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The 10,000 Hour Rule

By Edwin Ozawa posted 02-03-2017 15:33


The author Malcolm Gladwell spends a chapter discussing the so-called "10,000 Hour Rule" in his book "Outliers." The Rule states that it takes about 10,000 hours of deliberate practice to become an expert in a task. 

The Rule is considered to be controversial. However, from personal experience, I find that there may be some merit to the Rule when it applies to Healthcare. 

I completed my Residency in July 2003 and immediately began working at Lahey Hospital and Medical Center the following month. When I started as a new Attending Physician, it was a bit of a shock. I had the necessary skills to take care of patients, but not to function as an employee with a high degree of independence. I started off by taking simple cases in healthy patients but eventually moved into performing more complex anesthetic cases such as for liver transplantation. 

Becoming comfortable with my career took a while. In fact, it took five and a half years. This fact makes sense according to the 10,000 Hour Rule. If one figures 40 hours a week at work, over 5.5 years at 47 weeks a year (excluding vacation weeks) this totals about 10,340 hours. Early in 2009, right on schedule, I started feeling bored with work. I was by no means the best anesthesiologist in the world. However, I was competent and able to handle virtually any hard case that got thrown my way. I kept asking myself, "what is the next step?" There were no answers that were obvious. I began seeking other challenges around the hospital to tackle. That is when I stumbled on Healthcare Simulation.

In 2009, an experienced surgeon was hired by my hospital to develop a simulation program under one roof. Many departments such as nursing, medicine, and surgery were already using simulation to train people, but they all took place in separate silos. This new head of simulation approached each department chair and asked for a champion from each specialty to help him build a unified simulation program. I was invited to be the champion for my department.

Six years later, I am now neck deep in the simulation effort at Lahey, and also in the Society for Simulation in Healthcare which is one of the largest societies devoted to promoting the discipline.

For the longest time, I felt that my need to develop and evolve was the product of a restless mind. However, I also felt that this need, perhaps, was a symptom of unnecessary dissatisfaction. After all, what reason did I have to complain? Wasn't I already living the dream?

The point of the 10,000 Hour Rule in the context of this post is that the Industry of Medicine does not change rapidly enough to make competence obsolete in 6 years time. For example, the practice of Anesthesia has marginally improved since I graduated from residency. 

So if someone like me wants to continue to evolve and grow in my line of work, then that someone will probably have to look outside of day to day clinical practice to find that challenge. 

Part of the answer to my question of where to find the next challenge came from Atul Gawande's book "Better" in which he lays down a formula for how clinicians can advance in their field and also improve the environments that we work in. If you have not read the book, it is well worth the read.

I feel that we in the Healthcare Industry have an obligation to grow ourselves, our careers, and the profession once we become comfortable in our specialty. 

To expand on Gawande's suggestions, here are six things we all can do to improve ourselves as well as the healthcare industry once we become completely comfortable with our jobs:


We all have stories and opinions. Find pet peeves or issues that get under your skin and get them onto paper. Try starting a journal or even a blog if you do not mind sharing your ideas. 


As with writing, if you have strong opinions about things and solutions to share, why not tell others about it?

Get involved with quality and safety

How many times have you seen something at your workplace that isn't right? Either you can stand back and complain, or you can problem-solve and help to work on a solution to make that pet peeve go away. 

Do research

Gawande suggests we should "count something." If you want to make things better, how do you know if your efforts are making an impact unless you can identify measurable objectives? Figure out ways to collect data about your projects.

Join committees

Often we have a hard time getting out of our silos and meeting other people outside of our specialties. Getting involved in hospital or medical school committees is an excellent way to connect with people from diverse backgrounds who are also interested in making an impact. 

Get involved with professional societies

Bring your ideas, thoughts, and numbers to a national or international conference. Get outside the walls of your organization and compare notes. 

I would love to hear your opinion about this post. Please feel free to leave me comments!