 10% is spent recuperating in unimportant and either urgent or nonurgent activities, respectively, quadrants III and IV."^[1]
Perhaps my coworker woke up in a pile of crumbs and operative reports because she was expending too much energy on quadrant I activities, which often leads to stress and burnout. The idea is to spend more energy planning and controlling events to increase your productivity. Instead of bringing all her operative reports home and waiting until the medical records department sends a threatening letter requiring her to complete her dictations in an urgent fashion (quadrant I), she could learn to use her time more efficiently and effectively and dictate the cases promptly upon leaving the operating room (quadrant II). This would leave more time to have dinner with friends or cook a meal and eliminate that pile of crumbs.
Although residency, with its significant time constraints, is especially challenging, it can also be extremely productive and exciting. I truly believe that with good planning and organization, the resident can step up to the challenge and achieve a more balanced life.

Response from Sarah Bernstein, MD
Resident, Department of Obstetrics and Gynecology, St. Luke's-Roosevelt Hospital, New York, NY