Balancing – Not a New Act

The concept of “work-life balance” seems newer to the field of medicine, which trails many other professions that have already incorporated creative and flexible options for work with the advent of telecommuting. Still, this term has been present now in medical circles for long enough that to suggest otherwise would be to appear out-of-touch…which is just what anesthesiologist Dr. Karen Sibert did recently when she wrote a New York Times Op-Ed suggesting that female physicians who worked part-time were doing a disservice to US healthcare system and not fulfilling a moral obligation to their patients.

Many physicians responded quickly and critically to the article in comments, tweets, and blogs. Some valid points were raised, including ones asserting that “balanced” physicians are better physicians and others that pointed out that the article placed an inordinate amount of blame for the current – and future – shortage of primary care doctors on female physicians who work less than full-time.

Putting aside the fact that the definitions of full- and part-time work are somewhat arbitrary (variable across employers, professions, and countries) the truth about work-life balance is that it is actually not a new concept. In fact, I would argue that Dr. Sibert, who completed her training in the 1980s and raised four children while working full-time as an anesthesiologist had it. It was just one that worked for her.

In its purest definition, work-life balance has always been present in some form or another. What changes over time – individually and societally – is the value of the items being measured on the scale.

 This is not to say that there are no seemingly unbalanced situations out there (like an older doctor I knew who was in the office till 8 or 9pm almost every night). But wouldn’t I be assigning my own value system to the variables in his equation for balance? That older physician’s iteration of work-life balance worked for him and his wife. If it didn’t, things would shift at some point, similar to the law of conservation of energy in physics. Today’s “work-life balance” is a representation of a definite societal shift in the value of the items being measured (work and life and let’s add in happiness, as if it was work-life-happiness balance).

Has medicine failed to provide enough $, stuff, and status to motivate full-time work?” asked one physician on Twitter.

A poignant conversation on Twitter briefly touched on some other potential factors that might be fuelling a trend of physicians desiring part-time work (which is not limited to female doctors or physician-parents, by the way). Whenever one looks at a career or job, there is a measurement of the trade-offs (benefits, commute, status, compensation, hours, prospects for advancement). Almost every one of us does this, irrespective of profession/job. It might be possible that, in the case of the field of medicine, interests outside of practicing medicine have gained value or the rewards of practicing medicine have diminished. Or both.

Based on my discussions with other primary care doctors, it appears primary care is following the law of diminishing returns or, in the case of physician burnout, even the law of negative returns. With a compensation model that favors proceduralists, an increasing workload to keep up overhead, a sense of dispensability from some employers and the public, anti-doctor sentiment (which is witnessed in social circles despite the presence of physicians in them), and monthly debt repayments equivalent to a mortgage for some, it wouldn’t be hard to imagine that some primary care physicians – a subset of a group of bright individuals who tends to delay happiness for the sake of training – might feel quite disheartened early on in their careers and seek some balance in the form of outside interests, including being more engaged in family life.

Medicine – when practiced within a certain frame of mind – is a field that is almost second to none in its ability to provide satisfaction. But, as in any demanding profession, there are definite trade-offs. “Work-life balance” is just a prettier way to describe it.

*For the record, I am a full-time primary care physician and really do enjoy working as an internist. I have worked no less than 90% of full-time and although no one can predict the future, I intend to continue to work full-time as long as I am emotionally, physically, and psychologically able to provide excellent care. I say this because I once had a glimpse of a place where there was potential harm in working full-time under certain circumstances. And that – rather than a decision by any physician to work part-time – is what is unfair and even dangerous to patients.

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**photo by Renjith Krishnan (freedigitalphots.net)

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About Linda Pourmassina, MD

Internal Medicine physician.
This entry was posted in Current Events, Work-Life Balance and tagged , , , , , , . Bookmark the permalink.

2 Responses to Balancing – Not a New Act

  1. Paul Constantine says:

    Interesting post. My father was a small-town GP in Western New York who completed his training in the early 1950s. His typical schedule was something like this:

    7:30 AM to the hospital; earlier if he had surgery
    12:00PM Home for lunch (his office was next door and the hospital around the corner)
    1:00 Office Hours began
    6:00 HOme for dinner
    7:00 Evening Office Hours
    10:00 Home.

    Tuesdays and Thursdays, he stopped seeing patients at 7:00 PM. The only other variations were that Office Hours ended at 3:00 on Saturdays and were on an as-needed basis on Sundays beginning at 1:00. Hospital rounds every morning, 7 days a week. He also was on-call for the ER on a bi-weekly basis.

    While I have always been interested in Medicine, that lack of balance certainly steered me in other directions. Interestingly, two of his other three male siblings (sons of barely literate Italian immigrants) also became Docs, one a pathologist, and one a med school prof, but that’s another story.
    –Paul

    ————————————————
    Paul Constantine
    Associate Dean of University Libraries
    Director of Special Collections
    University of Washington Libraries
    Box 352900
    Seattle, WA 98195

  2. Paul Constantine says:

    Interesting post. My father was a small-town GP in Western New York who completed his training in the early 1950s. His typical schedule was something like this:

    7:30 AM to the hospital; earlier if he had surgery
    12:00PM Home for lunch (his office was next door and the hospital around the corner)
    1:00 Office Hours began
    6:00 HOme for dinner
    7:00 Evening Office Hours
    10:00 Home.

    Tuesdays and Thursdays, he stopped seeing patients at 7:00 PM. The only other variations were that Office Hours ended at 3:00 on Saturdays and were on an as-needed basis on Sundays beginning at 1:00. Hospital rounds every morning, 7 days a week. He also was on-call for the ER on a bi-weekly basis.

    While I have always been interested in Medicine, that lack of balance certainly steered me in other directions. Interestingly, two of his other three male siblings (sons of barely literate Italian immigrants) also became Docs, one a pathologist, and one a med school prof, but that’s another story.
    –Paul

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