Medicine’s shifting culture of work-life balance

January 28, 2020

What are reasonable demands of a profession dedicated to the service of our fellow human beings?

At our organization, we are discussing behavioral-based interviewing for physician candidates. This entails identifying those behavioral competencies that we desire in any physician colleague. Your list probably matches mine, although the one area that may differ is under the broad category of how they approach work-life balance.

Everyone would agree that we want to recruit physicians who are patient-centered, who love to learn and practice evidence-based medicine, who are great communicators, and who are respectful of all team members. However, would you rather recruit a physician who is more “old-school” and looks at medicine as a lifelong calling, who is willing to work late and long hours, always available for a call from a patient, colleague, or nurse, and who finds their identity as “doctor” to be the top priority in their life-above family and personal wellbeing? Or, would your preference be for a physician who ardently seeks and maintains work-life balance, who is able to put the pager down and focus on their family, a hobby, or their own health and well-being, who draws boundaries with patients, colleagues, and nurses?

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This is a serious conversation in my organization, as I imagine it is in yours. I graduated medical school twenty years ago and was trained in the traditional model of complete self-sacrifice and self-neglect in service of one’s profession and one’s patients. My younger colleagues were not trained this way and their generation does not practice this way. A call group meeting that occurs on their “day off” may not be attended. If they are sick, they are not going to work sick, they will call in, stay home and get well. They are comfortable signing out patients and in-baskets and other responsibilities. They take vacations without a laptop. 

These are, of course, broad generalizations; however, there is no doubt that the culture of medical practice is changing, increasingly influenced by new norms of professional dedication. In fact, some of us who are older and more established are learning from the wisdom of our younger colleagues as well. All that said, I would argue that there is a happy medium that respects the competing demands on us as physicians. We have chosen a profession that requires 24/7 dedication-patients get sick without an eye to the clock or our scheduled office hours. We also are part of a culture that increasingly recognizes the need for balance and moderation, and few of us would willingly adopt a family life reminiscent of an old-fashioned physician who missed holidays, family dinners, vacations, and the very life of their loved ones in service of their patients.

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So, as our organization continues to identify the ideal behaviors of our future physicians, we will wrestle corporately with the same questions so many of us wrestle with personally. Where is the line between sacrifice and dedication? How does one balance a medical career and personal well-being? What are reasonable demands of a profession that is dedicated to the service of our fellow human beings?