Don’t Pawn Off the Work: Bob’s Method for Tackling Big, Hairy Projects

By  |  December 30, 2012 |  12 

In my last post, I promised – just in time for the New Year – to describe my fail-safe method for tackling overwhelmingly large projects. Please, please don’t waste this method on cleaning out a closet or writing an abstract. That would be like using a flamethrower to light a holiday candle. Rather, consider it when you find that simply thinking about starting some vast project induces a debilitating headache.

While the method can work for major life projects (such as dealing with those two dozen boxes you’ve moved, unopened, to your last three residences), I find that it works best with huge writing tasks. I last used it with my wife, Katie, who was trying to finish a revision of her memoir Mother Daughter Me (which will be published by Random House in July 2013). We were in London last year on sabbatical and Katie really wanted to slay the beast before we left, which gave her about 3 weeks. After receiving a boatload of suggested changes from her editor, she was staring at a lengthy to-do list whose contents ranged from tightening one sentence to rewriting several multi-page sections. She was overwhelmed.

Yet 21 days later (16 actually, so effective was the method), the draft was finished. Abraham Verghese, the physician-author and a friend, happened to be visiting us at the time and was awed by what he saw. Abraham encouraged me to develop an app for the method, and if I was more entrepreneurial I would. But I’m not, so here it is.

Although I invented this method long before the concept of “gamification” became trendy, it follows those same principles: it breaks down a seemingly overwhelming task into manageable chunks, and turns the completion of the chunks into something of a game. It also offers the erstwhile procrastinator a choice of how much to bite off each day, which, for reasons understood only by behavioral economists, feels liberating and stirs one to action. Finally, when used in the service of writing, it takes advantage of the age-old adage to write something every day, even when the act feels like opening a vein.

I’ve always enjoyed the game of chess, and my method is drawn from a central fact of the game: each piece has a different value. These values explain why, for example, one should be giddy about exchanging a bishop for a rook. For our purposes here, the relevant point values of the pieces are:

Queen: 9 points

Rook: 5 points

Bishop: 3 points

Pawn: 1 point

Katie had 74 tasks on her list – a near-paralyzing number – and a self-imposed deadline of 3 weeks.

To begin, I had her chronicle these tasks, one to a line (things like, “Find a quote to begin Chapter 5” or “Rewrite the restaurant scene”).

Next, I had her assign a point value to each task. If a task seemed like a no-brainer, something she could whip off in an hour or so, she deemed it a pawn and gave it a score of 1. At the other extreme were a few rewrites of entire chapters or sections; these would take at least a couple of days each and a huge amount of cognitive and emotional energy. She called these tasks queens and they received values of 9. The other tasks were intermediate: bishops were worth 3 points, and rooks, slightly more daunting, were 5 points.

We mapped this out on an Excel spreadsheet. The first column was the task, the next was its point value (1, 3, 5, or 9). We then summed up all the points: the 74 tasks added up to 250 points (17 pawns, 38 bishops, 13 rooks, and 6 queens). Next we divided the total points by 21 days, which yielded an average of 11.9 points per day. In other words, for Katie to complete the entire project in 3 weeks would require that she earn about a dozen points each day.

We then built a second spreadsheet. Its left-most column listed each of the next 21 days. The next column was for the points completed on that day (filled in at the end of that day’s work), the next for the points remaining (calculated by subtracting that day’s completed points from the previous day’s remaining points: 250, 245, 218…), and the next for the days remaining until scheduled completion (20, 19, 18…). A final column was called “New Point Target” – it derived by dividing the value in the “points remaining” column by the value in the “days left” column.

The beauty of all of this was that Katie now realized that she could get her daily points (I know, it sounds like Weight Watchers) via a number of different pathways. A solid 12-point day could involve knocking off a queen and three pawns, or a rook, two bishops and a pawn, or a rook and 7 pawns. She chose her activities by her energy level and the amount of time she had available that day.

The method also allowed her to see the impact of her daily work, including the fact that a below-target day wasn’t fatal. For example, on her first day, she only knocked off 5 points, which was a bummer. But the spreadsheet was a surprisingly gentle taskmaster, calculating that all this did was raise her required daily output for the next 20 days from 11.9 to 12.3. And the next day, she went on a tear and accumulated 27 points. This lowered her daily target from 12.3 to 11.5 for the remaining 19 days. Seeing all these options was astonishingly empowering; it also effectively extinguished the tendency to procrastinate.The method made clear that if Katie tackled a big task one day and got ahead of the game, she could either enjoy a light day or two or – if she kept up the torrid pace – finish the entire project early. For example, she could see that after a few strong days, she could be done with the project in 17 days rather than 21 (while continuing to average 12 points per day), or she could lower her daily point expectation to, let’s say, 10 points per day and still finish on schedule.

