Less is More: Redefining Balance

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Want a better work/life balance? Hint – it’s not about being better at multitasking.

I am tired of hearing about balance. We talk about it, we go to lectures on it, we give mandatory presentations on it to our interns. Yet few people would say they have actually achieved this elusive, zen state. In fact, more than 70% of ER doctors have signs of burn-out [1] – the opposite of balance. Too many presentations on balance give insipid suggestions to “make sure you exercise and eat well,” or “find time to sleep.” I can’t imagine that advice would be very helpful to someone who is already burning out and living in the margins of their free time and energy. Something is wrong with this picture.

First of all, let’s look at the language we use. We all talk about “finding” balance. Where did it go? Did we lose it? Did we used to have it? I imagine that we did used to have balance. Perhaps it was when we were in college, or in medical school. Maybe it ended when residency started, or perhaps when we started having kids. At some point, we jumped onto a treadmill called ‘career’. We ambled along, excited at our new position. Then that treadmill started to move a little faster. If you had a kid or four, then it felt like running on the treadmill carrying the kids with you.

We are all constantly adding more to our work lives, taking on new responsibilities, chairing new committees, stepping into new leadership roles. All the while we are trying to keep the peace at home with our spouses and children, stay active, and still maintain some vestige of our former hobbies. (Hobbies you ask? Those were those things we used to do for fun before we had busy jobs and busy families, like rock climbing, crocheting, or peeing without little humans storming the bathroom door.)

If you are like me, you have started to notice signs of burnout. The struggle is real. At work we have to take care of difficult and violent patients, meet core measures, chart, and deal with patient complaints. After our shift ends we come home to kids, errands, bills, and all the household stuff, like cooking something other than grilled cheese for dinner. I hear these refrains day after day, yet we all still seek this elusive thing called balance, as though we were in search of a mystical unicorn that we’ll never find.

Why have we arrived at this state of perpetual imbalance? What can we do to start to reclaim our own wellness and find this mysterious balance? Here are some suggestions, not from someone who has figured it all out, but as someone who is in the thick of it, striving to do better.

Redefine balance
Balance should not be seen as ’doing it all’. A balanced life does not mean being in five different leadership roles at work while also coaching your kid’s soccer team, sewing hand-made Halloween costumes and growing your own organic vegetables. If we define balance as doing everything and doing it well, we are bound to fail. Perhaps we should define balance as living a life that meets your own personal goals, understanding that there will have to be compromise. Your ideal life may look like 12-hour workdays, and frequent travel in order to reach further leadership positions at work. Someone else’s might look like working part time and spending more time with kids, or working close to quarter-time to have time to homeschool. We need to define what our own personal goals are, and then try to bring our lives more into alignment with them. Now obviously, we can’t define away doing medical charts, or define a higher salary for ourselves. There are financial realities and time constraints we have to deal with. We need to figure out what we want and what is negotiable in terms of hours, responsibility, pay, and time. When the pie chart of what you are actually doing matches the pie chart of your priorities – that is balance.

Choose what brings you joy
Ask yourself what floats your boat? What gets you up in the morning (figuratively, not what actually gets you up, which is probably a loud alarm, children, and coffee)? It is easy to say yes to so many things that crowd out what you really love. That one committee that will meet once a month? Reviewing a paper? Giving a lecture? These are all good things. But they can easily squeeze away the time we have for more important things. If it is something you love and are passionate about, then do it! If it is something that you have no choice about and have to do in order to meet your other goals that you are passionate about, then do it! If you don’t really want to, and you don’t have to, then say no. Those little things can add up and tip your balance. You are not a super hero with inhuman strength or stamina. Give yourself permission to say no to things. Cull what drags you down, and focus on the things that you love, both at work and at home.

If you are so burned out that you feel nothing brings you joy, then seek help, seek friends, find people to reflect with you and remember what used to bring you joy. Give yourself permission to live your life to meet your own goals, not the goals of the other people in your department, or in your Facebook feed. There’s a phrase used by non-profit organizations about keeping out of the red that applies well to us as physicians: “No margin, no mission.” If you are constantly over-extending then you may burn out and could risk losing your mission. Plus, life is just too short to spend it doing things you hate.

Think about long-term goals
There is no prize at the end of your life for the person who ran the fastest on that career treadmill. What do you want to be able to look back on and be proud of? Perhaps it is something related to your career, making a difference in your community, or the patients’ lives you have saved. But maybe it will also be the time you have spent with friends and family. To paraphrase Dr. Mike Myer [2], think more about your eulogy than your CV.

Realize that your goals will be moving targets
Balance and wellness can be hard to maintain because our lives keep changing. Perhaps for a short season we feel like we have captured balance, and we feel good. We are exercising and eating a paleo diet, and even have time to watch something on “the Netflix”, of which I hear tell. But then we lose it again. Our shifts change, our schedules change, and the pie chart of our goals changes. The needs of our family also change. Your baby has gone from needing diaper changes to needing homework help. So maintaining wellness requires a constant evaluation of our lives, a constant pruning of things that are no longer helping, and nurturing growth in other areas.

