a little overwhelmed: balance blues

February 18, 2013

so, that whole work/life balance thing . . . 
as i mentioned, we had a grand rounds speaker this week [dr. greg poland] come to speak on work-life balance.  i was excited that the topic was being addressed, though i’ve always been rather proud that pediatrics as a specialty tends to be a bit more progressive than others in this arena.  still, life during medical training is never a cakewalk, and the clinicians that duke attracts tend to be research/clinical/teaching superstars.  and to be perfectly honest, despite having evolved beyond the era where doctors were considered superhuman [and thus held to superhuman standards] i can think of several attendings i have worked with to whom ‘balance’ is probably still a dirty word.

the talk was interesting — though dr. poland didn’t bring up anything i haven’t thought about before.  a lot of what he said seemed to be derivative of the writings of my favorite life-improvement gurus:  leo babauta, of course, with a dash of gretchen rubin and laura vanderkam thrown in for good measure.  but i do think that medicine — and academic medicine in particular — could use a healthy dash of zen habits-style wisdom, so this in itself wasn’t such a bad thing.

he started with a slide show meant to emphasize the struggle that many physicians go through in devoting too much time to their work at the expense of . . . well, to put it bluntly, the rest of life.  i was glad that he brought the topic into conversation.  he then started going into his own career, and how things were before.

that’s where i got excited.  perhaps someone was finally going to explain how it was possible to really REALLY have it all in medicine — be there 100% for family, while paying attention to mental and physical health/fitness, and still making a great impact at work.  he presented a great slide that detailed his before schedule:  a grueling cycle of getting to the office at 6:30 am, heading home for a quick dinner with the kids [who was cooking? who cleaned up?] and then heading back to the office until midnight.  he admitted that with this regimen, the one who suffered the most was his wife, who was often alone — and eventually he burned out from working this way.

he then went on to explain the dangers of overwork, and in contrast the importance of taking time for ourselves and our families, from residency/fellowship to far beyond.  he [and his daughter, who did the presentation with him] spoke of the dangerous alternatives:  high risks of depression, mental illness — even suicide.  to my horror, they even discussed the inevitable ill effects on the offspring of ‘unbalanced’ physicians [and i don’t think they even meant 2-doctor households!] — including high rates of anxiety, depression, and eating disorders.

i heard what he had to say, and i was [and still am] completely on board with the idea that some sort of ‘balance’ is essential.  overall, i am glad the topic was brought up for discussion.  but what i kept waiting for was the how.  i expected that since he presented his before schedule, that we’d be rewarded at the end of the presentation with the [awesome! life-changing! secret-to-this-whole-thing] after.  

but after never came.

he did later admit that he still gets to the office at 6:30 am.  he didn’t mention whether he was still working late into the night, but i’m guessing that now that his children are grown he just has more free time.  he did discuss a few strategies — lots of templates, automation, outsourcing A LOT and eliminating wasteful time — but i am not sure how many of these are applicable for those in my position.  i’d love to outsource the pile of prior authorizations i get at work and a lot of the pages i get that could easily be handled by a diabetes educator, but as a fellow that’s not an option for me.  at home, it would be awesome to outsource the laundry, the grocery shopping, and some food prep [and eventually MAYBE I WILL] but right now that’s just not feasible.

sadly, i think this talk is one of the reasons i’ve felt frustrated all week.  frustrated that despite trying so hard to DO all of these things — be wife/mother/doctor/runner/writer-extraordinaire — i just can’t do enough to make me really feel like i’m doing an amazing job in even one of these arenas.  i can’t get myself to motivate to study at night.  i did only 60% of my long run today.  i didn’t get to spend nearly enough time with annabel this weekend [i was on call].  i don’t feel like josh and i get enough quality time together.  i don’t feel like i get to read enough and i’d love to have more time to just sit down and relax.

i do usually get enough sleep, so . . .that’s something.  and yes, omdg:  i’m still flossing 🙂  so there’s that.

i just don’t feel like there is a lot of extra hidden time [or energy] to ‘find’ to do the things i listed above [in a day or so, perhaps i’ll write out my schedule.  maybe you all can troubleshoot!].  so is this belief in ‘balance’ as an achievable reality as damaging as it seems to be, or am i just confusing ‘balance’ with perfection?

at least we have the most perfect baby in the world

lots of things to contemplate.

notes added after the fact:
1) this post was written after a very busy call weekend when josh also happened to have bronchitis.  so, not the ideal situation for making life feel easy.