When the tasks were done, ahead of schedule, all we had left to do was celebrate, and marvel at how easily humans can be helped to perform beyond our own expectations. Sometimes, all it takes is organizing the work differently – particularly dividing a daunting task into many bite-sized ones, and figuring out a way to generate a little dopamine squirt after each little victory.

If one of your New Year’s resolutions is to tackle a big, hairy project that you’ve been kicking down the road, think about giving this a try. It really works.

Happy New Year to you and yours!


  1. ingrid December 31, 2012 at 1:56 am - Reply

    This is a nice tool, thank you! It reminds me of “story points” used in agile software development but applied to other types of projects.

  2. Mark Neuenschwander December 31, 2012 at 6:21 pm - Reply

    Project: Try Wachter’s Method.

    Read Bob’s Article: Pawn
    Write a thank you to Bob for sharing his method: Rook
    Find a project to apply Bob’s method to: Bishop
    Start new project: Watch Bowl Games today: Rook
    Take a nap: Pawn
    Find a better project to apply Bob’s method to: Queen

    Happy new year Bob. Thanks for sharing your method. I’m certain I will use it.

    • Jon January 2, 2013 at 4:22 am - Reply

      Mark, just love your reply to Bob’s method; I can see you will be properly applying it to many keys aspects of your life. LOL.

  3. Cheryl Clark January 2, 2013 at 4:03 am - Reply

    LOVE this.
    In procrastination mode, I do gamification myself to accomplish stuff. It works when other incentives don’t.

    Sometimes, I get overwhelmed. I may have 5 errands (get coffee), 10 writing or story ideas to finish (magazine deadline coming up), 15 household items (fix the curtain rod), 8 bookkeeping projects (taxes!), 10 phone calls (yell at my roofer!).

    I’ll note each task on separate slips of paper and place these slips into jars, depending on the category. If i’m having trouble figuring out what to do first, i just close my eyes, and put my hand in one of the jars to pick out a slip of paper. The absolute caveat, however, is that I must do that one thing, however disgusting and horrible. that’s the rule of the game. I have to do this one thing.

    some might say this entire exercise is incredibly anal or ocd. But it works for me when i get in a mental rut. Congrats for devising a much more sophisticated strategy!

  4. Jon January 2, 2013 at 4:21 am - Reply

    Is it just me, or do any of you find this post by Dr. Wachter a bit unsettling, if not outright disturbing? Dr. Wachter, the eager new CEO of the ABIM, makes a handsome living, far more handsome than the average clinician, from the MOC fees of hard working clinicians such as myself, who need to see 25 or more patients a day in order to pay expenses and earn a living. He has been making quite a splash of late, trying to convince anyone who will listen that MOC is “essential to ensuring quality physician care”, or something like that, without any rigorous and credible scientific evidence to support such a contention, and without ever acknowledging the obvious conflict of interest between someone who advocates for MOC and someone who earns a handsome income from MOC.
    It seems, however, that Bob has a little extra time on his hands (guess with all of that MOC money, he doesn’t have to worry about seeing those 25 patients each day that I do), and so we get this, Bob’s “as promised – just in time for New Year…fail-safe” primer on how to “tackle overwhelmingly large projects”. Don’t worry Bob, I wouldn’t dream of using your method on something as mundane as “cleaning a closet or writing an abstract” as that would be an extreme case of overkill, using your “flame-thrower” methods.
    But the real issue is this, just how did I, a 50 year old triple board (IM, pulm and CC) recertified (for the LAST time, that’s for sure) physician, co-partner of a very successful, long standing and thriving multispecialty medical practice, husband and father of two successful sons, possibly make it to this stage of my career and life WITHOUT Bob’s method to guide me? For that matter, how did any of the successful highly trained, skilled, hard working professionals likely to read this Wachter’s World thread get where they got in their lives without Bob’s method? Dumb luck? I don’t think so. Somehow, we all figured out how to succeed in our very challenging professional and personal lives by our own efforts and methods, without the mid-life pontificating of a patronizing bureaucrat. Imagine that.
    Don’t be fooled, fellow colleagues; the tone of this post from Bob goes hand in hand with Bob’s, and the ABIM’s, agenda of cramming the ever more costly, time consuming and fundamentally irrelevant money making scam that is MOC down our throats. Why? Because Bob knows what is best for all of us, didn’t you know? Next week, perhaps, there will be a post from him on how to organize our garages or tend to our gardens; there is no way we could tackle such things without his guiding hand.

