Work-life balance in medicine: Is it possible?

Unless you’ve lately returned from a retreat at a remote Cistercian abbey, if you’re interested at all in women’s issues you’ve probably read Anne-Marie Slaughter’s recent article in the Atlantic, “Why Women Still Can’t Have It All.”  The author eloquently tells how she left her dream job in the State Department as the first woman director of policy planning in order to return to her husband, her two adolescent sons, and her tenured professorship at Princeton University.  The weekly commute to Washington proved impossible, and her family needed her.

Professor Slaughter’s article is well worth reading for its meditations on how difficult it can be to combine motherhood and a challenging career.  Her conclusion is that work practices and work culture need to change.  Unfortunately, her take-home points have little application to the life of a physician.  She quotes from Republican political strategist Mary Matalin, who wrote, “Having control over your schedule is the only way that women who want to have a career and a family can make it work.”

That certainly leaves me out.  If there’s one thing I don’t have as an anesthesiologist, it’s control over my schedule.

I’m expected to be in the hospital every day in time to set up my drugs and equipment, evaluate my patient, and have the patient ready to go into the operating room at 7:15 a.m.  Since our practice does not employ “physician extenders” such as nurse anesthetists or anesthesiology assistants, I’ll be with my patients continuously until the day’s surgery is finished.  Unless I have a life-threatening domestic crisis at home—something like an actively hemorrhaging child or rising floodwaters—no one is going to show up and offer to take over my cases so that I can go home.

One section of Slaughter’s article is titled, “Changing the Culture of Face Time.”  She argues that time spent in the office isn’t always necessary, and that being able to work from home “can be the key, for mothers, to carrying your full load versus letting a team down at crucial moments.”  She mentions video-conferencing as one way to manage working off-site.  A clever mother can even use her smart phone to call in to a meeting while watching her child at a playground.

But if your job involves “face time” with a patient, it’s different.  Telemedicine is championed as a great way to extend the range of some physicians, like radiologists and dermatologists, when visual and interpretive skills are required.  But if I need to insert a catheter into someone’s artery or jugular vein, or a breathing tube into the trachea, I can’t see any way to do that from home.  Just as soldiers speak of “boots on the ground”, most physicians have to be at the bedside or the operating table to get the work done.

Physicians aren’t alone in needing to appear in person.  Nurses, traffic cops, beauticians, mechanics, dog walkers, personal trainers—all of us have to be on site to do our jobs.  There is no way to phone it in.  Nor do most of us have the freedom to be “open and indeed proud” if we defer a task for child-related reasons, let alone leave early whenever we choose.  For most people in hourly positions, that would be a sure route to losing wages or getting fired.  In this economy, men and women would be eager to snap up any vacant position whether or not it offered flexibility.

Has the culture in medicine changed at all over the past 20 or 30 years, since women began to comprise a greater percentage of medical school classes?  Certainly it has.  Having a baby during residency is commonplace now, and I’m told it is almost “de rigueur” in dermatology residency programs.  It’s politically incorrect to question whether or not pregnancy might have a detrimental effect on learning, or confer an unfair burden of extra coverage on the other residents in the program.

At the top of the medical pyramid, male physicians have started to play the trump card of work-life balance quite brilliantly.  I’ve had the dubious pleasure of working with a plastic surgeon whose marriage was plagued with infertility issues.  He would routinely come in late on the days his wife was ovulating, oblivious to the inconvenience he caused to the operating room personnel—mostly female—who were obliged to clock in on time and wait for him.  A thoracic surgeon on his second marriage, with two small boys, often drives his sons to school at 8 a.m. though his first case in the OR is scheduled at 7:15.

If there’s such a thing as a work-life balance abuser, the blue ribbon goes to one orthopedic surgeon at my hospital.  He likes to go home, have dinner with his wife, and tuck his children into bed—all reasonable things to do.  But he then books his emergency hip fractures for 8:30 or 9 p.m.  This means that a host of other on-call personnel—anesthesiologist, OR nurse, surgical technician, radiology technician—are held hostage in the hospital waiting for him.  Work-life balance only works in this setting if you’re the one who gets to call the shots.

What would I do if I were in a position to control the OR schedule?  For a start, I wouldn’t schedule the first case of the day before 8:30 a.m.  I think it would be wonderful if all the people who work in surgery could have breakfast with their families and see their children off to school.  My children are grown now, but I remember so well having only a moment to say goodbye in the morning while they were still snug in their pajamas.  It would have meant the world to have an extra hour.  But the reality of life as an anesthesiologist—then and now—is to be in the operating room ready to go, often before dawn, and heaven forbid that surgery should ever be delayed on our account.