2) i did email the speaker [he invited us to do so] to ask him for the ‘after’.  i’ll definitely report back if he responds.

3) i realize part of the answer is that i just need to get out of my head more and live IN THE MOMENT.  but sometimes that’s easier said than done!

okay, back to work!


  • Reply Anon March 10, 2019 at 7:16 pm

    Oh Sarah I don’t think there is balance just lots of shifting sands

  • Reply Angeliki March 10, 2019 at 7:16 pm

    Sarah, I understand your disappointment with the talk. I’ve been to similar talks myself and they don’t seem to offer any viable solutions. I’ve even talked to my mentor about it who seems to be very balanced but her tips could not be applied to my position as a fellow. I’m giving up on the idea of balance and just try to juggle as best as I can.

  • Reply Jen March 10, 2019 at 7:16 pm

    I don’t know if they have this kind of thing where you are, but I’ve recently started getting a box of organic vegetables delivered every week (and there is the option to add in things like eggs, meat, tofu etc), which has really cut down the amount of time I need to spend shopping. It might be something to look into? I live in Japan though, so while it’s a very common thing here I don’t know if it’s a thing at all where you are!

  • Reply Eileen March 10, 2019 at 7:16 pm

    oh man, this post brings back memories of the "work-life balance" seminar I went to as a grad student, through the engineering department. It turned out to be the story of a guy who worked a grueling career as a consultant (which peaked my interest since my husband works as a consultant who travels a lot), and how he balanced his stressful work life by pursuing his interests in flying, dedicating his weekends to his flying lessons/ flying for fun. It didn’t make a ton of sense from a family perspective though, and in the question portion after his talk, a few of the women in the audience (which was as usual ~ 70% male) got him to admit that his wife gave up her career to raise their kids, and he hardly ever spent time with them. It sounded like the opposite of balanced, and I was very frustrated that this was the speaker who’d been chosen for this topic! Yes, it’s great that people are talking about this, but it still seems like the conversations are very male-centric in a lot of ways (at least for engineering, and sounds a bit like medicine is the same way). From my husband’s perspective in the consulting world, most of his coworkers who have kids also have wives who don’t work. But that’s not the plan for us, so we have to figure out this balance thing without a lot of good examples to follow.

    I have no answers for you, but I’ll chime in that one reason I really enjoy reading your blog is because you do seem to have a pretty good balance in terms of a family with 2 parents with demanding careers, and a new baby. I work in research which is pretty flexible, but I do work a lot, including lots of evenings and weekends at the office. And as I said, my husband travels a lot and also works a ton of hours when he’s home/ on the weekends. Like you, I prioritize working out and sleep – this helps keep my energy levels up for handling work stress. But I am still frustrated with how the house never seems to be clean, I eat way more microwave meals than I should, feel lacking in my social life, and feel like I don’t get to spend enough time with my husband. We’re thinking about having kids, but it’s really overwhelming to think about how we could possibly handle those demands in addition to everything else.

    In any case, thanks for sharing all of your own efforts with this – it really does help me to see examples of other moms with demanding jobs.

  • Reply Ana March 10, 2019 at 7:16 pm

    Its not that I don’t think men can talk about work-life balance…I just don’t think ANYONE who isn’t equal-partners in family/home maintenance will be able to address this topic in a way that resonates with the majority of us. And the lack of an after….yeah. Sounds like they wanted to get a talk on the topic but didn’t have anyone to really do it, so this guy filled in.