Finally, let’s help each other
As a group, we perpetuate the ideal of doing it all, rather than living a life that is in line with our goals. We applaud people who seem to be doing everything. Perhaps instead of just saying: “Congratulations on taking on that 500th responsibility,” we should also ask, “Are you able to maintain your own wellness with all that’s on your plate?” When we see colleagues who are starting to burn out, let’s reach out to them. Burnout is incredibly prevalent, and increases the risk of substance or alcohol abuse, medical errors, and suicide. The equivalent of over three medical school classes of physicians commit suicide every year [3]!

The number one reason for burnout among physicians is bureaucratic tasks [4]. It is not taking care of patients – that’s what we trained for a decade to do. It is the system that surrounds care delivery that is making doctors lose job satisfaction and sometimes leave medicine all together. There are many things that could be done at all levels to reduce burnout, from institutional support for things like charting (let’s get scribes), core measures (let’s build systems in our EHR that make it easier), work hours (let’s schedule shifts to allow fewer day/night transitions). There is plenty more that could be done at even higher levels, but most of us have little control over those things. What we can control is our own attitudes and our interactions. Let’s build wellness into the fabric of our own lives, our departments, and our residency training.

Let’s start being realistic. Instead of talking about how to stay “balanced” while doing it all, let’s talk about what we need to do to maintain wellness, resiliency, and longevity in our lives and careers. The first step may be to figure out what the ideal pie-chart of time expenditures would look like for you to be well. Define it for yourself, pursue it, choose it, and encourage it in others.


REFERENCES

  1. AMA Wire. Specialties with the Highest Burnout Rates 1/15/2016. http://www.ama-assn.org/ama/ama-wire/post/specialties-highest-burnout-rates
  2. Emergency Physicians Monthly, Making the Most of 2016, by the EPM Community 1/1/2016. http://epmonthly.com/article/making-the-most-of-2016/
  3. Medscape Physician Suicide 06/01/2016. http://emedicine.medscape.com/article/806779-overview
  4. Medscape, Physician Burnout: It just keeps getting worse 1/26/2015 http://www.medscape.com/viewarticle/838437_3

 

ABOUT THE AUTHOR

Dr. Shenvi is an assistant professor in the department of emergency medicine at the University of North Carolina. She authors RX Pad each month in EPM.

6 Comments

  1. gene saltzberg on

    To the point!! However, I feel that a large part of the “burnout” etiology is administrative abuse!! We are not trained, nor should be in the business of dealing with IT issues, order entry etc. Scribes replace all the frustrations piled on by administrators who are beholden to insurance codes, charting requirements etc etc. They don’t really care if your patient is dying in room 3, but you HAVE to order his ECG in the EHR before it can be done. That’s what burnout is caused by, and only we can fight for remediation of these problems!!

  2. Christina Shenvi on

    Hi Gene,
    Thanks for the comment – I do think that a lot of burnout stems from systems issues and not individual issues, so the solutions need to primarily be systems-based solutions, not just attempts to help individuals manage. We should try to prevent or fix the problems, not just figure out ways to cope with them more effectively!

  3. Well said Dr. Shenvi, fantastic advice, thank you!
    “What is your Yes worth if you can’t say No”? Learning to say “NO” to administrative tasks and not reading administrative emails that insidiously lead to more assignments has been very therapeutic for me. The more I deny, the more comfortable I am doing it. It’s difficult at first but is so liberating it becomes enjoyable.
    Over the last two years, saying “No” more frequently, obtaining scribes (which has positively changed the dynamics of my clinical work exponentially), and increasing my fitness level has done wonders for my mental and physical wellness.
    Thank you again for a great article.

    • Christina Shenvi on

      Thanks! Glad you have found things that have worked for you and helped you get the most out of work and personal life.

  4. thomas fiero on

    Christina,
    very nice article.
    i am embarrassed to say how many years it took for me to even consider a real attempt to “balance”.
    sometimes , there is the idea that we are “weak”, or “incapable”, or “a workplace or personal failure”, if we don’t do 25 12-hour shifts, half days, half night and holiday weekends. i especially like your words:
    “We need to figure out what we want and what is negotiable in terms of hours, responsibility, pay, and time. When the pie chart of what you are actually doing matches the pie chart of your priorities – that is balance.”

    we need to , preferably with some help of loved one(s), colleagues, and others perhaps, consider strongly those priorities, i think, and then make the pie (chart). and find the environment, ER , and team, that might respect and assist with that.
    tom

    • Christina Shenvi on

      Thanks! I’m a very visual thinker, so the idea of the pie chart makes sense to me. I heard it from someone else, and it resonated. I think about it a lot, and whether the pie chart of my time is spent in a way that is consistent with my long term goals. Sometimes good things come along that I wish I could do, but can’t without going crazy, and causing everything else to suffer. But it can be hard to figure out in real time what is going to be worth while.

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