  5. Ryan January 2, 2013 at 6:03 pm - Reply

    This is a great technique. Thanks for sharing. Happy new year.

    • Bob Wachter January 3, 2013 at 3:55 am - Reply

      I’m glad my method has proven helpful, or at least interesting, to a number of people.

      Re: the comments by “Jon”, while he has every right to his opinions about the ABIM and Maintenance of Certification (as do the many others who have weighed in), I’d like to correct a falsehood. I am not the CEO of the ABIM; that is Dr. Christine Cassel. Chris is stepping down in June, when she will become CEO of the National Quality Forum, and we are presently searching for her replacement as ABIM CEO. I am not a candidate.

      I am the chair of the board of the ABIM, a one-year position for which I receive a modest stipend. The position ends in July, at which point I will rotate off the Board. Even as I leave the Board of Directors, I will remain highly committed to the ABIM’s work (and to MOC), which I see as essential to professionalism, to physician self-regulation, and to the quality of patient care in the U.S.

  6. Ken Simone, DO, SFHM January 3, 2013 at 11:43 pm - Reply


    Great write. DId Kate approve of your expose’? LOL. We could all do better in time management and modifiying beaviors in this fast paced and demanding world, whether writing a book, practicing medicine, being more efficient in work or life tasks or being a more accessible husband, father/mother, or friend. Happy New Year!


  7. Jon January 4, 2013 at 5:47 am - Reply

    My apologies; I did indeed mistakenly refer to Dr. Wachter as CEO, rather than Chair. The issue of compensation for the Chair remains a tad murky. The 2009 tax forms for the ABIM, available online, show remarkably handsome compensation for the CEO and many other members of the ABIM, but the compensation for the chair at that time, Richard Baron, is listed as zero, which does not seem possible. At a 2010 public meeting on the merits of MOC, one of Dr. Wachther’s predecessors, Steve Ruben, acknowledged publicly making $1000/day in his position as ABIM chair, not exactly a pittance. Perhaps Bob has accepted a pay cut? But no matter. Again, the bigger issue is this: are tens of thousands of successful doctors, loved and respected by their patients for good hard work and excellent care, now going to allow themselves to be taken by the hand, like errant children, and be told what is good for us by a handful of bureaucrats, citing dubious science, many of whom have a great financial stake in the promotion of MOC? I don’t need to set up an Excel spreadsheet or two to realize something is very wrong with this picture.

  8. Deborah January 8, 2013 at 3:23 pm - Reply

    Thank you for providing an elegant, simple “helpful medicine” tool; I’ll use this to more efficiently manage my home and work tasks. Gratitude.

  9. Lou January 12, 2013 at 8:30 pm - Reply

    Re: the comments by Jon: Jon, you are clearly an out of touch, dissatisfied, unfulfilled physician who must be burned out to critical levels to spew such words. Accusatory, hateful, and clearly inappropriate. You can state your opinion as well as I, but to personalize it is wrong and shows deeper issues on your part. From my perspective, I see docs all the time that are still practicing as if its 1985 & haven’t picked up a book in 20 years. MOC is a valuable tool that I don’t want to have to deal with, but I would NEVER push myself to keep up as much without it. I doubt that Bob personally singled us all out to be punished. We as hospitalists WANT to be known for our excellence & should embrace higher standards. Could he receive a stipend for being on the board? Why not? Perhaps you should be more involved on a committee level to voice your opinions in a better forum. You might even get a stipend, too. Perhaps your income issues arise from patients perceiving the same negative attitude you spew here. I recommend cutting back a little, examining your own life, or, if that fails, a little ativan.

