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The Work-Life Spectrum

December 30, 2021
Matt E. Kalaycio, MD
Chair, Department of Hematology and Medical Oncology at the Cleveland Clinic Tausig Cancer Institute

I wish we had a better term for the relationship between work and life, because, in my understanding, "work-life balance" suggests that in order to have one, you must sacrifice the other. I don't believe in such a dichotomy of work and life; they are intertwined and inseparable.

Work is life, and life is work. I see them as one and the same. What I strive for is less like work-life balance and more like work-life integration. My work is a large component of my life as it is for most anyone in our profession. However, I do not consider my home life "not work."

If you asked my wife what her work-life balance is, as a stay-at-home mother, she would say her life is her work. That's true for me, too. There are plenty of people who stay home and raise kids. Does that mean they can only have life balance because they don't work outside the home? No – their work is their life.

When I visualize "work" and "life," I see a Venn diagram, not a perpetual see-saw.

In the work-life balance model, people tend to think that the sacrifice is one-sided: Family and personal time suffers due to work obligations. Obviously, if I come to work, I'm sacrificing time at home with my kids. There's simply no way around that. Conversely, the time I spend with my kids is time I sacrifice from work. When I am at a soccer match with my kids, I'm not reviewing literature, writing papers, returning phone calls, or answering emails. Yes, there has to be some compromise/balance between family time and employer time, but everybody sacrifices from both sides. I don't exclusively sacrifice my personal life for work, and vice versa. I pick and choose my priorities. We all integrate work and personal life without even thinking about it.

An Evolving Perspective

My perspective has certainly changed as I've gotten older. I've become more circumspect about my priorities. When I was a young, impressionable, naïve pup, I was much more concerned about getting my next paper published, seeing the next patient in clinic, or worrying about how I would treat the next patient.

I was also trying to develop an inpatient leukemia service at my home institution –Cleveland Clinic, so I felt it necessary to spend as much time as possible doing inpatient work to set a standard. To do that, though, I missed a good friend's wedding. My determination to set a good example at work and establish my credentials as a passionate leukemia doctor won out over my social commitment. In hindsight, I shouldn't have done that: It was far better for me to go to that wedding than to spend another weekend on the inpatient service. If that situation were presented to me today, I would choose differently.

As younger doctors start out, they often want to prove their commitment, and their personal lives often suffer. Mine did, and I was lucky to learn relatively quickly that things had to change. The decisions we make at the beginning of our careers have large import for what happens later. At the time, though, we don't realize how important those decisions ultimately become.  The key to having it all is to create your own definition of having it all without worrying about other people's definition.

My experiences as a leukemia doctor and bone marrow transplanter also contributed to changes in my outlook. My clinic includes many younger people whose lives are interrupted with horrible consequences, and the treatment we give them (even if it cures them) irrevocably changes their life story. It didn't take me long to figure out that my original priorities – career reputation above all – were misplaced. I needed to find a way to spend time with my family, while still managing to develop my career to provide for their needs. Does that mean I couldn't have it all? I suppose that depends on your definition of "all." My definition probably differs from yours, and by my definition, I have it all.

Teaching – and Learning from – the Younger Generation

In reality, no one becomes a doctor by prioritizing personal life over work. That just doesn't happen. But, once you become a doctor, you do have the ability to shift your priorities. You have to ask yourself the question, "How can I achieve everything I want in my personal life and my work life?" It's not an all-or-nothing deal; you have to actively decide to blend the two in the proportions you feel most comfortable with.

I believe the way the millennials are approaching their careers is better than how we baby boomers approached it. Fellows today are much more tuned into their personal lives, values, and needs than previous generations. When I came through, the emphasis was firmly on career at all costs. Our way – and previous generations' way – contributed to the horrifying burnout statistics today. I suspect that the burnout statistics of the future will look much better.

There are three things we should give fellows throughout their training: scientific knowledge, emotional intelligence, and a sense of leadership.

There is, however, a fourth gift that we cannot give them: Time. Time is something they have to provide for themselves – the time to spend with their families or on themselves, to develop spiritually and physically, and to reflect on that which is most important to them.

I have seen plenty of mid-career and senior physicians who did not give themselves such a gift and suffered the consequences later in life, whether in burnout, depression, ruined relationships, or – something we don't like to talk about – suicide. Now, we are fortunate to have this discussion, and we know better what we need to do to avoid these tragedies.

I implore those planning to devote their life to caring for cancer patients to first take care of themselves. My attending during my gastroenterology rotation in residency summed it up nicely: I was buying lunch from the hospital cafeteria on a rare break, and he happened to be behind me in line. "I'm glad to see you in the lunch line," he said. "Before you can take care of somebody else's gastrointestinal tract, you've got to take care of yours."


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