For a group that prides itself on managing the health of others, physicians themselves lead some of the most unhealthy, unbalanced lives you will ever see. In medical school, we’re taught about the association between stress and chronic conditions like heart disease, anxiety and depression but no one ever teaches you how to manage a busy practice and a busy family.
In residency, you’re required to learn strategies to mitigate fatigue, but there were no lectures on how to juggle meetings and still make it to the preschool holiday program. No one ever sat me down during residency and told me how to find time for exercise, church, friends, date nights, reading or travel — all the things I enjoyed outside of my work life.
Early in my career, I knew I wasn’t the only person struggling to find an extra hour in the day. Looking around at my peers it seemed that many had adopted an “all or nothing” strategy to deal with the demands on their time. There were those who tried to hold on to everything, and maintain a frenetic pace without sacrificing anything, and there were others who resigned themselves to giving up most of what they enjoyed outside of their careers. Neither group seemed happy. Neither seemed balanced.
I, too, tried to “do it all” and found myself in the same, stressed, sleep -deprived boat as everyone else. It’s no wonder that so many physicians deal with chronically feeling burnout and nearly ¼ of physician marriages end in divorce. You don’t have to be a doctor, however, to know the stress of competing demands. At some point, everyone wishes they could be in two places at the same time; we all want to have it all.
In reality, the search for “work life balance” is as fruitful as devoting your life to looking for Big Foot or the Loch Ness Monster. Every “yes” is a “no” to something else. Every moment you invest in an activity is time stolen from another. Life is a series of trade-offs. It was only when I learned to embrace this sobering reality rather than fight against it, that I found relief from the fatigue of the “do it all” mentality. Here are two simple strategies that I learned early in my career, that others can use when struggling to find that balance.
Manage the Imbalance
In her book "Pick Three," former Facebook exec Randi Zuckerberg describes her battle to juggle work, sleep, family, fitness and friends. Her solution is simple: Stop searching for work-life balance. Instead, focus your energy on managing the imbalance. “In order to set myself up for success, I know I can only realistically do 3 things well every day,” she writes. “So, every day when I wake up I think to myself: Work. Sleep. Family. Friends. Fitness. Pick Three. I can pick a different three tomorrow, and a different three the following day. But today, I can only pick three. As long as I wind up picking everything over the long run, then I’m balancing my imbalance.” In other words, choose your trade-offs daily. I know that a “yes” to working out in the morning means sacrificing sleep, so I don’t exercise on successive days. I know that attending an after-hours meeting means a “no” to family, so I’m careful to rarely accept those invitations. The key is understanding the trade-offs, and making sure that I don’t end up sacrificing the same thing all the time. For me this means checking in with my wife often and looking at my calendar to make sure I’m not leaning too far in one direction.
Create Margin
Margin is the space around the page you can use in case you run out of room. Margin is the boundary that keeps you from extending over the edge. Having margin in life means leaving a few minutes early for work so that if traffic is bad, there’s still enough time to ensure I can make it to work early enough to begin the day feeling prepared instead of hurried. Margin means saving a little each month, so an unexpected expense doesn't break the bank. Margin means saying no to good opportunities, so I have space to invest my time in great opportunities.
When I learned to create margin, I found more space for family, hobbies, travel and the other things I desperately didn’t want to give up for my career. How do you do it? Learn to say no. The only way to create space in a life that’s already full is to empty it of something. It’s not easy but there are committees, trainings and work functions that I have to withdraw myself from to maintain some degree of space. Creating margin requires you to examine yourself and decide what you need to give up to make room for something else more valuable. Then you have to create boundaries around your schedule to protect it from filling up again. Boundaries need to be well thought out and preplanned, otherwise you’ll be tempted to cross them anytime there is a new ask.
By creating margin and managing my imbalance, I find that I have more time for the things I love, both in and outside of work. It helps me fight stress and worry. I don’t have it all figured it, and I often have to recalibrate my schedule throughout the year because I tend to naturally drift towards busyness. But when you’re ready to start getting serious about fighting the undertow, of busyness, here’s a life raft you can cling to. Doctor’s orders.
Cerrone Cohen is associate program director of the Duke Family Medicine Residency Program. Email cerrone.cohen@duke.edu with questions.
Editor’s note: A member of the Duke Family Medicine Residency Program faculty guest blogs every month. Blogs represent the opinion of the author, not the Duke Family Medicine Residency Program, the Department of Community and Family Medicine or Duke University.