Perhaps we shouldn’t complain.  Work-life balance, after all, is a first-world women’s issue, and even within the first world it’s primarily a concern of affluent white women.  Most women of color, and for that matter women of any color who lack the advantages of money and education, seldom have the luxury of obsessing over whether to work, how much to work, and whether or not they’ve achieved optimal work-life balance.

Yet I agree with Professor Slaughter that we could do better.  I don’t think that working less is the answer in medicine, because there is so much to learn and so much experience needed to do a merely competent job, let alone a great one.  But maybe something as simple as starting the OR schedule an hour later could make a difference to a great many families.  Maybe we should eliminate grueling 24-hour calls altogether, and divide up the work day differently.  Medicine may not be as flexible as other fields, but there’s a chance that with enough good will and effort it could—perhaps—become more humane.

Karen S. Sibert is an Associate Professor of Anesthesiology, Cedars-Sinai Medical Center.  She blogs at A Penned Point.

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  • Madhav (Mo) Ghanta

    I don’t understand. my anesthesiologist friend who works for one the more business-like hospitals in the area only works 3 x 12 hour days a week! Yes, maybe he’s on call every 3rd week, but he pulls in $400K+/year on 36 hour 3-day workweek. Granted, I appreciate what doctors do and the liability they go under… but come on, give me a break. This guy can be with his family for 4-day weekends every week, including 2 school days a week!

    • http://twitter.com/DocTor42910875 Doc Tor

      I’m an anesthesiologist and I make half of that while working 6 days per week and one weekend per month. Fortunately, most reasonable people don’t draw hasty conclusions with sample sizes of one.
      Come to think of it, my police officer friend on long island makes 150k while collecting 75k pension. Guess I should’ve been a cop since they all make over 200k.

      • Madhav (Mo) Ghanta

        Thanks for your reply. I never seem to understand doc’s salary I guess… because they (they being industry articles and surveys) never break out (in these physician group practices or small practices), how much is revenue versus the actual doctor’s take-home pay. Perhaps that number is just revenue and doesn’t account for all the malpractice insurance, office staff, overhead, etc. — and this is as the son of 2 specialists (a surgeon and a psychiatrist).

  • http://www.thehappymd.com/ Dike Drummond MD

    Thanks for this article Dr. Sibert.

    Work life balance is possible and it takes conscious, persistent planning and effort. Without a plan to create balance your career will always be the #800 gorilla throwing its weight around. One thing I find in my work with overstressed docs is that creating a structure for your time away from work really helps.

    Your practice will always be highly scheduled and structured and you would never question a call schedule. But most doctors don’t schedule time with spouse and family and friends. When you do schedule your non-medical life it all becomes easy to defend … “Sorry, I am already booked at that time”. Without the schedule it is much harder to say no.

    That’s just one of many work life balance tips … it all happens in these small actions

    Dike
    Dike Drummond MD
    http://www.thehappymd.com

  • LBENT

    As a surgeon for more than 30 years, I have seen many models of anesthesia groups that seem to work much more effectively than the practice you work in. They have much more control, more flexibility and more predictability than you presently enjoy. It sounds like you need more of you to have evening relief and night calls or nurse anesthetists or assistants to get you started in the morning or take call in the evenings. As for starting later, we surgeons often see patients after the OR, although I will admit to having gone home for supper with my kids when they were young.
    Yes, some surgeons do things for their own convenience at times, but many more times we are also bound by our patients’ needs. Most ORs have rules and most people follow them. Finger pointing is not helpful.

    As for Anne Marie Slaughter’s article, her point that women still cannot have it all, used the same reasoning that you have used. Because she could not do it, it was not possible to do. She had it all, she wanted more, impossibly more. Everyone makes choices, hers were poor ones. I hope you and your readers will read my thoughts on this. http://thebrodskyblog.com/?p=2789
    As a woman physician, I truly believe you can have YOUR all. It takes time, planning, and a lot of thought. Why don’t you start by talking within your group and trying other models? We help women do this at Women MD Resources. (www.womenmdresources.com)

  • RJones

    I have had surgery, and have taken family to surgery appointments. It is very irritating that they require everyone to be in the hospital getting ready so very early. Why has this time culture where a 6 am or 7 am admission established itself?

  • RJones

    As to ‘having it all’ … what does that even mean? No one, but no one, gets to ‘have it all’.
    I’m a woman, I have a very demanding career that requires me to work weekends, evenings and of course the so-called ‘normal’ business hours. I’m a real estate agent, very much on call to my established clientele. Luckily, I enjoy my clients, and my job, and find what I do to be more rewarding than anything else I could do.
    The best thing I can do for my family is to ensure that I am happy too.

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