Questioning a Physician’s Right to a Work-Life Balance

December 6, 2011

Should doctors expect to have balance in their lives? Or, is the privilege of doing what we do a fair trade for a life that demands an excess of our time, energy, talent, and attention?

I’m reading a book right now about a midwife-turned-surgeon during the Civil War. It is fictional, but realistic. The book chronicles a young woman, determined to be a doctor so that she can do more than deliver babies - she really wants to understand pathology and anatomy and physiology - and combine healing and knowledge.

Of course, she runs into all kinds of obstacles along the way, mainly centered on her gender. As you might expect, the war provides just the opportunity she was seeking. While called a nurse, she functions as a surgeon, working 20 hour days to care for injured and wounded soldiers. She gets what she wants, at a great price. She does not have work-life balance.

When I was a medical student at Children’s Hospital in Boston, one of the attendings detailed his own internship. He lived adjacent to the hospital and was on call every other night. He was derided for leaving the hospital on nights he wasn’t on call. “If you’re only on call every other, you’re missing 50 percent of your learning,” he was told. How far we’ve come from those expectations. Now, interns are not allowed to be on for 24 hours continuously in the hospital.

Historically, being a physician has come with a great cost. Almost everything else in your life was subject to your calling. Patients needed you and colleagues depended upon you. You never really stopped being a doctor, even when you were on vacation or off-call. Nowadays, being a doctor is more like being an accountant or a lawyer. You are a highly skilled worker in an intellectually demanding field. However, you expect to be paid for the hours you put in and you expect to have a fair amount of control over those hours. Limits are not only acceptable, they are encouraged.

As a physician who enjoys a four-day work week and fairly strict boundaries on her time, I have to say I’m glad I practice now and not 50 or even 20 years ago. But, I wonder if we are losing something in our profession. Are we substituting balance for passion? Do our patients sense that corporate medicine is more about servicing a customer than it is about treating a human being? Should doctors expect to have balance between their professional and personal lives? Or, is the privilege of doing what we do a fair trade for a life that demands an excess of our time, energy, talent, and attention?

I think our profession can and should achieve some measure of a reasonable lifestyle for its practitioners. However, we need to do this while still cultivating the unique nature of what it means to be a physician. Patients aren’t widgets. They need us, sometimes more so at three in the morning than at three in the afternoon. They are not a product or a customer or a client. The relationship we have with them is so special, so inimitable that it requires special rules - a mutual respect, if you will.

I’m not really sure where all this meandering leaves me, except to say that in my all-out goal to achieve work-life balance, I hope I can keep my calling, my professionalism front and center.

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