The fallacy of work-life balance in medicine

Physician well-being, burnout, and “work-life balance” are pretty common topics in training.  We start at intern orientation, discussing how to work 80 hours a week, eat, sleep, exercise, and still have some semblance of social life.  It’s like we’ve forgotten the origins of our job title: “resident” or “house staff” — implying that, until recently (and even now, in places outside of North America), we, the physicians-in-training, lived at the hospital.  And that sometimes (oftentimes), we still spend more time at the hospital or clinic than we do anywhere else in a week.  There are 168 hours in a week, and just under half of them are considered reasonable for us to work.  That’s double a “normal” full-time job (40 hours per week).

I’m definitely not saying that medical training, should be shorter or encompass fewer hours.  If anything, sometimes it feels like it should be longer (or maybe that’s just the slight fear of my first “attending” shifts coming up — because now it really is my call on things). We have enormous responsibilities, and that responsibility requires intensive training.  In all honesty, another critical component of medical training is the lesson that we are all life-long learners — that our education cannot and does not stop simply because we graduate, get an attending job, and go into practice.  There it is again — a word that, if we look at it, reveals the origins of medicine.  We practice.  We try things; we learn new things; we keep working at getting better.  This is not to say that the first patients I see on my own will be poorly taken care of, but just that (as with many professions) we all get better at our jobs over time.  We hone that sixth sense, trust our guts a little more, get better at pattern recognition, and know when to call other experts to help our patients and us.  We keep practicing, trying to make perfect.

That search for perfection is inherent to many physicians.  As a group, we are type A, driven, competitive people.  It is one of the things that allows us to give nearly a decade of our lives to school and training to do our jobs — prime years, usually in our 20s and 30s.  Those same years, though, are the ones when other people are starting careers, developing hobbies and interests, buying first homes, and starting a family.  When we do go looking for our first jobs (as residents, fellows, and first-time attendings), we are expected to be ambitious, well-rounded, compassionate, and well-developed people, not automatons.  So, during our medical training, we have to fit life into the 88 hours per week when we are not at work.

This brings me back to the idea of balance.  I take issue with the phrase “work-life balance.”  When I picture a balance, I picture something where the two sides offset each other, like old-fashioned scales.  With this picture in mind, then, work-life balance would mean that the two sides are equal.  In my 88 hours of “personal” time each week during residency, I drive to and from work (round trip totaling at least 1 hour each day), sleep (hopefully at least 7 hours each day), shower/get ready for the day (and, since I’m a girl, that realistically takes an hour each day), and cook/eat/do laundry/clean my apartment/see my husband.  That doesn’t really leave a lot of time for any sort of a life, hobbies, research, or anything else that would help me to be a thriving and well-rounded person.  Something always gives when people are busy (regardless of their field), and it is usually their personal lives.

I don’t necessarily have a way to fix this: We need long and intensive medical training to be good at our jobs.  We need to find time to sleep and take care of ourselves so that we can first do no harm (to ourselves).  I just don’t think it is fair to say we are striving for balance because we aren’t.  We are striving for survival, until the next step in our careers, when we might get more time for ourselves.  We are putting off relationships, families, houses, retirement funds, and many other things while we train.  Maybe one way to help with this is to develop robust programs at every institution to help trainees (and honestly, all physicians) accomplish some of these life tasks (e.g., laundry, food, cleaning services).  But I think one (free) thing that would help with this is to stop calling it “work-life balance” and admit that it will always be unequal and weighted toward work while we are in training, and perhaps for a large part of our careers.  One of my husband’s attendings once told him that you could have two out of three: family, fame, or fortune — but not all three.  Something will always give in medicine.  It’s just easier to accept that we’re giving up something if we don’t pretend we can have it all.

Ellen Poulose Redger is an internal medicine chief resident who blogs at Insights on Residency Training, a part of NEJM Journal Watch.

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