    I actually agree with the first comment. I am struggling myself to let go of this ideal of life as an equally divided pie, with plenty of space for all my priorities. We ARE, as solitary points out, managing two full-time jobs…its going to be a constant battle with shifting priorities and percentages that hopefully all evens out in the long run. Now I can’t remember where I read this, but it was about the idea of "flexibility" instead of balance…that sometimes work is going to come ahead, and sometimes children…and even sometimes hobbies or friendships or something else entirely…and then it’ll shift again.

    And yes, you are clearly doing an amazing job, and yes, I think you are confusing "balance" with "perfection"—60% of your long run should not feel like a failure. YOU ARE EXERCISING. That is a success. Busy call weekends or days or weeks happen occasionally & you have to shift your focus way way more than 50% to patient care….that’s OK. Remember this is all a choice. If it stops being OK, if it stops being fulfilling…nobody would (or should) fault you for making a different choice.

    Stupid conference, I think it shook your confidence…better to avoid the topic altogether than some half-assed attempt that makes everyone feel bad about themselves.

  • Reply Rebecca March 10, 2019 at 7:16 pm

    My friend gets these already made dinners during the week- like dream dinners – I think you can opt dr organic or whatever and at least it’s not packaged and processed- it was cooked that say or the previous day … Dave the enjoyment of cooking on weekends 🙂

  • Reply Rucky March 10, 2019 at 7:16 pm

    I have a lot on my plate, balancing 12mo twins and my FT job and DH’s FT job….In an ideal world, I would love to work 3 days, but it is not a financially viable option for us. DH and I make very similar salaries (and these are NOT high-rolling $$$$, TRUST ME, combined, we make way less than a Dr). So, like whomever stated above, at least you have the option of not going into the Poor House if you cut your hours. DH and I are doing OK, but when you add financial stress on TOP of the Work-Life-Home-Marriage balance…it is tough. If we deduct DC costs out of my net salaray, I make less than $250/wk!!! I should add that DH acts like his job is "more important" than mine….and while he does a LOT of stuff at home (incl DC runs, feedings, etc)..I still take on more things on the Home End. I’m not bitter (at least not today) lol

    • Reply theSHUbox March 10, 2019 at 7:16 pm

      as i’ve said so many times – twin moms amaze me to no end. you are pretty much my hero. and i wouldn’t blame you if you were a little (just a little) bitter 🙂

      re: part time/cutting hours — yes, financially that would be fine. BUT finding a job doing my very specific thing in a specific city that would let me work a reduced schedule is not as straightforward. i’ve been so lucky just to get a (great!) offer and am really excited about it, but it’s for a full time position. perhaps in the future i’d have more ability change things but for right now i’m just thrilled to have a job doing what i want to do in what seems like a great place!

  • Reply Siobhan March 10, 2019 at 7:16 pm

    I remember I went to a similar talk after I had just had Ciaran. I left that meeting crying with anger and frustration because they didn’t describe *HOW* to have this balance. I would love for you to ask your blog following what people who work do… Your post really hit home, because clearly, my mental health suffered with Ciaran and my return to work and I was one of those victims of depression that the speaker discussed. But this time around I’ve learned that I can’t do EVERYTHING. I may only run twice a week (and that is only 3 miles), we may eat hot dogs for dinner (seriously, but always with a salad), I may get in to work at 9:30 am several days a week (as opposed to the 7:30 am that I strove for with Ciaran), but the most important thing for me in life is that I let my kids know that I will drop everything for them, and that the time I spend with them will be as focused as it can possibly be. I’m not saying I’m perfect during those hours, but I want to succeed at this part so badly. My work is going a little more slowly than it used to, but I have given myself a 3 year period where I will accept that I won’t be at the level of productivity that I once was. I will say no more frequently, and I will not feel guilty about it..

