Finding Medical Work-Life Balance

The work-life balance conundrum affects every living soul. If doctors are to hope for any chance at an alleged work-life balance in medicine, they first must confront and manage any guilt they might have about time away from journals and patients

The work-life balance conundrum affects every living soul. In Japanese Zen, the word for seeking this harmony is “wa.” And the many tentacles of this conundrum weave through our changing lives making it a permanent work in progress.

Doctors have all the usual competing forces that others do pushing on our lives, and to the point, we also have some additional burdens to add to the mix. And lest we forget, we chose to add them voluntarily!

Docs in training are in a prolonged, locked-step lifestyle. See patients, eat, sleep (maybe), study and repeat. “Balance” is vanishingly improbable. Then, relatively suddenly, after all those lock-step years, with no guidance whatever from our training (as I endlessly repeat in these columns) we’re turned loose to build a practice, build a family and make a life.

Most of us muddle through somehow, but, as in all things, a little time spent to study and reflect upon this subject will pay off in many ways. We will benefit emotionally, financially and in other ways beyond the purview of these pages.

Once you have assumed the mantles of practicing doctor, husband/wife, father/mother, homeowner, investor, etc., you still have other concerns. What about time for exercise, hobbies, community involvement, hospital/medical society activities and, dare I say, vacations? These are tough choices for our precious time.

Especially because docs have two self-imposed, additional responsibilities above the usual looming over us: the unending train of patients who need/want our time and the seemingly impossible task of “keeping up” with the geometrically expanding body of medical knowledge. What is an appropriate guideline to say “no more” patients/journals for today? How do we manage the carefully inculcated guilt/ duty that we all have?

In a New York Times op-ed in 2011, Dr. Karen Silbert put it succinctly: “Medical training is a privilege, not an entitlement, and it confers a real moral obligation to serve.”

So, if we are to hope for any chance at an alleged work-life balance in medicine, we first must confront and manage any guilt we might have about time away from journals and patients. Note: I am finessing my cynical friends here who look askance and say “Are you kidding me?” No.

In the interest of a “fair and balanced” article, I am going to play this one straight.

Obviously there is no one final answer for anyone and even any temporary working mix of activities and time slots will be highly personal, all subject to frequent alterations as we and the times change. We do what we must, and then we do what we can.

This is especially difficult because we are talking about vague concepts like “quality of life” and “finding meaning in our lives.” One person's pleasure is another's poison, and vice-versa. Even a rewarding profession such as medicine has its hazards, such as burnout, which, it is claimed, may affect up to half of all docs. So vigilance over our well being has some bearing on this balance as well as the pursuit of professional and personal satisfaction, simple pleasures and don't forget money is an important facilitator in our lives. I would hope that the dear doc/reader would not consider money an end in itself. Harumph.

Work, especially in medicine, has traditionally been a primary source of fulfillment and meaning. But an under-the-radar generational change has developed that I have cited before. Young docs have seen the toll that has been taken on older docs operating as small businessmen and have a new attitude about time off. Parenting, particularly, has seen changes as medicine has shifted to being half female. And with more than 50% of docs taking salaried positions, the siren call of more hours and more patients has been quieted by the limitations of opportunity/necessity inherent in shift work in groups.

Even so, we still need to deal with civilian life's competing pressures just as we had to learn to juggle the conflicting demands of an over-populated ward or over-large panel of patients.

Wryly, I recall that every patient I have ever asked, regardless of job category, has testified that theirs is “the most stressful.” Maybe, somehow, helping them reestablish balance, medical, emotional and otherwise, in their lives helps us reflect on finding and maintaining our own balance — our harmony, our “wa.” I hope so.