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The first step in balancing your work and personal life is recognizing that it is not just going to happen—you have to be proactive and work at it, and the time to do so is now.
Finding a balance between your work and your personal life does not just happen, according to professionals in the field of physician well-being. You have to work at it, and the time to do so is now.
“Balance requires effort, planning, and tradeoffs,” says John Schorling, MD, MPH, internal medicine professor and director of physician wellness programs at the University of Virginia School of Medicine. Referring to a psychology of postponement attributed to physicians, Schorling comments, “We always think life will be better in the next phase—when I'm out of residency, after my fellowship, as soon as my practice is built up.”1,2 But, Schorling stresses, life will never change if you are waiting for the future. The first step in finding work-life balance is recognizing that it is not just going to happen—you have to be proactive.
Reinforcing this approach, Ahnna Lake, MD, a physician life coach who offers workshops on physician wellness, states, “When we stop believing that we're just victims of our situation and see that we are really perpetrators, then we will see change.” Lake advises physicians to track important indicators of well-being over time, including close relationships, general health and energy level, and satisfaction with work and daily life. If there is a decline, look at behaviors and make adjustments.
For physicians, tracking these well-being indicators may not be as straightforward as it sounds, according to Lake. She notes that the process of medical training sets physicians up to fail at self-care. “You have to be a high performer. You ignore emotions. Taking time for yourself is discouraged. You ignore bodily signals. No matter how sick you are, it's irrelevant—you just soldier on.”
Even since the 2003 mandate to limit resident work hours to 80 hours a week, chronic sleep deprivation and fatigue among residents have been common, according to a report recently released by the Institute of Medicine.3 When physicians start practice—whether in academia or the community—demands on their time and energy are intense. There are no limits on work hours, and many find themselves with extended hours to which they are not accustomed. Sacrificing self-care, they press on, doing whatever it takes to succeed and not maintaining a sustainable work-life balance.
Schorling comments that the compulsive personality traits that got physicians into medical school and that make them good physicians are also contributors to a lack of balance in their lives. “Physicians get a lot of their self-worth from their work. The importance that work has for physicians makes it hard for them to set priorities and recognize that other things are equally important.”
Neglect of self-care, a compulsive drive to achieve, and the inability to prioritize are all traits that put physicians at risk for work-life imbalance. If ignored, such imbalance can lead to grim consequences, including burnout, depression, divorce, behavioral problems, mood disorders, and substance abuse.
Among his clients, Peter S. Moskowitz, MD, a life coach and the director of the Center for Professional and Personal Renewal, finds that people who burn out professionally are often those who had the brightest fires in the beginning. “Often the doctors who are the most compassionate, the most caring, and the hardest workers are the ones who get burned out,” he says. They do not have a self-care program in place to sustain their energy, and they become depleted emotionally and spiritually.
To create a sustainable, balanced lifestyle, take time to objectively assess your physical and emotional wellness and then keep track of the key indicators of your well-being over time.
The inability to say no and to set limits is a common problem among his physician clients, Moskowitz says. Saying no without feeling guilty is understandably difficult for physicians, he acknowledges. “They are not asked to do unimportant or worthless things. But if they continue to say yes, eventually they will not have time for anything. To be effective in work-life balance, you have to set priorities.”
Brian Link, MD, professor of medicine (oncology) at the University of Iowa, describes how realizing he could say no to selected perceived work demands was the key for him in finding work-life balance. Link joined the Iowa faculty 15 years ago, right after completing his oncology fellowship. As he approached the time when he would be evaluated for tenure, he felt compelled to achieve more—travel to more conferences to network, apply for more grants, write more papers. At some level, he says, he feared that if he did not make tenure, he would lose his job. At the same time, he had many family responsibilities and consequently felt significant pressure from the conflicting demands on his time. The pace of his activities was really not sustainable, and he approached the dean to talk about it. “Ultimately, I realized I could choose not to take on as much. I could say no to new proposals and yet not have my job threatened.” Link began turning down some grant application opportunities, and since that period, he has spent more time with his family. He feels successful in having created an environment in which his children can thrive, and he truly enjoys both the research and the patient care aspects of his job.
Link says that oncologists, early in their career, may not appreciate that they can say no. His advice? Recognize that your skill set is highly valued, and that you are in the driver's seat. Be true to your priorities.
Time and money are physicians' two principal resources—the commodities they have to navigate their work-life balance. Younger physicians often have significant financial challenges and demands on their time that call for hard choices. In addition to having significant school debt, matching the lifestyle of their more established colleagues is tempting. Having discretionary income for the first time, it is easy to be lured into purchases and a lifestyle that digs them deeper into debt.
As Link described, having a young family at the same time you are establishing your career creates conflicting demands on your time. In addition, for many physicians, productivity is tied to income, making personal time inversely proportional to increasing compensation.
Alan Metzger, MD, who started oncology practice three years ago in Greenbrae, California, offers examples of the time and money choices he and his wife, also a physician, have made. Among their financial challenges are the responsibilities of a first-time mortgage, paying off both college and medical school loans, and saving for the future of their two children. “It's pretty daunting,” he says. “We realize we have to live kind of conservatively. We do take time off, but we don't take travel vacations—just day trips and an occasional weekend trip. We're very happy with this.”
