The Changing Nature of Work
Two recent articles from non-medical sources discussed the changing nature of work and its impact on people. The first, from The New York Times, discussed a new program instituted by Amazon to retrain workers being displaced by automation. Amazon announced this month that it was going to spend $700 million to retrain about one third of its US workforce to do more high-tech jobs,
“an acknowledgment that advances in technology are remaking jobs in nearly every industry—and that workers will need to adapt or risk being left behind…The investment is a large-scale experiment in whether companies can remake their existing work forces to fit a fast-changing technological world. While government programs have tried to turn factory workers and coal miners into computer coders and data scientists, few of these efforts have succeeded. Corporate attempts have been limited.”
Amazon has been criticized widely for its treatment of employees, so its seems likely this effort is motivated by something other than good will. Susan Lund, an economist with McKinsey Global Institute, noted: “They can’t hire off the street everyone they need. They have no choice but to retrain their own workers.” Ardine Williams, a fellow at the Roosevelt Institute noted: “When they have to pay higher wages, when they have to struggle to find workers, then they take the steps they need to make sure those workers are worth the money.”
“Amazon’s announcement was met with some skepticism from experts. They noted that American companies had long spent less on training than their European counterparts—and that when they did offer training, it was usually for college-educated, white collar workers…Even if the retraining effort succeeds, some workers are bound to lose out. Not every one of them will be able to find a better job.
A report that the McKinsey Global Institute published on Thursday (July 10) analyzed the impact of automation and the clustering of skilled workers in geographic hubs. The research paper concluded that 25 cities and high-growth hubs could generate 60% of the job growth in the US through 2030. The 54 trailing cities and rural areas, where one-fourth of Americans live, could have no growth in jobs.”
The other article, published by the BBC on 15 July 2019, discussed how the modern workplace is ill-designed to promote the best thinking by people. The author discusses the work of Cal Newport, professor at Georgetown University, and poses the question:
“The next great revolution in the office will need to correct this, (the constant interruptions of electronic messaging,) according to one man who wants to reset the way we work. He believes the value someone can bring to a company will be judged not by their skill, but by their ability to focus. But how do we shut off distractions and do our best work?”
Professor Newport points out that “multitasking” is not something the human brain is good at, and that for many cognitive tasks, the multitasker underperforms. He also notes that being “switched on” all the time and feeling the need to make an immediate reply to a message creates anxiety.
“The average knowledge worker is responsible for more things than they were before email. This makes us frenetic. We should be thinking about how to remove the things on their plate, not giving people more to do…Managers spend 85% of the day in meetings, on the phone, or talking to people about work, not doing it. It’s flexible and adaptive, but conflicts with the way the human brain operates. Those context shifts are devastating and burn you out. People try to cope with hacks like no-email Fridays. But this doesn’t work because there is no workflow in place for not emailing each other.”
Deep thinking takes time. “Estimates of how long it takes us to refocus after a distraction vary. But at the top end, one study found on average it takes us 23 minutes and 15 seconds to regain deep focus after an interruption.”
The implications for medical work seem clear and multifaceted. First, we, too, are facing a shortage of workers. Nursing ranks expanded during the economic panic of 10 years ago but are shrinking as other options become more attractive. Automation is changing the nature of the work in ways we have not yet learned to handle.
And interruption is a way of life for both clinicians and managers in medical organizations. I doubt anyone I know working in the field gets 23 minutes to organize their thinking about anything. If anything, secure messaging, electronic alerts, and electronic health records are making the interruptions more frequent. Burnout is now a major issue, and the computer is blamed for a lot of it and the notion that interruption is bad for thinking is not being addressed. Consequently, we may be getting more RVU’s from the workers, but the work has less and less thought applied to it. This is what I would call the shadow side of the value proposition.
Another phrase I like is “the tyranny of busyness.” While we make like the feeling of busyness, which we interpret as saying, “I’m important,” it is a narcotic—it takes more and more to get less and less euphoria. New attendings always want to be notified of everything. Old attendings want to be notified only in life or death situations. Otherwise, they will get to it when they can. Maybe knowledge that this is a problem in other business is comforting, or maybe it will spur us to find time to do some deep thinking about solutions. It seems to me another urgent issue to address, though.
29 July 2019
 Casselman B, Satariano B. Amazon’s Latest Experiment: Retraining its Workforce. The New York Times, 11 July 2019. Accessed 12 July 2019 at https://www.nytimes.com./2019/07/11/technology/amazon-workers-retrain.html.
 Park W. How to Escape the “Hyperactive Hivemind” of Modern Work. 15 July 2019. Accessed 16 July 2019 at http://www.bbc.com/capital/story/20190715-how-to-escape-the-hyperactive-hivemind-of-modern-work.html.
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