Today, 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 "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.
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 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.