BACK of the BOOK
The Break Room
A look at the social side of medicine
WORK-LIFE BALANCE:
SOMETHING’S GOTTA GIVE
oday, the term “work-life balance” is
ubiquitous in discussions about our working lives, and everyone has an opinion about
its validity, how we can better achieve it, and
why it’s so good for us. For all the advice and
conversation about this topic, though, we still
face the same problem: There are only 24 hours in a day
to fit everything in.
In the past, you sucked it up and made choices to either disappoint your boss or disappoint your family. We
never really discussed it; now that it is in the zeitgeist,
though, we are talking about it more. Rather than making any of us happier, though, I think it might just be
making us feel guilty all of the time.
Can We Ever “Clock Out”?
“Work-life balance” takes on a different meaning to
different people. My perspective – as a single woman
without children – is very different from someone with
a husband or a wife and kids at home. The situation also
changes depending on whether you have a stay-at-home
spouse and on the age of your kids.
Work-life balance also takes a much different form
because of the career we have chosen. Medicine is not
a job, it’s a profession; people depend on you, so you
can’t just clock out. This concept that you – a man or a
woman – can “have it all” is inconsistent with reality.
You cannot give 100 percent to your job, 100 percent to
your family, and 100 percent to your own health. Something has to give.
When it comes down to it, I think people should
do the things that make them happy and minimize the
things that make them miserable. Work-life balance is
extremely important, but – and I hope I don’t scare too
many potential trainees away from my program – it
doesn’t give you free reign to shirk the important things
in your professional or personal life.
Your family absolutely deserves your time and energy, and I am sympathetic to those needs. As a fellowship
director, I am responsible for 18 trainees and – realizing
that I’m not the greatest example of a healthy work-life
balance – I make a distinct effort to remind them to go
home and be with their families.
But, when a first-year fellow tells me during rounds,
“I just need you to hurry up because I have a tennis
lesson at 5,” I’m not going to be too sympathetic to that.
If you want to be able to make your tennis lesson, be an
accountant.
A New School/Old School Problem
During my training, 40-hour days were not uncommon, and I rarely went home. Now, the concept of
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ASH Clinical News
“shift work,” as mandated by the American Council for
Graduate Medical Education, has the unfortunate side
effect of fostering the idea that medicine is something
you can walk away from. Does that mean that the current crop of trainees is irresponsible? Of course not, but
it is a definite attitude switch.
I certainly thought that my life would be easier once
I finished training – more control over my hours and
more control in choosing what I do and when I do it.
Obviously, as faculty I do enjoy those benefits; however,
now the pressures are internal rather than external. I
know that, to a certain extent, my job is never done.
We talk about
“work-life balance”
so much more in our
conversations about
our working lives
today, but is it making
any of us happier?
As a program director on the other side of training,
though, I have the opportunity to make better choices.
For example, when I turned 39 ½ and was looking 40
dead in the eye, I switched my priorities. I joined a
gym, and I started actually using my vacation days to
travel. That doesn’t mean that I have had a day off in two
months, though.
To cope with that – and to inject some “life” back
into my work-life equation – I treat myself to flowers or a
massage or outsource chores during the work-dominated stretches. In some respects, not having those external
pressures pulling me away from my job makes balancing
work and life a little more difficult: It’s not uncommon
for me to start working at 6 AM, and when I look up
from my desk, it’s suddenly 7 PM.
Growing up with crazy Asian parents with a crazy
Asian upbringing (minus the piano lessons), the skepticism about work-life balance was probably ingrained
in me since birth. I was raised with the full expectation
By Alice Ma, MD
that I would work. I asked my father what he thought
about this topic, and he was perplexed: “Work-life balance? That’s for when you retire.”
My best friend from fellowship and I had very similar
upbringings. Today, she’s married with two children and
works at my rival institution that shall not be named.
How does she juggle her career and caring for her family (her physician-husband, her children, and her older
parents)? She’s made peace with constantly feeling guilty,
wishing she could always give more time to both work
and life. Her family is the most important part of her life
– with tremendous and unique and priceless rewards –
but she also values her career. So, she makes the choice to
do the best she can with the 24 hours in a day that she has.
The people who have what we imagine as the optimal
work-life balance are people who can survive on four
hours of sleep a night, which leaves 10 hours to give to
work and 10 hours to home. Of course, is shortchanging
your personal health that way sustainable – and does it
negatively impact the other aspects?
A Prescription for Balance
At the end of the day, the juggling act we all play is about
making the best choices for ourselves. My advice is to
make those choices and never look back. Constantly
second-guessing those choices will simply end up driving
you crazy. Twenty-four hours is a hard and fixed rule that
we work within; we don’t get to make more time, but we
do get to prioritize and steal time from one activity to give
to another.
Above all, I believe in promises. If you promised
your son or daughter that you would be home for his or
her birthday, that’s a promise you have to keep – even
if it means something gets dropped at work. Likewise,
if you promise your collaborators that you will have a
grant done on time, then you owe it to them to keep that
promise – even if it means you are not home for dinner
for a week. So, be careful about what you promise so that
you disappoint as few people as possible.
We all have some form of work-life balance – unless
we are independently wealthy and can afford to walk away
from work. We have to realize that as a privilege; there are
people without jobs and people who work three jobs just
to survive. The fact that we have a choice as to how we balance our work and life is a privilege. Even though it may
feel like an unbelievably difficult decision, it is still our
choice to make, and we should celebrate that. ●
Alice Ma, MD, is an associate professor in the Department of
Medicine, Division of Hematology and Oncology, at the University of North Carolina School of Medicine in Chapel Hill.
May 2015