Achieving work-life balance: More than just a juggling act

Making life manageable is not about how many hours you work, experts say. It's about setting realistic goals and working toward them.

By — Posted Jan. 4, 2010

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Coming out of medical school and residency, some physicians have resigned themselves to a life of working 12-hour days and weekends, and having little time for anything else.

But a yearning for a life that includes time for family, recreation, professional development, community service or even just regular exercise has driven some to wish for a less-hectic lifestyle. In fact, surveys show that physicians -- men as well as women -- respond positively to questions asking if they seek greater work-life balance.

But what is work-life balance, exactly? And how do you achieve it?

Experts say there is no single definition and some don't even like to use the phrase. But generally they agree work-life balance translates to satisfaction with one's entire life -- professional and personal -- and it can be reached even while working long hours.

"I think it's an ongoing process and not something you achieve and it stays that way," said David Ballard, PsyD, assistant vice president for marketing and business development at the American Psychological Assn., and director of the APA's Psychologically Healthy Workplace program.

He dislikes the phrase "work-life balance" because it implies a false dichotomy between two parts of life, not a whole life that includes many elements. "It also implies it's a 50-50 balance," Ballard said. "It's really about how you allocate your resources, your time and your energy, and whether the way you actually spend your time matches your goals."

Experts say success lies not only in carefully defining how you want to spend your time, but in making sure you adjust your life and work as your needs change. Sometimes even small changes can make a difference.

An unmanageable schedule and out-of-control home life can lead to depression, poor performance at work, conflict with family and a feeling of burnout that can lead physicians to question whether to stay in medicine at all.

Out-of-balance physicians "don't enjoy their work as much as they used to, they are feeling they are dropping balls in other areas of their life and it is costing them more -- whether costing them energy, relationships, or money," said Iris Grimm, an Atlanta-based life coach for doctors.

Experts say the first -- and possibly most important -- step in creating a fulfilled, balanced life is to assess honestly what you need and what you want out of your whole life, not just work or home in isolation.

Do you need time to exercise? Do you want time to volunteer outside of work? Do you set aside one day every weekend to spend with your family? Or maybe it's work that needs more time, because you are striving for a promotion or starting a new project.

"If there's a physician who feels completely happy working 12 hours and is communicating with his family, and the family is fine with him staying at work for 12 hours, that might be a work-life balance definition that works for him," Grimm said.

Once you've taken time to look carefully at what will make you feel satisfied, reassess regularly. Work-life balance is not only different for each individual, but it changes over time. Grimm said she encourages her clients to take an hour each year on their birthdays to self-assess and decide to adjust what is no longer working. Otherwise, "many times they only think about this question when they are in a crisis."

Steps that can help you get to a balanced life can be split into those that are highly personal and sometimes purely internal to practical steps to take on the job, sometimes involving colleagues or employees.

Balance goals

One major step is to recognize the reality of compromise: You can't have it all. Accept that and think about what you're willing to give up, Grimm said.

"My mantra is, 'Every prize has its price,' " she said. "The physician needs to ask, 'What price am I willing to pay to get the prize I want?' "

Both Grimm and Ballard said sometimes physicians just need to take a step back and look beyond their day-to-day frustrations to see what they are doing that isn't working. Sometimes it's a change in mind-set that's needed, not a change in behavior, Grimm said.

Grimm also helps doctors think of ways to make work more manageable, including learning to delegate. Physicians "think everything depends on them -- well, yes, that's true in a way, but if you didn't have support you wouldn't have production."

Many doctors also need help learning to communicate with colleagues and staff and to resolve conflicts.

Grimm said she helps her clients focus on a goal that would show they've improved their lives. For some, that's getting home for meals, for others it's having time for charity work, or going to the gym every day. "Where do you want to go? What would get you excited? What would motivate you to dig deep and make lasting improvement?" Grimm asks.

John Schorling, MD, MPH, a professor of medicine and public health and director of the Physician Wellness program at the University of Virginia School of Medicine, said doctors often fall into a "psychology of postponement." Because medical education takes so long, they become accustomed to delaying happiness. Then, that date gets later and later, so "when I get into med school" becomes "when I retire."

So one major step physicians can take in learning to balance their careers -- and the rest of their lives -- is to learn to be in the present and make it the best it can be, he said.

A change in mind-set, however, is of limited value unless you also change the way you work.

Balance in work

Some experts suggest focusing on what keeps you working unnecessarily long each day. Doug Couper, MD, an internist with Martin's Point Health Care in Portland, Maine, said he reached a low point in 2007 after spending a year adjusting to a new electronic medical record system that he felt made him less productive. "I started to think back, 'Why did I go into medicine?' "

Around the same time, his medical group gave him the opportunity to work with a practice coach and reevaluate how he and his staff moved patients through the office. They began by trying to cut the average time from when a patient checked in to when he or she was seen. That required small changes, including learning to always start on time, because any lag would only worsen over the course of a day.

Dr. Couper and his staff still meet regularly to discuss process improvement. They also are working on clinical goals, including improving management of patients' diabetes and hypertension.

That has brought him to what many physicians find is the key from going from burned out to inspired. "I'm getting back to, 'Why am I a doctor?' "

These days, Dr. Couper can leave work in time to have dinner with his family. Maybe more importantly, he feels in control and efficient when he is at work.