Regarding their time, Metzger and his wife have made their children a priority. They do not have a television, and if he has medical records to complete or other work to do in the evening, he does so after the kids' bedtime. “Our time is precious,” he says. Although both of their jobs are stressful, he says they try hard to leave their work at work.
Metzger emphasizes that one's choice of a practice to join is fundamental in achieving work-life balance. He feels supported by his group and says his day-to-day interactions make him feel good. His advice to oncology fellows starting out: “The people you work with are probably the most important thing when looking at a practice to join. They are going to be pivotal in your happiness.”
It is well known that caring for patients with cancer takes an emotional toll. In addition to the emotional loss that physicians experience with the death and suffering of patients, other emotions can emerge, including a sense of failure, feelings of powerlessness, and a desire to avoid patients to escape these feelings.4
The following resources have been recommended by professionals in physician well-being who were interviewed for this article.
Finding Balance in a Medical Life, by Lee Lipsenthal, 2007 (www.findingbalanceproductions.com)
The Joy Within: A Beginner's Guide to Meditation, by Jean Goldstein and Manuela Soares (Simon and Schuster, 1990)
Crucial Conversations: Tools for Talking When Stakes are High, by Kerry Patterson, Joseph Grenny, Ron McMillan, and Al Switzler (McGraw-Hill, 2002)
Stress for Success, by James E. Loehr (Three Rivers Press, a division of Random House, 1997)
Dr Moskowitz may be reached at the Center for Professional and Personal Renewal: http://www.cppr.com.
Dr Lake may be reached at 802-253-9369; e-mail: moc.loa@dmekala.
“The work can be soul-sapping,” says Minneapolis oncologist Stuart Bloom, MD. “It's very, very easy to become cynical.” To avoid this pitfall, develop an approach to patient care that keeps you involved at a personal level. Denying an emotional connection is draining and can lead to depersonalization and eventually to burnout.5 Many physicians distance themselves from patients because of the painful emotions that emerge if they are more involved. Bloom, who had an acting career before starting medical school at age 33, offers advice from his training as an actor. “If there is something that makes you uncomfortable, that's what you should probe.”
Bloom's approach is to be open with his patients. He talks about his own colon cancer diagnosis a year ago, for example, and he encourages patients to share their fears about the future and possible regrets about their life. “I always talk about the big picture stuff with patients,” he says. “I think it's just as important as the science, the treatment.” His advice for young oncologists: “Never lose sight of why you got into it.”
Recognize that a balanced life is not just going to happen. If change is needed, you are going to have to initiate it.
The first step in creating work-life balance is identifying what is important to you. All three wellness professionals consulted for this article emphasized the importance of aligning your personal values and priorities in your career and personal life. Moskowitz calls living according to your values “living with authenticity” and asserts that people who live authentically are happy.
If you find it hard to express your priorities, you may have a mismatch between your life and your values. Moskowitz reports that professionals suffering from burnout often find it difficult to answer the question, “What are your deepest-held values?” Professional coaching can be useful in helping to set priorities and develop strategies to achieve work-life balance. Lake notes that a physician coach will serve as an ally while helping you see your own situation objectively.
Effective time management, more delegation, and improved efficiency are not strategies for achieving work-life balance. They are useful skills that can enhance your effectiveness, but developing and sustaining a work-life balance involves incorporating an ongoing program of self-care. Wellness experts suggest incorporating the following strategies that involve physical and emotional aspects of your life:
Even if it is only 5 to 10 minutes, allow yourself a thoughtful quiet period every day to keep a journal, meditate, or read inspirational materials. Meditation is a restorative practice recommended by many professionals.
Do what you tell your patients: Exercise regularly, eat nutritious meals, maintain a health body weight, and develop good sleep habits. In addition, consult with a primary care physician regularly. If you do not have a primary care physician, get one.
First, make sure you have someone in your life in whom you can confide. Then, make sure you carve out regular time to do so. Moskowitz suggests that married couples have an annual meeting or a weekend getaway specifically to talk about their personal and relationship goals.
Interacting with people who are not in medicine will give you a broader perspective on the world. Join an astronomy club, play on a community sports team, sing in a chorale, or join a hiking group, for example.
Take time to do something that brings you joy. Activities that are not related to medicine are great stress-busters. A solitary hobby like woodworking or watercolor painting doubles as a quiet time for personal reflection, and a cooking club or bowling league can lead to rewarding friendships and social interaction.
Find ways to incorporate these activities as a regular part of your lifestyle. You will still encounter times when your schedule or the events in your life tax your energy or add significant stress. But those are exactly the times when inner stores of resilience, developed through an ongoing self-care program, are essential.
Bloom, the Minneapolis oncologist, offers examples of how he has incorporated several of these strategies into his lifestyle. He reads while he works out three times a week on an elliptical machine for an hour. “I get up at 4:30. I'm done with my workout by the time I wake up,” he jokes. He talks with his wife (“we're best friends”) about the interesting people he has seen, but cautions, “It's bad to bring work home if you're not working it through—not processing it, trying to learn from it.”
Reinforcing Schorling's comment that balance requires effort and planning, Bloom says, “I have the balance because I want it. Those things are important in my life.”