The 80/20 rule: How doctors achieve more by doing less

In the late 19th century, banking consultant Vilfredo Pareto was busy tending to his well-kept garden when he noticed something interesting.

As he admired his freshly-harvested vegetables, Pareto couldn’t help but notice that 80% of the peas he collected came from just 20% of his pea pods. He had recently made a similar discovery while working with his banking clients—80% of the bank’s wealth was owned by just 20% of its customers.

The ubiquitous 80/20 rule, or the Pareto’s principle (as it is formally known), can be found in almost every situation where cause and effect is at play. The principle states that approximately 80% of the effects in any given situation results from 20% of the causes. The good thing about the 80/20 rule is that you don’t have to be a statistics nerd to believe it. An economist may have devised it and statistical analysis may have proven it, but it remains one of the most powerfully simple principles governing our lives today.

I can give you plenty of examples from the real world, as evidenced by the numerous statistical analyses done to confirm the existence of this golden ratio—20% of criminals commit 80% of crimes, 20% of drivers cause 80% of accidents, 20% of customers represent 80% of company revenue, 20% of employees create 80% of results, and so on.

Of course it doesn’t always have to be 80/20. Sometimes it’s more like 90/10 or 70/30. The main point is the fact that a small percentage of causes is responsible for the majority of the effects. So the key to effectiveness and productivity in any realm comes down to an ability to identify the 20% of inputs that will yield 80% of the outputs.

But as a physician, how is the 80/20 rule relevant to you?

Let’s say you’re at the hospital for a particularly long shift. You’re tired. You have a lot to do, dozens of patients to see, and you need a way to get the most important things done before you leave for the day. You know that you need to choose your One Thing for the day, but you also have a lot of other stuff to get through. You also know that 20% of your work delivers 80% of your results, but how do you find that 20%? How do you identify the biggest drivers within your day?

Take a moment to really think about the work you do on a day-to-day basis and ask yourself the following questions:

• Which 20% of patients take up 80% of my day?
• Which 20% of routine tests make up 80% of my total investigations?
• Which 20% of colleagues help me with 80% of the work I delegate?
• Which 20% of tasks completed will solve 80% of the problems I have to face today?
• Which 20% of conditions do I treat in 80% of my patients?

This is just a very small sample of the line of questioning you could undertake to help clarify your priorities at work—but it gives you an idea. If you’re in hospital or clinic management, these questions could easily be applied to the problems you face too:

• Which 20% of workflows are responsible for 80% of the medical errors we deal with?
• Which 20% of patients are responsible for 80% of readmissions?
• Which 20% of treatments are being prescribed 80% of the time?

Conversely, you could also ask these questions:

• Which 80% of tasks do I complete day-to-day that only give me 20% of my results?
• Which 80% of treatment options do I use that only help 20% of my patients?
• Which 80% of healthcare costs are attributed to 20% of our patients / workflows / etc?

Again, the list can go on and on. The important thing to remember is that 80/20 is a guide, not a rigid rule. The proportions can look a little different (10/90 or even 30/70) but the concept stays the same—find the few causes that get you the most results (whether those results are negative or positive)!

That’s all well and good in the hospital but how does the 80/20 rule apply to your personal life?

When you look closely at your personal life, you’ll start seeing the 80/20 ratio everywhere. It’s easy to make the logical leap of recognizing that there’s a good chance that 80% of any stress, inefficiencies, or misery currently in your life are probably the result of just a few little niggling causes. Most people are too busy juggling their lives to dig deeper and find out where that 20% lies. Conversely, there are probably a few things in your life that contribute most to your happiness and overall well-being, but you likely don’t have enough time (or so you tell yourself) to engage deeply in those activities. The trick, once you identify your happiness determinants, is to avoid wasting time on the 80% of activities that don’t contribute much to your life and focus on the 20% that do.

This applies both to your professional life and your personal life. The steps you need to take to build an 80/20 lifestyle will differ from person-to-person, but here are some tips to getting started.

Outputs versus inputs

We’re all consumers. Whether we’re consuming tangible stuff (cars, clothing, gifts, homewares) or absorbing intangible things (music, Netflix, Facebook) our lives are spent mostly on receiving inputs from various sources. However, research consistently shows that excess consumption is damaging to our mental health, which begs this question: How many of us are focusing on a far more satisfying genre of activities—that of creating rather than consuming? Focus more of your time on producing outputs that other people will consume and benefit from (or create them purely for your own enjoyment). Not only does this provide more satisfaction, but it also stops you from falling into the consumption cycle yourself. Which brings us to the next point—the 80/20 of personal growth. Lou Holtz famously stated that when you stop growing, you start dying. How are you allocating time to your personal growth and are you selecting the right activities to begin with? What are the 20% of personal growth activities that contribute most to your personal growth? This also applies to your professional learning. As physicians, we have a lot of information we need to absorb and learning it all is impossible. At Medmastery, we build each of our courses with one very specific aim in mind—teaching the 20% of clinical skills that will solve 80% of your clinical problems. Take the same approach with your own personal growth and professional development and you’ll be amazed by the acceleration you’ll see in both areas of your life!

Go meta

A life lived to the fullest doesn’t happen by accident—it is engineered. Living one-day-to-the-next without a built-in meditation or reflective practice that keeps you accountable to your goals, is a recipe for an unfulfilling life. Ask successful people about the biggest factor behind their achievements and there’s a very high chance they’ll attribute it to some sort of consistent reflective practice. This can be in the form of journaling, meditation, or mindfulness practice. Aside from the 1001 benefits such a practice can bring to your life (totally made up figure but you get my point), it’s also a critical sidekick to building an 80/20 lifestyle. Ultimately, it’s not about the numbers, but about the principle. Find the handful of practices, activities, and skills that make you the happiest, most productive, and best physician, and do them consistently. Similarly, find the biggest headaches, stresses, and challenges you have to deal with, identify the handful of causes that are responsible for the majority of these headaches, and then work on eliminating these causes from your life.

Take out a piece of paper—your notebook, computer, or whatever medium you prefer—and carve out 20 minutes of uninterrupted reflection time to ask yourself the following questions:

• What activities in my life are currently providing me with the most happiness and satisfaction, compared to other activities?
• Who are the 20% of people in my life that contribute to 80% of my happiness / growth / success?
• Who are the 20% of people in my life who contribute to 80% of bad times and grief?
• What are the activities in my professional life that I have to mechanically do, over and over again, that I don’t enjoy?
• How could I outsource or automate these activities?
• What 20% of unnecessary activities are taking up 80% of my wasted time?

The list can go on, but these are likely to take up a good chunk of your time to work through. As you generate a few aha! moments working through this list, you might stumble upon a few other hidden areas in your life where the 80/20 rule applies. Build the habit of constantly assessing your life for these 80/20 patterns so that you can amplify the 20% that generates goodness in your life and weed out the 20% that causes you the most trouble.

Do you have tips for living an 80/20 lifestyle? Write them down below!