But even practical changes take maintenance -- as Ballard and Grimm said, balance is not a permanent state. "It's just a process of continual improvement," Dr. Couper said. "I can't say that you put in implementation and everything stays that way."

For doctors in settings with restrictions on work process, having control over work schedules has been shown to dramatically improve feelings of balance and work satisfaction. Recent studies have fine-tuned this finding to show it's not necessarily more control that promotes greater satisfaction. Rather, the ideal situation involves a degree of control that matches what the person wants, a metric sometimes known as "schedule fit," said Rosalind Barnett, PhD, a senior scientist at the Women's Studies Research Program at Brandeis University in Boston.

Ballard said sometimes people don't want the responsibility of setting their own schedules, so what's really important is that the degree of control they are happiest with matches up to their workplace's policy.

Physicians and other professionals often fear that showing an interest in working part time or taking advantage of flexible work hours will put them at a competitive disadvantage with colleagues who work long hours. That feeling has likely only gotten worse as the economy threatens job security, Barnett said.

Dr. Schorling said the University of Virginia School of Medicine has tried to overcome that kind of cultural barrier a few different ways -- first, by offering learning about emotional intelligence and mindfulness as part of a physician leadership course.

The school also recognized it needed to adjust its tenure path to allow faculty to work toward tenure over 20 years, not six to 10, as was once standard.

As the medical culture changes, individuals become less resistant to learning coping skills, he said.

"I think there's a growing awareness that these are all stresses that we face," he said. "In order to function optimally, to be at our best, we need to be able to address them, to develop techniques. Among the current generation of physicians, and even physicians who trained a while ago, there's more of an awareness that this is important."

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More control, more balance

In one survey of physicians, control over work schedule was the greater predictor of reported work-life balance. Demographic and work-life factors, in order of how strongly they affect work-life balance:

  • Control over schedule and hours worked
  • Total weekly hours worked
  • Number of children at home
  • Total weekly hours "on call"
  • Age
  • Gender
  • Income

Source: "Predictors of Physician Career Satisfaction, Work-Life Balance, and Burnout," Obstetrics & Gynecology, April 2007 (link)

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10 steps to achieving better balance

Experts say a balanced life is a more satisfying life, and can include both a rewarding career and time to take care of other things that matter to you. Here are steps they suggest along the path to balance:

1. Take time to assess your values and priorities periodically. Some people do this each year on New Year's Day, or on their birthdays. When you think about what you want your life to look like, accept the fact that you are going to have to make some tough decisions to find balance and meet your personal and professional goals.

2. Try to avoid a cycle of constant "delayed gratification" by thinking "I'll finally be happy when ..." or "I can finally slow down when ..."

3. Take short breaks -- anywhere from 1 to 5 minutes a day -- to breathe or stretch between patients. Studies show short breaks actually improve productivity, so you'll more than make up for the time you lose by pausing for a moment.

4. When "perfect" balance is unattainable -- for example at exam time, a busy rotation or before a deadline -- make caring for yourself a priority by designating time for sleep, exercise and relaxation.

5. Visit your own physician to make sure you are taking care of your own health.

6. Talk to a friend or a counselor if you feel powerless to change a situation making you unhappy.

7. Find a mentor or role model who can give advice on career development, time management and setting priorities.

8. Carefully assess the daily routine at your office in collaboration with support staff to find ways to save time and energy. A well-run practice can mean a shorter work day, more satisfied employees, improved revenue and happier patients.

9. Perhaps you are working too hard and not "working smart." Are you spending time on administrative tasks that you could outsource, or hire someone to do while you see patients? Could you eliminate commute time and stress by working on paperwork at home with a remote computer system?

10. Ask yourself whether you could be missing the big picture. Is your practice ideally located to attract patients, or are you spending time and energy on marketing across town? Where else are you spending time that could be eliminated by making one large adjustment?

Sources: The Colleges of the University of Washington School of Medicine; Doug Couper, MD, Portland, Maine, internist; Iris Grimm, physician life coach; David Ballard, PsyD, director of the American Physcological Assn.'s Psychologically Healthy Workplace program (link)

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Help to get in balance

Both broad-based and specialty-specific medical organizations have taken on the issue of work-life balance and offer plenty of research and tools for physicians trying to find their own definition of work-life balance.

The AMA, through a joint project of the American Academy of Pediatrics and the AMA Women Physicians Congress, offers help on work-life balance for physicians, called "Explorations in Work/Practice Options," including self-assessment tests to help you better understand your own needs, profiles of physicians working unconventional schedules, and more information about working part time. Resources are online (link).

The AMA Women Physicians Congress offers additional resources from the "life balance" tab of its home page (link). Among them: "Making every moment count," tips for finding balance and refreshing oneself, and information about an ongoing study on work-life balance among women in health care fields.

The American College of Emergency Physicians also has a section focused on physician wellness, and its Web page offers print and audio resources as well as a list of recommended reading (link).

In 2007, the Medical Board of the State of California established a Wellness Committee focused on improving physicians' well-being as a way to improve quality of care. Its Web site offers more information about the committee as well as suggested reading about the link between physician wellness and quality of care (link).

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