Best intentions are often not enough to manage extra demands on a physician's time. Saying "no" can be a necessary and welcome evil.
I arrived home late tonight after a work meeting that took place about an hour away. My thoughtful husband left the garage lights on for me, but the rest of the house was dark, assuring me that everyone (hubby included) was already tucked in for the night. Ahhh, blessed relief - there are few worse times to arrive home after a long day than at bedtime. Arriving home after everyone is already asleep is peaceful. It allows me a chance to unwind, decompress, and quietly get ready for bed myself.
Planning my schedule remains one of my biggest work-life balance challenges. An unwieldy schedule has contributed significantly to many professional choices - the decision to leave the military, leave academia, and give up obstetrics and inpatient medicine, to name a few. I value both a sane schedule and the opportunity to be the primary manager of my time. What I find, though, in every job I take is that my work hours fail to stay in their cage. They are continuously rattling the bars and trying to escape. They often succeed.
I increasingly find myself managing meetings that start early or end late, trying to fit them into the bookends of my day. Since mornings are a chaotic blend of exercise for my husband and I, making school lunches, and getting four kids out the door, an early morning meeting can be stressful. Conversely, evening meetings cut into the one time our family has together each day - dinnertime and often bedtime. The guilt factor for the morning is primarily around my husband and all the solo work he has to do in order to launch our horde on their way for the day. In the evening, my guilt is for my children for whom I'm not available to hear about their days, tuck them in, or read them a bedtime story.
As a result, I am wary about meetings that exist outside typical business hours. After all, if it's important enough to meet about, shouldn't the topic be important enough to include as part of the regular business day? As doctors, we are used to the 3 a.m. page for a patient in labor or an emergency room admission - these cannot be helped. However, our willingness to attend to our patients does not necessarily translate into a willingness to discuss ICD-10 coding changes at 8 p.m. at night or 6:30 a.m. in the morning.
What I've found is that folks are generally understanding about having to say "no" to meetings that interfere too much with family obligations. However, I suspect that my professional reputation also takes a hit for each breakfast or dinner meeting I miss. It's the most direct example of choosing family over work and your absence can speak quite loudly about which you value most.
I realize the practical reasons why these meetings occur, especially among busy clinicians. However, I still long for a cleaner line between the start and end of the workday.