    • Jon January 13, 2013 at 9:46 pm - Reply

      Well, let’s see. Out of touch? Sadly, I feel I am only too well in touch with the undeniable reality of the over-regulation of medicine. Dissatisfied? Yes, without question, some of the time, like more and more doctors nationwide. Unfulfilled? Well, it is still a privilege and a pleasure to practice the art of medicine, but the intrusiveness of needless over-regulation at times greatly diminishes some of that fulfillment. Burned out? Well, sure, some days, I suppose, like more and more doctors, according to survey after survey. Accusatory? Well, the fact are the facts. There are no independent rigorous scientifically compelling studies to prove, or even convincingly suggest, that MOC docs are better or more efficient docs that non-MOC docs. Nonetheless, members of the “non-profit” ABIM, people like Christine Cassel, soon to be former president/CEO, who earned a salary of $534,222 in 2009 or Lynn Langdon, Sr. Vice President and COO, who earned $402,562 in 2009 (amounts from publicly available tax Form 990), for example, make obscene salaries from the test fees and other revenue related to MOC. People who, in some cases, did not bother to do MOC themselves, for its own sake and educational value, for decades but who suddenly did MOC upon becoming members of the ABIM (a requirement to be a member of the board). Hateful? Yes, I hate getting shafted. Inappropriate? Don’t see how it is inappropriate to speak out against a scam. Those docs you mentioned who have not picked up a book in 20 years? Well that is unfortunate and hopefully an exaggeration, but that is what CMEs are for and what I and the doctors in my community do routinely, by our choice. Let me be clear. I am all for ongoing medical education, but MOC is not a “valuable tool” to achieve that education. Instead, it is an exercise in test taking and transiently memorizing esoterica as part of that test taking. If YOU “need” MOC to force you to keep up with medicine, that is your issue, but that does not sufficiently validate MOC so as to justify its becoming the mandatory, linked-to-licensure (as in every two years) entity that the various boards are exploring and promoting in a dozen or more “pilot” programs nation-wide. Whether or not Bob has or has not singled out anyone for “punishment” is not something I can speak to but as far as unfairly picking on Bob, as you clearly imply my post did, hey, he is the Chair of the ABIM; his is the face and name that first greets you when you go to the ABIM homepage and so it is part and parcel of his position that he takes some heat for a system that is deeply flawed, unfair, onerous, unproven and costly. I have no problem with him, or any member of any board, being fairly paid for their work; I just have a problem with anyone being paid exorbitantly by forcing a dubious product onto the backs of already overworked professionals. As to whether all this “negativity” that you feel I am “spewing” is hurting my revenue stream vis-a-vis my patients, my packed schedule (25 patients or more every day) weeks in advance would seem to suggest otherwise. Guess I am still professional enough to keep it together in the exam room and save my negativity for after hours. Of course, since reimbursements go steadily down and overhead goes steadily up, it is indeed a little tougher to make a buck now than it once was and that may indeed have something to do with the negative vibe that seemed to catch your attention. I appreciate your advice to cut back, and I do so when I can, believe me. I also examine my life continually, no worries about that. And as far as the Ativan, well, a glass of red wine Friday and Saturday night with dinner seems to do the trick.

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About the Author: Bob Wachter

Robert M. Wachter, MD is Professor and Interim Chairman of the Department of Medicine at the University of California, San Francisco, where he holds the Lynne and Marc Benioff Endowed Chair in Hospital Medicine. He is also Chief of the Division of Hospital Medicine. He has published 250 articles and 6 books in the fields of quality, safety, and health policy. He coined the term hospitalist” in a 1996 New England Journal of Medicine article and is past-president of the Society of Hospital Medicine. He is generally considered the academic leader of the hospitalist movement, the fastest growing specialty in the history of modern medicine. He is also a national leader in the fields of patient safety and healthcare quality. He is editor of AHRQ WebM&M, a case-based patient safety journal on the Web, and AHRQ Patient Safety Network, the leading federal patient safety portal. Together, the sites receive nearly one million unique visits each year. He received one of the 2004 John M. Eisenberg Awards, the nation’s top honor in patient safety and quality. He has been selected as one of the 50 most influential physician-executives in the U.S. by Modern Healthcare magazine for the past eight years, the only academic physician to achieve this distinction; in 2015 he was #1 on the list. He is a former chair of the American Board of Internal Medicine, and has served on the healthcare advisory boards of several companies, including Google. His 2015 book, The Digital Doctor: Hope, Hype, and Harm at the Dawn of Medicine’s Computer Age, was a New York Times science bestseller.


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