    Anyways, that was a bit of a ramble. But I guess my main point is that the *HOW* is different for everyone. But the first step to *HOW* is accepting that our level of productivity pre-children will never be reached again until after our kids are in university. (And realistically, for many of us, our pre-productivity level was at the extreme side of the bell curve. Home-cooked meals every night, marathons every 4-6 months, 50+ miles running a week, graduate and post-graduate degrees, travel, ANTM marathons 🙂 That is definitely not average..) But our lives are enriched for it. And our happiness is reflected in our children’s happiness. So all working mothers need to collectively give ourselves a break, and to be as supportive as we can of each other.

    On another note, today was Shia’s first day of daycare. So sad… I hope it goes okay…


  • Reply Annie March 10, 2019 at 7:16 pm


    I find this post really interesting because I’m in a Clinical Psychology PhD program and we get GRILLED about work-life balance constantly. It’s fascinating how different the culture of our training is compared to medical school.

    Anyways, I wonder if you’ve ever considered meditation? Yes, it would be one more thing to add to your list, but the health effects are astounding and just a few minutes here and there could really help bring you to the present and feel even just a teeny bit relaxed. I actually have reviewed some literature saying that mindfulness meditation results in better quality of life for physicians! Also, I think you need to give yourself some credit because you are seriously kicking ass at life right now.


  • Reply Stephanie S. March 10, 2019 at 7:16 pm

    Again, I’m a long-time reader, but rarely comment (read blogs on my phone at the office a lot of the time… oops). Anyway, I often remind myself of the phrase "Don’t let the perfect be the enemy of the good." I know this is overly simplistic (in many areas we must strive for perfection… your medical responsibilities, for example), but it can bring a lot of comfort. If "perfect" is home cooked meals 7x/wk, then "good" might be your compromise of 3x/wk plus leftovers. Maybe this simple mantra will bring you some of the comfort it does for me!

  • Reply Boquinha March 10, 2019 at 7:16 pm

    Wow. This post hits home. My husband attended medical school while I attended graduate school – he and I graduated within a year of each other, he as a physician and I as a counselor. During that time, we also started having kids.

    My husband (I should mention that he is most definitely an EQUAL partner in our home and marriage and parenting – in fact, he probably does more than half the stuff around here) has given lectures on work-life balance. Our family is our top #1 priority and we have made some HUGE changes in our lives to live by that.

    After reading "The Medical Marriage" (really pessimistic book, by the way) and "Take Back Your Time" (VERY much inspired us, that one – highly recommend) during residency, we knew we needed to think outside the box.

    One of my husband’s attendings during residency told him that if you’re planning to work, say, part time, then start that way, because there’s no such thing as starting full-time and scaling back. She said she really got trapped by that.

    My husband’s take on the "how" is to come up with alternate practice models (the current system just doesn’t support work-life balance very well). For us, it has meant taking on some additional training and opening our own business/clinic and being our own bosses. We have a great deal of flexibility with this (yes, there are pros and cons to this model).

    We also took a huge pay cut to do this, but we’re okay with that. You can’t put a price tag on family time and flexibility. He moonlights at a local hospital, but our clinic is our main gig and we’re happy with it – we both get to work in it in a way that suits us and helps the community, too. Like I said, there are pros and cons for sure, but we’ve had to think outside the box to make it work.

    I really think the entire system needs to change. I went through major depression during residency – it was a VERY difficult time. We had moved to a place where we knew no one, I was home with two small children, and residency hours were GRUELING. We knew, even then, that that lifestyle was NOT us. Something needed to change. We didn’t want to find a way to conform to it. IT needed to conform to us and our priorities.

    We began thinking outside the box during an FMLA leave my husband took (yes, I was that depressed) during residency. It was a big wake up call – hard decisions when you’re so in debt with student loans and when you’ve put in so many years of study and work.

    I’m not at all saying that’s the answer for everyone (not even close), but it’s how we’ve made it work for us. And it’s a work in progress. Also, having our own business feeds our creative side in a way traditional jobs just don’t.

    Anyway, great (and honest) post. Thank you for sharing. Great comments, too. Such good food for thought and such an important topic to discuss. We’ve seen so much evidence online of unhappy physicians who feel "trapped" (that’s a recurring theme we see) and it’s really sad. Something needs to change. Thanks, again.

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