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Balancing Act

As society changes, so too does what it means to be a doctor.
By: Stephen H. Dayan, MD, FACS

“You need a better work-life balance…”

Has anyone ever said this to you before?

Probably. But is there really even such a thing as a work-life balance anymore?

We are all subject to constant reminders from “friends,” family, colleagues, professors, and advertisers who pontificate on what they determine is the most appropriate balance.

The dissonance occurs when we question whether we are meeting their standards.


Can we ever truly achieve a sense of balance? A new generation seems to have accepted and embraced this way of living. They have a shrewd ability to quickly shift priorities, determine what is important, and devote the appropriate attention, while allowing other “buckets” to be deemphasized for a cycle.

To be fair, we must look at the scales that we are willing to accept as being an appropriate “balance.” The Work- Life metronome is a dynamic state that is forever oscillating. We can snap a photo, capturing “a moment” while seemingly in balance and then plaster it on social media for all to see. The position of the pendulum, however, is likely more influenced by the Heisenberg uncertainty principle. It states that, matter is in a constant state of motion. As humans, however, we have only the limited ability to make judgments on matter as if it is static. (This may be one of the reasons why we continue to primitively use static before-and-after photos to measure outcomes instead of the dynamic ones that measure the true success of our interventions).

Life-impacting influences are not measured by differences in weight on either end of a see-saw. One extreme is not necessary to balance the opposite extreme. Rather, we too are constantly in motion physically, psychologically, emotionally, professionally, and even romantically. And it is in the snapshot moments in time that our lives may or may not appear to be balanced.

But that moment, like time and space, is relative to the observer. There may be a large differential in what a successful work-life balance is for those who love what they do compared to those who don’t. And work-life balance scales may vary based on the era, profession, region, and culture. For years, the thinking was that medicine is not just a career, a job or a 9-5 shift, but a calling and a lifestyle. Like a priest or rabbi, a physician was expected to be available at all times for those in need. And this came with a prerequisite fiduciary responsibility to always do what is in the best interest of others and subordinate one’s own needs. As Sir William Osler said, “The practice of medicine … is a life of self -sacrifice and of countless opportunities to comfort and help … and to raise up those that fall.”

And this sense of responsibility carried over to academic, community, and society duties. And it often came at the expense of family gatherings, hobbies, and other interests. This was the accepted norm for generations. Those pursuing a life in medicine were aware of that compromise. As we move forward into a new era, the social patriarchal positioning of a physician has dissolved as the expansive smorgasbord of options to capture our attention, time, and interests has exploded. This has led to a constant temperature taking of “work-life balances.”

There are so many tentacles, screens, and venues that need and want our attention. Kids and grandkids have multiple soccer games, school recitals, and dance performances each week. Every Hallmark holiday is an event not to be missed. There aren’t just three TV networks, but upward of 250. There isn’t just email messaging and texting but checking Facebook, Instagram, or Snapchat sites as well. There is so much to garner attention that a new neuroses has emerged “FOMO” (Fear Of Missing Out). FOMO goes beyond social interest. Professional lure has expanded as well. There was a 46 percent increase in articles published in the last seven years of the 20th century vs. the previous 23 years,1 and surely it is still increasing. There are now at least a dozen aesthetic medical journals, a must-attend meeting each week not to mention the newest devices and latest regulations to keep abreast of. It’s close to impossible to stay current in our own fields. We no longer straddle a dipole with two buckets to be balanced, but a multipolar matrix that is constantly being weighted one way or another.

Can we ever truly achieve a sense of balance? A new generation seems to have accepted and embraced this way of living. They have a shrewd ability to quickly shift priorities, determine what is important, and devote the appropriate attention, while allowing other “buckets” to be deemphasized for a cycle. The previous generations may struggle in the new environment, and a reset may be needed to adopt those things which can be accepted and forego, without grievances, those that can’t. Defining buckets and equilibria of a healthy work-life balance today is much more individualized. What works for one often does not work for another.

And while many have reached an acceptable state of equilibrium for themselves, a consortium will likely be needed to address the impact of work-life balance on a macro level, specifically academic societies. How do the academic institutions and meetings of the future adapt? Do we require the same commitment from all members and participants? Do we need to have different levels of membership from social membership to executive level memberships so that those who want to give more gain more? Do we consolidate meetings? Provide more tracks of information? Increase the types of services and opportunities outside of medicine to attract those with other passions?

Work-life balance is not an absolute, but a relative fluid assessment. And while we grapple with these issues on an individual basis, our societies and academic institutions must as well. Like all governments, religions, and businesses…success is based on providing a framework that allows for adaptation and future growth.

Are we ready for that?

1. Druss BJ, Marcus CS. Growth and decentralization for the medical literature: implications for evidence based medicine. J med libr assoc 2005 Oct:93(4) 499-501.