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Editor's Corner: All Those YESterdays

December 30, 2021

May 2021

Aaron Gerds, MDAaron Gerds, MD 
Deputy Director for Clinical Research, Cleveland Clinic Taussig Cancer Institute
Associate Professor, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University 



A few weeks ago, I was on a Zoom call with a candidate interviewing for a faculty position. The topic of work-life balance came up, as it inevitably does in this type of encounter. Given that work-life imbalance is often cited as a key element in the day-to-day stress we all face – the underlying pathology of burnout – it's no surprise that any prospective faculty would want to set themselves up in a position to avoid it.

The ensuing near rote discussion leads off with details about clinic days, inpatient service obligations, nursing support, and how many clicks it takes to get to the Tootsie Roll center of our electronic medical record. (The world may never know.) Then, in an abrupt pivot, I begin to preach the Gospel According to Cleveland, extolling the virtues of the Forest City. I tell the candidate that living in America's Rust Belt offers a unique combination of big city access and ease of living. From this small insight, a candidate is supposed to determine if they can strike a workable work-life balance.

In any occupation, a tension exists between home life and work life. Personal sources of stress like heath, finances, and relationships can influence performance on the job. Conversely, difficulty with coworkers, looming deadlines, and missed productivity goals latch on our coat sleeves like unwanted pathogens and make their way right into the home.

Many of the standard strategies to address work-life balance have fallen short. In my most cynical moments, I'm convinced we're trying to end work-life balance just by changing its name.

"It's not work-life balance anymore, it's work-life blend." Are we making smoothies?

"Actually, it's not work-life blend, it's polarity." Now we're iron filings caught between magnets in a middle school science fair project. That doesn't sound like a place where one can sustain a career.

Nomenclature aside, many institutions have made honest efforts to help employees achieve balance, ranging from the practical (discounted childcare) to the purely recreational (family fun day at the local ballpark). Some have launched entire departments with the objective of addressing faculty wellbeing and combating burnout.

Noble as these efforts are, I wonder if what's actually holding us back from achieving work-life balance is our culture of "yes." In the field of medicine, "yes" is the drug of choice from the start. Medical school is a competitive environment. It's tempting to jump at every opportunity, no matter how challenging or inapplicable to one's career goals. In postgraduate training, you're looking for any springboard to fellowship or faculty. As junior faculty, you have to launch your career in five years because it's up or out! At that point, you can't stop yessing.

Sure, you're a leukemia doc, but do you want to collaborate on a study looking the effect of beta blockers on left-handed king cobras? Why yes, of course! Will you serve on this new administrative committee? It meets at 5 a.m. on every day that end with a 'y'. Sure, why not? During late-night panics about productivity, you even consider responding to one of the hundreds of emails you've received from predatory journals. A publication is a publication, right?

When you're not saying yes to every opportunity, it's tempting to worry that you're falling behind. You could lose your edge! Your career could stall! In reality, that won't happen. The well will not dry up. Opportunities are like public buses – maybe even more reliable. Another one will come along.

Work-life balance may be a universal goal, but it's also highly individualized: My balance is different than yours or theirs. Introspection isn't often encouraged in the ultracompetitive environment of medicine, but it should be. Self-reflection is a way to identify strengths and sources of joy. It can help you determine what is important and what is possible.

When I'm trying to decide whether to take an opportunity or embark on a project, I sometimes consult a highly sophisticated 2 × 2 table to help sort it out (see FIGURE). You might catch it on my whiteboard in the background of a Zoom call, along with some of my kids' doodles.

Another strategy I've taken to recently is just waiting. I give that email invitation a good 24 to 48 hours to steep. Then, if it still seems like a great opportunity, I take it. If it interferes with hockey practice, swim lessons, or plain old taco Tuesday, a quick glance at the family photographs on my desk recalibrates my decision-making process. As Nancy Regan urged, I "Just Say No."

My YESterdays are not so far away, so I need all the help I can get to maintain the courage of my convictions. I engage my department leadership in frank discussions about overall value. In the past, I took on certain tasks solely because I thought my chair wanted me to; it turns out that was not the case. While clinical revenue and publication impact factor are easy to track, those numbers don't represent everything an individual brings to the table. Like when we evaluate training program applicants, there is always more to a candidate than their scores on standardized tests. At my institution, we have begun to develop a dashboard to better track progress and capture value. Performance reviews also can be an opportunity to substantiate your worth, beyond the metrics of relative value units and publications.

I don't have any surefire solutions for that prospective faculty on the other side of my iMac's glass who is seeking his or her own version of work-life balance. While I like to think a move to Cleveland will assist them in getting there, it may actually push things further out of balance. But no matter where they end up, careful consideration of when to say yes and – perhaps more importantly – when not to, has helped me get a little closer to finding my own balance. I am happy to have them join me on that journey.

Aaron Gerds, MD

Disclaimer: The content of the Editor's Corner is the opinion of the author and does not represent the official position of the American Society of Hematology unless so stated.


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